yogabook / pathologie / ischialgia

ischialgia

Sciatica

Definition of

Ischial nerve-associated radicular pain syndrome, usually caused by disc hernia (see explanations there), mainly due to prolapse, usually more severe symptoms than lumbalgia. The term sciatica is misleading because it is not the sciatic nerve that is compressed but the spinal nerve from which the sciatic nerve originates

ICD M54

Diagnosis

1. Lasegue/straight leg raise: passive lifting of the extended leg is painful
2. Bregard: Lasseque + dorsiflexion of the foot is painful
3. Archilles and patellar tendon reflex
4. Heel and toe position

Symptoms

1. Sharp, stabbing pain that extends beyond the knee joint, usually to the lateral foot
2. Sensory disturbances in the upper/lower leg, possibly paralysis of the muscles.
3. Reflex attenuation to failure.
4. Mostly forced posture (due to minimal pain)
5. Highlight: Coughing, pressing, sneezing aggravated
6. Further symptoms by affected segment:

Therapy

1. Step bed positioning,
2. After some time or if there is a risk of recurrence: Surgery (preferably minimally invasive, because the further the muscles are cut open, the more unstable the back becomes and the more likely it is that neighboring segments will be affected)
3. Improvement of posture and muscular situation