Piriformis syndrome. Methods of treatment.

Neurologist (algologist)

Vasilenko

Marina Gennadievna

25 years of experience

Head of the Pain Treatment Center, neurologist-algologist, member of the Society of Neurologists and Neurosurgeons, Russian Society for the Study of Pain, Association of Interdisciplinary Medicine, International Association for the Study of Pain (IASP)

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Sciatica of the sciatic nerve is an inflammatory disease, which, due to the degree of discomfort it causes, is included in the list of the most painful human pathologies. The sciatic nerve is the largest nerve fiber in the human body, connecting the spinal column to the lower limb. It starts in the lumbar region and ends in the phalanges of the toes. It is a paired organ present in both lower limbs. When the nerve fiber is compressed, severe pain occurs, which is localized in the sacral area, spreading to the buttock, thigh and lower down to the foot.

Symptoms of the disease

The most important symptoms of sciatic nerve sciatica are:

• pain localized in any part of the body along the passage of the nerve fiber: in the lower back, buttock, back of the thigh, lower leg, foot;
• loss of sensitivity, numbness of the lower limb along the nerve fiber;
• paresthesia - tingling sensations, “pins and needles” in the foot and toes.

The nature of the pain is most often shooting, but it can also be burning, dull, aching, etc. During periods of exacerbation, when moving the spine or leg, it can intensify and become unbearable. As a rule, the disease affects one limb, but sometimes pain appears in both legs at once. In the most severe cases, the disease leads to paralysis of the leg muscles, sometimes spreading to the pelvic muscles, causing urinary and fecal incontinence in the patient.

The principle of the procedure and indications for the use of blockade

Neuralgia of the sciatic nerve is manifested by burning pain, a sharp decrease in muscle activity and disorder of reflexes in the gluteal area, in the area of ​​​​the feet and legs. A blockade when the sciatic nerve is pinched helps to quickly return the patient to normal life, after which the neurologist prescribes a comprehensive treatment for the problem, which includes a drug complex, manual therapy, massage and exercise therapy. In other words, the principle of action is to create a local analgesic block, which inhibits receptor activity and prevents pain impulses from spreading to other parts of the human central nervous system. The procedure itself is not a treatment method.

Recommendations for blocking the sciatic nerve causes a complex of symptoms:

• excruciating pain (not only during movement, but often at rest);
• lower paraparesis (weakening of leg muscles, impaired reflexes);
• decreased pelvic organ function (eg, loss of bladder control);
• feverish state (body temperature above 38° C).

The blockade is necessary for severe sciatica, if medications and physiotherapeutic methods do not demonstrate a positive result. To diagnose sciatic nerve damage, the doctor checks the symptoms using a battery of tests and samples.

Causes

Sciatica of the sciatic nerve is a disease that can be caused by a number of reasons, either vertebrogenic, i.e. associated with the spine, or non-vertebrogenic.

• Compression of the sciatic nerve or its branches is the most common cause of pain resulting from deformation, herniated disc, inflammation of the piriformis muscle, or a displaced vertebra.⁠
• Injuries to the lower spine, pelvis, or limb can cause nerve compression and damage to nerve endings.
• Degenerative-dystrophic changes in the structure of the spine - osteochondrosis, spondyloarthrosis - lead to compression of the sciatic nerve.
• Infectious diseases - scarlet fever, influenza, malaria, etc. - are accompanied by the release of toxins leading to inflammation of the nerve fiber.
• Toxins that enter the body from the outside - at work, when drinking alcoholic beverages - can also cause inflammation.
• Systemic diseases - diabetes, gout, etc. - become the background for the appearance of pain.
• A malignant or benign tumor compressing the nerve is another probable cause of the pathology.
• Hypothermia or excessive physical activity sometimes become the beginning of the inflammatory process.

Some experts identify the psychosomatics of sciatic nerve sciatica as a separate group of causes, believing that the disease can develop against the background of excessive psychological tension, stress, chronic fatigue, fear or phobia.

