There are 5 bones in our waist. The coccyx bone is located under these 5 bones. The nerve that passes between the 5th bone at the end and the coccyx bone and goes from the middle of the hip to the heel is called the ‘sciatic nerve’ (S1 nerve), and the compression of this nerve is called ‘sciatica’. Therefore, the problem called sciatica occurs as a result of the compression of the sciatic nerve for any reason. This compression can occur at various levels.
WHAT IS THE CAUSE?
The sciatic nerve can come out for many reasons. For example, this problem can occur as a result of a herniated disc, a bone displacement or another event that occurs between the left waist bone and the coccyx bone. The sciatic nerve, also called the S1 nerve, comes out of the waist, goes down from the middle of the hip, behind the leg and reaches the heel.
WHERE IS THE PAIN FELT?
When the sciatic nerve is compressed, the patient complains of pain, numbness and tingling in the hip, leg or from the hip to the heel, depending on the level of compression. For example, in sciatica pain caused by herniated discs, when the sciatic nerve between the last spinal cord and the coccyx bones is compressed, pain and numbness occur from the leg to the heel. Apart from this, in this condition called piriformis muscle syndrome in the middle of the hip, the pain is again around the hip. And the pain increases with hip movements. Sciatica pain can also spread to the waist, but it mostly occurs with pain and numbness in the lower back and hip, going down to the heel.
WHICH PAINS CAN IT BE CONFUSED WITH?
Sciatica pain can be confused with other pains around the hip. It can also be confused with disorders such as lumbar displacement, lumbar curvature (scoliosis) that cause pain from the waist to the hip. In addition, there is a possibility that some nerve compressions seen in other hip diseases, such as hip arthritis or tendonitis around the hip, can be confused with sciatica.
HOW IS THE DIAGNOSIS MADE?
In order to diagnose sciatica, first of all, the patient’s anamnesis and the type of pain described are important. If the patient describes a complaint such as pain, numbness and tingling that spreads from the hip to the heel, the diagnosis can be confirmed. However, it is still useful to review the condition of the muscles. Because when the sciatic nerve is compressed, weakness may occur in the muscles fed by this nerve. Therefore, whether there is sciatica or not can be understood from the weakness in the muscles fed by the sciatic nerve. Sciatica also causes a decrease in some reflexes such as the Achilles reflex. However, of course, all these are findings that can be understood with an examination by a specialist. Therefore, if you are complaining of this type of pain, it is useful to consult a specialist doctor as soon as possible instead of diagnosing yourself. There is not much evidence to be obtained with an X-ray in diagnosis. Whether there is compression of the sciatic nerve, hernia or any kind of lumbar displacement in that area can only be determined with MRI or CT.
WHO IS IT MORE COMMON IN?
It is not possible to make such a distinction between genders for sciatic pain. It can be seen in both men and women. However, it can occur in women due to excessive weight gain during pregnancy, which is a special period, due to the forward shift of the waist mechanics. When considered in terms of age, it can be said that it is more common in young people due to heavy lifting or not using the waist properly. In later ages, it occurs with the addition of calcification of the joints and other degenerative events. As a result, it can be said that sciatic pain can knock on the door at any age.
HOW IS IT TREATMENT DONE?
If there is a newly formed compression, if the disease is still in the acute phase, if the patient only complains of pain and muscle weakness has not occurred, drug treatment is first applied. In drug treatment, B vitamins, painkillers and anti-inflammatory drugs called edema that may occur due to muscle spasm in that area and cannot be eliminated with treatment, it is necessary to apply physical therapy to the area up to the waist, hips and heels. In this physical therapy; superficial heating infrared, pain relieving currents called TENS and deep heating ultrasound are applied. However, if there is muscle weakness, special devices that increase the strength of the muscles where this weakness occurs can also be used. In this way, the device works the weakened muscle without the patient working or getting tired. In this way, the muscles that have lost their strength are restored to their former strength and physical therapy is completed.