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坐骨神經痛治療
了解成因及症狀

坐骨神經痛治療

What is Sciatica?

Sciatica is a condition where the sciatic nerve is irritated or inflamed causing nerve pain in the patient. The hallmark characteristics of sciatica is radiating or shooting sharp nerve pain down the entire leg. The sciatic nerve is the largest branch of the sacral plexus and is the largest nerve in the body. It branches from the lower back (L4 to S3), passes through the sacral promontory and ala and descends in front of the piriformis muscle into the posterior thigh. It then continues as the tibial and common fibular nerves travelling down the leg and towards the foot. Lumbar disc herniation or inflammation is one of the most common factors causing compression of the sciatic nerve thus sciatica.

Cause of Sciatica

Sciatica can be caused by multiple factors; spinal disc herniation, spinal stenosis and piriformis syndrome are amongst the most common. As mentioned above, spinal disc herniation in the lumbar spine accounts for about 90% of all sciatica cases under 50. Injury or abnormal increase in pressure loading of the spinal discs can results in herniation and swelling or inflammation of the disc, which can lead to compression of the sciatic nerve root. With lifting injuries, patients commonly report an increase of pain when bending forward or sitting. Pain level is usually very high.

Spinal stenosis is a less common contributor to sciatica; however, it is the most common chronic cause of sciatica; over the age of 50. Lumbar spinal stenosis is a condition where the space where the nerve passes through and exits is narrowed due to osteophytes (bone spurs) or spondylolisthesis etc. With decreased available space for the nerve to exit, the chances of compression or irritation increases. Due to the nature of osteophytic degeneration, treatment can be complicated compared to other causes of sciatica.

Lastly, piriformis syndrome is a less common condition that can contribute to sciatica. It accounts for 8% of lower back or buttock pain and is usually diagnosed as an association with sciatica. In 17% of people, the sciatic nerve runs through the piriformis muscle rather than beneath it, thus when the muscle spasms due to injury or overuse, the sciatic nerve can be irritated, causing sciatic pain. Piriformis syndrome has been referred to as “Wallet syndrome” where carrying a wallet in the rear hip pocket for an extended period of time can compress the piriformis muscle causing inflammation and sciatic pain. Sciatica caused by piriformis syndrome is usually the least severe and easiest to resolve.

Risk factors of sciatic includes smoking, obesity and occupational and physical injuries. Non-modifiable risk factors includes aging, being male and having a history of lower back pain. Less reported risk factors includes a history of hip replacement with an association of 0.5%-2% chance of sciatica as a complication.

Symptoms

Sciatica can last from months to years, most commonly reported by males between the age of 30-50 years old. The male to female ratio of sciatica is 4:1. Due to the presenting sharp radiating pain, patients will experience the inability to bend at the waist and hard to find a comfortable position to sit or stand. Walking can be difficult and weakness in the lower limbs is a common reported symptom. As the condition progresses, patients might experience insomnia due to the sharp and burning pain. Without proper treatment and management, numbness can develop in the lower back and pelvis which can eventually spread into the leg. Muscular atrophy and diminished reflexes are seen in the later stages with reported nervous system complications such as urinary incontinence and impotence.

SCIATICATreatment Option

骨神經痛There are four major treatment options; chiropractic care, medications, epidural injections and surgery.

Chiropractic care remains one of the most common non-invasive option for lower back pain and sciatica. As the sciatic nerve becomes irritated and compressed by the surrounding structures; muscular tissue and/or spinal discs, chiropractic care helps to stabilize the structures to decrease compression thus inflammation. Our spinal discs and vertebrae are responsible in handling weight bearing and loading in our day to day lives. Stability and proper loading distribution allows the spine to function more effectively. Medication is also another popular option. Patients can be prescribed muscle relaxants and/or NSAIDs to chemically decrease inflammation and swelling.

而另一種骨神經痛治療方法是服用藥物治療減輕疼痛,包括消炎止痛藥、非類固醇藥、神經止痛藥及神經放鬆劑。視乎情況,醫生有機會開處方6-8週的藥物緩和神經受壓的症狀。若疼痛還沒有減緩,病人可選擇於脊柱注射硬膜外類固醇。硬膜外腔位於硬膜脊髓外層與脊髓骨間之間,而硬膜外類固醇是將皮質類固醇注射到硬膜外腔,可以減少對神經根的刺激及有止痛,消炎消腫的作用。一般而言,注射的止痛能維持數星期至三個月不等,止痛的效用較短期,而注射類固醇可能會產生副作用,因此長期注射是不建議的。

In summary, each treatment option can benefit the patient and will depend on the current condition and contributing factors. If you are experience sciatic pain, please contact your healthcare provide to discuss the most appropriate option for you.

Dr. Lai’s Recommendations:

Prevention trumps treatment and therapy. There are many ways to prevent or lower the risks of lower back pain and sciatica. Our spinal health relies on mobility, regularly exercising and maintain a healthy body weight can have a huge impact. Avoid excessive alcohol use and smoking can be beneficial. Long hours of sitting and office work can be combated by intervals of stretching and walking. Apply proper technique when lifting heavy items and bending forward can protect your spine and discs. Lastly, osteophytes and degeneration are signs of chronic problems. Do not wait until a condition becomes severe before seeking professional help, treatment options can be more complicated with time.

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