Acute Sciatica isn’t very “cute”

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I was reminded of just how painful sciatica can be when a friend of mine found himself unable to move with searing pain down the left leg. Fit and active middle-aged chap, a little overweight but no warning signs. Just bang! Acute pain!

The medical name is “Sciatica”.

Why does this condition happen? Would it surprise you if I said that ‘vanity’ was one of the prime reasons we get back pain? The reason is because our Neanderthal forefathers decided we looked better walking on our hind legs, instead of all four. Just like a horse, the bones of our spines lock together nicely when we are on all fours, and weight can be carried easily on our backs. However, when we stand up and try and lift, it all goes pear-shaped from there. The spine was not designed to carry loads, or pick up loads, in the vertical position.

But unfortunately, lift and carry is what we call on people to do, from mothers lifting babies to laborers lifting bags of pledged rice. The presenting situation is one we meet only too often. The patient is doing something and suddenly everything locks up and they are immobilized, frozen to the spot.

Back pain is one of the commonest orthopedic problems, and the often used terms such as lumbago, sciatica and slipped discs are spoken about frequently.

Let’s look at the “slipped disc” problem. First thing – discs do not “slip”. They do not shoot out of the spaces between the vertebrae (the tower of cotton reels that makes up your spine) and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out through the edge of the disc and hits the nerve root. When this happens you have a very painful condition, as anyone who has had a disc prolapse (our fancy name for the “popping out” bit) will tell you. Think of the pain when the dentist starts drilling close to the tiny nerve in your tooth. Well, the sciatic nerve is a large nerve! When the nucleus of the disc hits the sciatic nerve, this produces the condition known as Sciatica – the acute searing pain which can run from the buttocks, down the legs, even all the way through to the toes.

Just to make diagnosis a little difficult you can get sciatica from other reasons as well as prolapsing discs. It may just be soft tissue swelling from strain of the ligaments between the discs, or it could even be a form of arthritis. Another complicating fact is that a strain may only produce enough tissue swelling in around 12 hours after the heavy lifting, so you go to bed OK and wake the next morning incapacitated.

To accurately work out just what is happening requires bringing in those specialist doctors who can carry out extremely intricate forms of Medical Imaging called CT Scans, Spiral CT’s or MRI that will sort out whether it is a disc prolapse, arthritis or another soft tissue problem. The equipment to do these procedures costs millions of baht, and the expertise to use them takes years of practice and experience. This is one reason why some of these investigations can be expensive.

After the definitive diagnosis of your back condition has been made, then appropriate treatment can be instituted. The forms of treatment can be just simply rest and some analgesics (pain killers), physiotherapy, operative intervention or anti-inflammatories and traction.

Now perhaps you can see why it is important to find the real cause for your aching back. The treatment for some causes can be the wrong form of therapy for some of the other causes. “Self diagnosis” is dangerous!

So what do you do when you get a painful back? Rest and paracetamol is a safe start. If it settles quickly, then just be a little careful with lifting and twisting for a couple of weeks and get on with your life as normal. If, however, you are still in trouble after a couple of days rest, then it is time to see your doctor and get that definitive diagnosis. It is the orthopedic chaps you need to see.