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... there is no single symptom reported during history taking or result on a physical test that has a sensitivity or specificity large enough to definitively diagnose sciatica, clinical guidelines recommend a combination of history taking and physical tests in order to arrive at a conclusion. 4,5 Signs and symptoms that are indicative of sciatica and should be addressed during history taking are: the dominance of leg pain (more than back pain); the location of the leg pain (ie, to assess whether it radiates down below the knee and whether it aligns with one or more dermatomes); paraesthesia and/or sensory loss (roughly) in line with the dermatomes of the affected spinal root ( Figure 1); weakness and/or reflex changes in a myotomal distribution; and an increase in leg pain with coughing, sneezing and/or taking a deep breath. ...
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Aim: This study aimed to evaluate, using ultrasonography, the morphological changes of the sciatic nerve in the dorsal thigh in terms of its cross-section area (CSA) in patients with unilateral S1 radicular symptoms.
Methods: This observational study was performed in 15 participants (12 females; mean age 46.9 ± 9.9 years; mean body mass index 26.5...
Background: Prevalence of obesity is increasing worldwide and obese patients constitute a major portion of the spinal surgeon s practice. The patients with lumbar disc herniation present the most in the outpatient department of neurosurgery. Obesity not only leads to the disc herniation but also causes a surgeon a difficult ordeal while operating a...
Purpose
To establish the prevalence and agreement between reported and observed leg weakness in people with sciatica. To establish which factors mediate any identified difference between reported and observed leg weakness in people with sciatica.
Methods
68 people with a clinical diagnosis of sciatica, records from spinal service, secondary care N...
Objective: To compare the effects of positional distraction with stabilisation exercises versus stabilisation exercises alone in the management of lumbar radiculopathy. Method: The randomised controlled trial was conducted from July to December 2020 at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, and the...
Citations
... It can also cause inflammation [14]. The combination of immunological procedure along with compression and inflammatory changes leads to the pain caused by sciatica [15,17]. Sciatica is a syndrome that does not have a particular diagnostic criterion. ...
Introduction-Sciatica is a term used to describe pain, weakened sensation, numbness, or tingling in the posterior region of the leg. The evidence on the efficacy of physiotherapeutic interventions for sciatica is widely acknowledged. This study endeavours to delineate the global research for physiotherapeutic interventions for sciatica. Exploration through bibliometric analysis on physiotherapeutic treatment for sciatica is scanty. Methods-Bibliometric exploration was conducted using data sources from Scopus, Web of Science, Pubmed and Google Scholar screening the literatures from 2013 to 2022. The data was analysed through analytical tool VOS Viewer and further Microsoft Excel 2007. VOS Viewer is used for the visualization of databases. The present research investigates the annual growth trends contributing top journals, authors, hotspots related to author-co-author collaboration, co-citation pattern, co-author relationship, prominent keywords and widely used physiotherapeutic interventions for the management of sciatica. Results-The finding of the study reveals that the most research has been published on the topic of sciatica in the year 2021 and 2022. The author Maher, C.G. was found to have published the highest number of articles on the treatment of sciatica. The organization that topped in publishing literature for sciatica treatment was Syddansk Universitet. The leading countries that contributed were the United States, the United Kingdom and Australia. Conclusion-The authors dwell at length and concludes the study elucidating the most used physiotherapeutic interventions in sciatica that includes electroacupuncture, lifestyle factor improvement, exercise programs including stretching and strengthening, manual therapy, home program exercises, traction therapy, extracorporal shockwave therapy, electrical stimulation and ergonomic care including positioning and posture control. The outcome of this investigation underscores the importance of raising awareness and promoting the future research endeavors.
... Sciatica also can be seen in patients, along with low back pain (LBP) in most of them. Usually, compression or irritation of the nerve roots from L4 to S3 causes radiculopathy pain and paresthesia in the sciatic nerve course known as sciatica or lumbosacral radiculopathy [1]. Mostly this compression and irritation occurs due to a herniated disc at the lumbosacral region and sometimes due to piriformis syndromes [1]. ...
... Usually, compression or irritation of the nerve roots from L4 to S3 causes radiculopathy pain and paresthesia in the sciatic nerve course known as sciatica or lumbosacral radiculopathy [1]. Mostly this compression and irritation occurs due to a herniated disc at the lumbosacral region and sometimes due to piriformis syndromes [1]. Lifetime incidence of sciatica is reported to be between 10% and 40%, with an annual incidence of 1% to 5% [2]. ...
... Manual therapy such as neurodynamic mobilization is also considered an effective tool apart from other physiotherapeutic treatments by many studies [5,9]. A topical review by Ostelo reported that kinesiophobia can also be considered as an indication for exercise therapy like neurodynamic mobilization [1]. Patients with sciatica often show kinesiophobia due to the sciatic pain they experience. ...