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Contraindications

Reviews of blockades for pinched nerves indicate the high effectiveness of the procedure. However, it is not shown to everyone. Blockade therapy should not be prescribed in the following conditions:

• for serious cardiovascular pathologies, liver and kidney damage;
• against the background of the patient’s history of hemorrhagic syndrome;
• with decompensated severe shock (for example, traumatic);
• in patients with severe damage to the central nervous system;
• in case of infectious or necrotic processes, pronounced fibrotic changes in the area of ​​the proposed blockade.

The blockade should be used with caution in patients suffering from stomach ulcers, diabetes and severe metabolic disorders, and in pregnant and lactating patients. In such cases, supervision by a specialized doctor is necessary. Hypersensitivity to anesthetics and their intolerance manifest themselves in the form of allergic reactions (from urticaria and dermatitis to Quincke's edema and eczema). In this regard, preparation is necessary in the format of passing a special allergy test.

Establishing diagnosis

This disease is characterized by a rather complex diagnosis, the first stage of which is conducting reflexology tests for flexion and extension of the leg. To finally clarify the clinical picture, the following is prescribed as necessary:

• lab tests;
• X-ray of the affected area;
• MRI;
• ;
• electroneuromyography;
• Ultrasound of the pelvic area.

The task of a neurologist is to identify symptoms characteristic of sciatica, and treatment should be aimed at eliminating the causes of nerve fiber compression.

Treatment

The choice of therapeutic methods depends on the severity of the clinical manifestations of the disease. When initially contacting a neurologist, conservative methods of treating sciatica of the sciatic nerve prevail:

• non-steroidal anti-inflammatory drugs;
• hormonal drugs for the most severe cases;
• analgesics that relieve pain;
• antispasmodics, muscle relaxants.

Great importance is attached to all kinds of physiotherapeutic methods, which are used both during exacerbations (UHF, electrophoresis, laser or magnetic therapy) and after them.

Massage for sciatica of the sciatic nerve is of great benefit, significantly prolonging periods of remission. Depending on the nature of the compressive factor, the patient may be prescribed a general massage to relax the spinal muscles, therapeutic, acupressure or cupping. In many cases, acupuncture sessions bring considerable benefit.

Therapeutic exercises for sciatica of the sciatic nerve is another extremely useful technique, widely used after the acute phase of the disease. Moderate physical activity aimed at strengthening the muscle corset and improving blood supply to the tissues of the back, pelvis and limbs allows patients to maintain their body in good physical shape and prevent recurrence of attacks of pain.

Inflammation of the sciatic nerve

Inflammation of the sciatic nerve is called sciatica. The disease affects the largest nerve located in the lumbar region. It is accompanied by pronounced symptoms, similar to some diseases of the spine. Sciatica is diagnosed mainly in adults, more often in men after 30-35 years.

Causes of inflammation of the sciatic nerve

The inflammatory process affecting the nerve occurs for various reasons. Conventionally, these reasons can be divided into local and general. Local causes of sciatica include:

• hernia in the lumbar spine. The risk of the disease increases with the progression and size of the hernia;
• advanced stage of osteochondrosis;
• sacral spine injury. Injury can be caused by getting into an accident, falling from a great height, as well as constant physical work associated with lifting weights and playing strenuous sports;
• dystrophic processes in the spine.

Common causes of inflammation of the sciatic nerve include:

• infectious diseases of the body;
• endocrine pathologies. For example, diabetes;
• hypothermia. You can encounter signs of sciatica by getting a cold in your lower back;
• disruption of the body's hormonal levels;
• gynecological diseases, menopause in women;
• pregnancy. Women in the last stages of pregnancy often suffer from sciatica. The disease in this case is associated with excessive stress on the spine. Special physical training for pregnant women helps to avoid its development;
• benign and malignant tumors of the spine.

Less common causes of sciatica include fibromyalgia and spinal canal narrowing.

Symptoms of inflammation of the sciatic nerve

Sciatica can occur slowly or develop rapidly. In the latter case, the symptoms of the disease increase rapidly within a few hours.

The main symptom of the disease is pain at the location of the sciatic nerve. Usually the pain is localized only on one side and has a shooting character. In some cases, the pain can become acute, making breathing difficult. The development of sciatica primarily affects the lower extremities. The legs may go numb, this symptom is especially pronounced from the side of the inflammatory process. With significant inflammation, pain from the lower back spreads to the legs, in some cases reaching the knees and heels. Also, in the area of ​​the inflamed nerve, the skin becomes less sensitive, and sometimes a tingling sensation is felt.

