Pain along the course of the great sciatic nerve, that is, down the back of the lower limb, is described as sciatica. Usually it is caused by inflammation of the nerve, sometimes it is caused by the presence of an overloaded bowel or of a tumor in the pelvis or by disease in the hip joint, but in other instances the pain is purely neuralgic in character. Pain resembling that of sciatica may be due to disease of the spinal cord or the vertebral column, or to disease in the sacroiliac joint, and must be distinguished from sciatica. It is important also to recognize as early as possible the existence of pressure or other local disease as a cause of sciatica.
In the remaining cases the possibility of some kind of poisoning should be considered. Lead and alcohol, toxins from sepsis in the mouth or elsewhere in the body, the poisons of influenza and other infections, and diabetes, are possible causes of neuritis. When sciatica exists on both sides of the body the likelihood is that diabetes is the cause.
As contributory causes, exposure to cold and damp and excessive muscular toil are of some importance, and the pressure of a hard seat may have something to do with the occurrence of the disease in clerks and others who may sit on un-cushioned seats when at work. Sciatica is a much commoner complaint in men than in women, and most often occurs from thirty to fifty years of age. The pain may begin at the back of the hip, but sometimes there is first lumbago and then an extension of the pain downwards. The pain is very severe and is variously described as being of a burning, sharp or stabbing character. It abates somewhat for intervals, but acute paroxysms recur and it is made worse by jarring the body, as in coughing.
Even when it has quieted down there is a sharp pain at the back of the hip if an attempt is made to straighten the leg at the knee when the thigh is bent up towards the abdomen; this maneuver tends to stretch the nerve. Points of definite tenderness are found at the back of the hip and knee, over the middle of the calf and on either side of the ankle. The severity of the attack may moderate in a week or two, but in a lesser degree the disorder may last for a month or two or in some cases for many months or for years.
A victim of acute sciatica should rest in bed with a pillow below the knee, and the limb should be immobilized by sand bags or by a well-padded splint, reaching from the armpit to below the sole of the foot. Pain may be relieved by the application of heat from a hot-water bag or a large poultice. A hot-air bath, baths of other kinds, and diathermy are other methods of using heat.
Aspirin, sodium salicylate, quinine and phenacetin are some of the drugs used in this disorder, sometimes, however, an opiate is required. The introduction of drugs into the body by ionization may be the best form of medication.
Other methods of treatment are the application of fly-blisters along the course of the nerve, galvanism and other forms of electricity, acupuncture, or piercing the nerve with a needle, and the application of ultra-violet rays. Massage should be started as soon as possible. When the disease is obstinate the operation of nerve stretching may have to be carried out. Chronic cases of sciatica may derive much, benefit from treatment at a spa. In some cases, such as those in which gout or diabetes exists, it has been found that a correct diet is an important part of the treatment. See: Neuralgia.. Neuritis..
Known also as the inferior gluteal artery, the sciatic, which is a branch of the internal iliac, artery emerges from the pelvis along with the great sciatic nerve. It is deeply placed in the buttock and so is rarely injured by ordinary accidents.
The great sciatic nerve supplies the back of the thigh and the leg, both front and back, and contains motor and sensory fibers. It is about the thickness of the little finger and is the largest nerve in the body. It emerges from the pelvis about the middle of the buttock and passes downwards in the groove between the tuberosity of the ischium and the great trochanter of the femur. In the popliteal space it divides into the internal and the external popliteal nerves. The chief affection of the nerve is sciatica. The small sciatic nerve is a sensory nerve, supplying skin over the buttock, and the back of the thigh and leg as far as the middle calf.
Application and treatment:
Pain along the course of the sciatic nerve, usually a neuritis. It is attended by abnormal sensations such as burning, pricking or sensations of insects crawling over the area, tenderness along the course of the nerve, and sometimes by wasting of the calf muscles.
The sciatic nerve is the largest peripheral nerve of the body with a diameter about that of your thumb. It passes out of the pelvis through the greater sciatic foramen, under cover of piriformis muscle, then on down through the hamstring muscles, it supplies the muscular braces there, and just above and behind the knee, it divides into its terminal branches called the tibial and peroneal nerves on down to the foot.
There is nothing so effective as frequency as applied to sciatica or any other type of nerve inflammation, and often complete recovery from this disorder occurs after only one session, and does not return.