Abstract Introduction Sciatica refers to a pain that travels along the course of the sciatic nerve. Patients also often experience paresthesia along with the pain in thighs, which may further radiate to the legs. Most commonly, compression of the lumbosacral nerve root is the cause of this syndrome. Neurodynamics and conventional exercises are considered effective treatment procedures for sciatica. This study aims to find out the efficacy of neurodynamics along with conventional exercises and conventional exercises alone. Methods A total of 58 patients with sciatica aged between 30 and 60 years of both genders were included in the study and randomly divided into a neurodynamic group (n=29) and a conventional group (n=29). Pre-test data were collected before the interventions, and post-test data were collected on the 14th day. The 101 numeric pain rating scale (NPRS) was used to measure data of sciatic pain, the patient-specific functional scale (PSFS) was used to measure the health-related quality of life (HRQL), and a surface electromyography (EMG) biofeedback instrument was used to measure the peak and average muscle activation of the biceps femoris muscle. Results The pre-post data analysis of the neurodynamics and conventional group showed significant (p<0.05) improvement in 101 NPRS, PSFS, and peak EMG values. Insignificant (p>0.05) improvements were seen in average EMG values in the conventional group, and significant (p<0.05) improvement were seen in the neurodynamic group. Between-group analysis showed insignificant (p>0.05) differences in 101 NPRS as well as peak and average EMG values and showed significant (p<0.05) differences in PSFS values. Conclusion Neurodynamics with conventional exercises can help in reducing pain, improving muscle activation of the biceps femoris, and elevating the HRQL of the patient. Categories: Pain Management, Physical Medicine & Rehabilitation, Therapeutics Keywords: emg biofeedback, straight leg raise, sciatica, conventional exercise, neurodynamics
... Therefore, clinical guidelines recommend a combination of history and physical examination to reach a definitive diagnosis. 72 Overall, appropriateness patterns were fairly similar between lumbosacral and cervical radicular pain, although additional analyses learned that neurosurgeons were firmly against the use of PRF to treat radicular symptoms in patients with a history of Grade III WAD. Anesthesiologists, however, did not exclude these patients from PRF, especially not if the pain was caused by disc herniation or foraminal stenosis and the diagnosis of radicular pain was confirmed by a positive Spurling test. ...
Background
Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain.
Methods
The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios.
Results
For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well‐selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e‐health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region.
Conclusions
A multidisciplinary European expert panel established patient‐specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org ). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.
... [30][31][32][33][34] Although intense physical stimulation is a major factor contributing to tissue damage, 35,36 it can be widely used as a therapeutic approach in a variety of diseases if the parameters are properly adjusted. [37][38][39][40] Previous studies have demonstrated that exosomes are highly sensitive to physical factors. 41 Synonyms and alternative terms were also taken into consideration. ...
Mesenchymal stem cell‐derived exosomes (MSC‐Exo) offer promising therapeutic potential for various refractory diseases, presenting a novel therapeutic strategy. However, their clinical application encounters several obstacles, including low natural secretion, uncontrolled biological functions and inherent heterogeneity. On the one hand, physical stimuli can mimic the microenvironment dynamics where MSC‐Exo reside. These factors influence not only their secretion but also, significantly, their biological efficacy. Moreover, physical factors can also serve as techniques for engineering exosomes. Therefore, the realm of physical factors assumes a crucial role in modifying MSC‐Exo, ultimately facilitating their clinical translation. This review focuses on the research progress in applying physical factors to MSC‐Exo, encompassing ultrasound, electrical stimulation, light irradiation, intrinsic physical properties, ionizing radiation, magnetic field, mechanical forces and temperature. We also discuss the current status and potential of physical stimuli‐affected MSC‐Exo in clinical applications. Furthermore, we address the limitations of recent studies in this field. Based on this, this review provides novel insights to advance the refinement of MSC‐Exo as a therapeutic approach in regenerative medicine.
... LBP and sciatica are among the top ten causes of years lived with disability in developing countries and the leading cause in 45 developed nations [2]. The incidence of sciatica in Western countries is estimated to be 5 per 1000 [3]. One of the most common conditions associated with LBP is sciatica, with lifetime prevalence ranging from 1.2 to 43% [4]. ...
Background
In deep gluteal syndrome (DGS), the piriformis muscle could impinge the sciatic nerve. The FAIR (flexion adduction internal rotation) test is a provocation test used to identify sciatic nerve irritation caused by this muscle. Compression and stretching exercises are usually prescribed to treat this syndrome. The aim of this study was to compare the effects of these two treatments on surface electromyography (sEMG) of the gastrocnemius and tibialis anterior in patients with low back pain (LBP) and DGS.