The presence of the disease may be indicated by minor, periodically increasing pain in the lower back, hips, and leg joints. At the beginning of its development, sciatica is accompanied by a feeling of discomfort, fatigue in the lower back, which occurs after a long walk, a long stay of the body in an upright position, etc. Over time, the discomfort turns into aching pain, which prevents you from fully relaxing and falling asleep at night.

Inflammation of the sciatic nerve negatively affects the condition of the internal organs. It contributes to disruption of the genitourinary and digestive systems, and in men can lead to decreased libido.

Over time, the symptoms of sciatica completely disappear, but if left untreated, they quickly return and intensify.

Treatment of inflammation of the sciatic nerve

Modern specialists use medicinal and surgical methods to treat inflammatory disease of the sciatic nerve. If you notice the first symptoms of sciatica, it is recommended to consult a neurologist. In order to diagnose the disease, the specialist will examine the patient, prescribe a general blood test and an x-ray of the spine.

In the conservative treatment of sciatica, non-steroidal anti-inflammatory drugs are used in the form of tablets (Ibuprofen, Ketorol). In the absence of positive results from such treatment, steroid drugs are indicated. If necessary, the doctor may prescribe injections for inflammation of the sciatic nerve: Prednisolone, Hydrocortisone or their analogues.

Good results in eliminating the symptoms of sciatica are obtained by regular use of local preparations - gels and ointments that have a warming and anti-inflammatory effect. The most famous among such drugs are Bystrum gel and Voltaren gel. The most effective ointments for inflammation of the sciatic nerve include Indomethacin and Diclofenac. Their regular use helps reduce the inflammatory process, but in most cases does not in any way affect the cause of the disease.

Physiotherapeutic procedures, lumbar massage, acupuncture, and folk and homeopathic remedies are used as additional methods of treating sciatica.

Statistics

Sciatica is a fairly common disease in the age group from 35 to 50 years. It is at the most active age that the majority of initial visits to the doctor occur. The disease affects men more often than women. According to some experts, throughout their lives, up to 40% of people have at least once experienced an attack of pain in the sacral lumbar region, buttock or back of the thigh, but not all of these attacks become chronic and protracted. Cases of visiting a doctor are about 20-25 people per 100 thousand population.

Diagnostics

If a patient complains of pain in the sciatic area, doctors can carry out three diagnostic options:

• Radiography;
• CT scan;
• Magnetic resonance imaging.

Among these diagnostic methods, MRI stands out especially. Using a magnetic resonance imaging scanner, the doctor can quickly identify the causes of pain. The MRI machine is highly safe, and it can even be used when examining children and pregnant women. The decision to undergo the procedure is made by a specialist who conducts an initial examination of the patient and draws a conclusion about his state of health after checking reflexes and listening to complaints. Treatment is prescribed only after the doctor has the results of all prescribed examination methods.

Diagnosis and treatment of sciatica of the sciatic nerve in Moscow

JSC "Medicine" invites Muscovites and guests of the capital to consultations on the diagnosis and treatment of sciatica of the sciatic nerve. At your service are the most modern diagnostic and physiotherapeutic equipment, as well as the qualifications and experience of medical personnel. In our clinic, we see neurologists and orthopedists of the highest category, who can relieve pain in the shortest possible time and return you to a full life. Call us to make an appointment with a specialist, or leave a request online on our website.

How is the examination and diagnosis carried out?

If sciatica is suspected, a neurologist examines the lumbar and sacral areas, then, using special instruments, evaluates the sensitivity, tone and strength of the muscles along the sciatic nerve. The doctor also asks the patient to perform a series of simple exercises in order to determine the nature of the pain based on clinical signs. Pinched sciatic nerve requires surgical treatment in the neurosurgery department or in a specially equipped neurologist's office, since the condition threatens loss of sensation in the legs and complete immobility.

To clarify the diagnosis, it is necessary to identify all associated factors. For this, additional studies are prescribed:

• blood and urine tests;
• radiography;
• tomography;
• consultations with specialized specialists (rheumatologist, vertebrologist, vascular surgeon).