Materials and methods
Forty-five participants were allocated to three groups of stretching exercise, compression or control. In addition to 15 min of heat and 15 min of electrical nerve stimulation for pain relief, participants in the compression exercise (CE) group received self-compression exercise, those in the stretching exercise (SE) group received self-stretching exercise and those in the control group received no extra interventions. For the two intervention groups, three sets of two minutes of exercise with two minutes of rest in between were applied. The sEMG amplitude values of the gastrocnemius and tibialis anterior muscles of the affected buttock side of any one group while performing the FAIR test were compared to the others. Pain and disability were assessed and the changes were compared between the two groups.
Results
After the intervention period, no group demonstrated a change in the sEMG of the gastrocnemius or tibialis anterior muscles (p > 0.05). There was no difference in the change in this variable between groups (Mean difference (95% CI) of gastrocnemius was ranged over= -4.04 to 7.72 (-19.44 to 23.14); p = 0.603); (Mean difference (95% CI) of tibialis anterior muscles was ranged from − 2.44 to -6.43 (-18.28 to 9.31); p = 0.550).; Pain and disability also decreased significantly in all three study groups (p < 0.05). However, only the disability of patients who performed stretching exercises improved compared to the compression exercise group (Mean difference (95% CI) = -12.62 (-20.41 to -4.38); p = 0.009).
Conclusion
Neither stretching nor compression exercises altered the sEMG of the gastrocnemius and tibialis anterior muscles in patients with DGS. Furthermore, performing stretching exercises improved disability compared to the other interventions.
Trial registration
The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on 10/01/2017 as IRCT201604178035N4. URL of the record: https://en.irct.ir/trial/8473.
... Anterior pain is experienced when the S1 nerve is compressed. Pain is felt on the dorsolateral side if the L5 nerve is compressed [7]. The link between the piriformis muscle and sciatica has long been known. ...
To identify the predisposing factors of piriformis tightness and its association with lower back pain in office workers due to prolonged working hours. In this cross-sectional study, a convenient sampling technique was used to collect data from the study participants. The study setting was private office setups in Faisalabad, Pakistan. A sample size of 250 office workers was selected through defined inclusion criteria after the screening of almost 400 workers. The selection criteria were individuals aged 26-50 years having a minimum of 2 years of work experience. The study period was from October 2021 to March 2022. Seated piriformis test was used to check the presence of piriformis muscle tightness. The visual analogue scale was used for pain assessment and a structured questionnaire was used to check the predisposing factors. Piriformis tightness was found in 76% of the office workers. Chi-square test resulted in a significant association of piriformis tightness with lower back pain (p<0.05). Conclusively, it was observed that piriformis tightness was frequent in office workers due to prolonged working hours. Furthermore, it was highlighted that predisposing factors, included prolonged working hours, uncomfortable chairs without appropriate foot support, poor posture, and work-related pain.
... Therefore, clinical guidelines recommend a combination of history and physical examination to reach a definitive diagnosis. 72 Overall, appropriateness patterns were fairly similar between lumbosacral and cervical radicular pain, although additional analyses learned that neurosurgeons were firmly against the use of PRF to treat radicular symptoms in patients with a history of Grade III WAD. Anesthesiologists, however, did not exclude these patients from PRF, especially not if the pain was caused by disc herniation or foraminal stenosis and the diagnosis of radicular pain was confirmed by a positive Spurling test. ...
... Evidence-based guidelines for the management of LBP have supported mainly psychological and physical therapies with less focus on pharmacological therapies [6,[14][15][16], but they have overlooked older people specificities that should be considered in the decisionmaking processes (e.g., chronicity of the condition, comorbidities, and polypharmacy). In this way, efficacy of pharmacological and non-pharmacological therapies should be clarified in this population, considering their context [17,18]. ...
Background
The purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making.
Methods
We will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta‐Analysis (CINeMA) framework.
Discussion
This NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice.
Systematic review registration
PROSPERO CRD42022312565
... Patients with LRP have demonstrated high diagnostic accuracy on the SLR and slump tests. Exercises and physical therapy are also advised by guidelines since they have been shown to be helpful in the conservative treatment of people with lumbar radicular pain [25]. ...
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniation and treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.
... • Pain localization -whether it radiates below the knee and whether the pain coincides with dermatomes • Dominance of pain in the legs over back pain • Presence of paraesthesia and/or dermatome dysaesthesia • Weakness and/or reflex changes in the myotomal distribution • Worsening leg pain when coughing, sneezing or taking a deep breath [40]. Pain can be described or associated with burning, heaviness, or pressure sensation. ...
This review examines the role of the physiotherapist in diagnosing piriformis muscle syndrome (PS), taking into account the exact anatomy of the muscle and the arsenal of tests the physiotherapist can use. In the works we researched, talking about PS ignores the role of the physiotherapist as the first specialist the patient should turn to. Many works emphasize the physician’s physical examination and often surgical intervention. The participation of a physiotherapist in the process of diagnosing ailments such as PS requires further research, but already with a high degree of reliability, a physiotherapeutic examination can speed up the process of diagnosis and treatment.
