Does Obesity Lead to Sciatic Pain A Comparative Study

Abstract

Background: Obesity leads musculoskeletal problem which is affecting the Spinal disorder are related to low back pain. This is more affected in obese people with the impact of workload. The Sciatica is a clinical condition characterized by severe pain started from the low back region and radiating down along the course of the leg. Very few studies were conducted in the Indian population. Therefore, an attempt has made to study the NCV in obese patients of sciatica pain common. To the observer the relation of overweight and obesity with sciatica pain.
Methods: The study was carried in the physiology department in which we have included 100 patients, which was suffering sciatica. The patients were evaluated for the straight leg raising test (SLR) positive. These patients were referred to the NCV based on BMI for rule out the obesity. NCV study was done on RMS EMG EP Mark-II.
Result: The mean value of Motor nerve conduction velocity was 51.79+3.46 in a normal subject and it was 48.02 + 5.17 on the in an obese subject which was significantly decreased.
Conclusion: We conclude that obese patients are increases risk of radiating pain which is specific in men and women. Taking into consideration the recent situation of worldwide obesity we emphasis on the does obesity lead to sciatic pain. We found sciatic neuropathy in obese patients.
Key Words: BMI, Nerve conduction velocity, Overweight, Obesity, Sciatica, Straight leg rising test

Full text

Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020 120
Corresponding Author:
Dr. Shweta Dadarao Parwe, Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Salad (H),
Wardha, Datta Meghe Institute of Medical Sciences (DU), Nagpur, Maharashtra, India; Contact: +919403142270;
Email: drshwetaparve@gmail.com, shweta.parwe@dmimsu.edu.in
ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online)
Received: 19.06.2020 Revised: 25.07.2020 Accepted: 27.08.2020 Published: 07.12.2020
Research Article
International Journal of Current Research and Review
DOI: http://dx.doi.org/10.31782/IJCRR.2020.122314
INTRODUCTION
Obesity is the major problem in worldwide which is associ-
ated with a different complication like cardiovascular dis-
ease, diabetes mellitus, hypertension atherosclerosis, now a
day’s obesity is correlated with musculoskeletal problems.1
Overweight and obesity are correlated to accelerated the risk
of lower back pain.2 Many patients’ complaints regarding the
low back pain (LBP). Sciatic neuropathy is one of the lower
extremities most common peripheral neuropathy. One of the
most common sciatic neuropathy presentations is drop in the
foot. Because weakness of the ankle dorsiflexion, with or
without sensory impairment of the lower extremity, can also
be associated with several other clinical syndromes, careful
evaluation is necessary before confirming a diagnosis of sci-
atic neuropathy. Electrodiagnostic testing is one important
device for confirmation of suspect sciatic neuropathy and in
assessing the potential for nerve function recovery.3,4
Few studies specifically examine sci atica, but some low
back pain studies in clude data on sciatica prevalence, risk
fac tors, and natural history. Low back-related leg pain, or
sciatica, is one of the most common variations of low back
pain.5 Sciatica is known in the literature through a variety
of terms such as lumbosacral radicular syndrome, radicu-
lopathy, nerve root pain, and nerve root trapping or irrita-
tion. There is controversy over the use of sciatica as a term
in clinical and research contexts.6,7 Sci atic pain is generally
defined as pain radi ating to the leg, normally below the knee
and into the foot and toes. As with low back pain, sciatica is
a symptom rather than a specific diagnosis,8 but lumbar disk
herniation and lumbar canal or foraminal stenosis are typical
pathologies that may cause sciatic pain.9
Sciatic patients usually have major pain which is lower back
pain radiating to leg. These patients having more disability
and they are irregular for the work due to the pain.10,11
.
ABSTRACT
Background: Obesity leads musculoskeletal problem which is affecting the Spinal disorder are related to low back pain. This
is more affected in obese people with the impact of workload. The Sciatica is a clinical condition characterized by severe pain
started from the low back region and radiating down along the course of the leg. Very few studies were conducted in the Indian
population. Therefore, an attempt has made to study the NCV in obese patients of sciatica pain common. To the observer the
relation of overweight and obesity with sciatica pain.
Methods: The study was carried in the physiology department in which we have included 100 patients, which was suffering
sciatica. The patients were evaluated for the straight leg raising test (SLR) positive. These patients were referred to the NCV
based on BMI for rule out the obesity. NCV study was done on RMS EMG EP Mark-II.
Result: The mean value of Motor nerve conduction velocity was 51.79+3.46 in a normal subject and it was 48.02 + 5.17 on the
in an obese subject which was significantly decreased.
Conclusion: We conclude that obese patients are increases risk of radiating pain which is specific in men and women. Taking
into consideration the recent situation of worldwide obesity we emphasis on the does obesity lead to sciatic pain. We found
sciatic neuropathy in obese patients.
Key Words: BMI, Nerve conduction velocity, Overweight, Obesity, Sciatica, Straight leg rising test
Does Obesity Lead to Sciatic Pain: A Comparative
Study
Milind Abhimanyu Nisargandha1, Shweta Dadarao Parwe2
1
2

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Nisargandha et al.: Does obesity lead to sciatic pain: a comparative study
121
LBP was longer duration is considered as a mainly neuro-
logical cause. However, in the past decade, many authors
report ed that socioeconomic and work-related factors which
were not previously investigated may contribute to LBP. Few
studies of sciatic pain exist. Therefore, assessing overweight
and obesity leads to Nerve conduction studies in the patients
of sciatic involvements.12 We undertake the present study, to
find out any relation in between overweight and obese sub-
jects suffering from sciatica pain.
MATERIALS AND METHODS
This study was conducted at MGM college and hospital
Aurangabad. The patients having LBP with overweight and
obese are categories initially and send for the neurophysiol-
ogy lab in the hospital for Nerve conduction study. These se-
lected patients’ routine clinical examination was carried out
and noted all anthropometric parameters. The patient having
mild, moderate, severe pain which is radiating to legs were
included in our study.
Anthropometric measurements: The height and weight
were measured after the recruitment of the subjects in the
study. In standing, position height was measured and weight
is in kg.13,14according to the weight and height BMI was cal-
culated as weight/height2 (kg/m2). Other variables like waist,
hip circumferences were measured and hip waist ratio was
calculated.15
Cardiovascular parameter: The pulse rate was recorded
by manually, the pulse was examined with three fingers of
the right hand over the subject of the radial artery with three
fingers, in semi flexed wrist with the distal figure for oblit-
erating the retrograde pulsation. Pulse rate was the count for
one minute. In the supine position, the blood pressure was
noted with a sphygmomanometer (Diamond) on the arm at
the heart level.16,17
MGM- ECRHS Approval Letter - MGM-ECRHS/2015
/07
Study Design: Case-Control
Sample Size: 100
Period of Study: Two year
Study Population: OPD/IPD overweight Patients Lower
Back Pain (LBP) willing for investigation.
Study Area: Mahatma Gandhi Medical College, Aurang-
abad
Inclusion criteria:
• Reproductive age group >20 to 60 years
• Patients having Sciatica
• LBP (low back pain
• SLR (straight Legs Rising) test Positive
Exclusion criteria
• Surgical intervention.
• Fracture in pelvic
Electrophysiological methods
Nerve conduction study was done on RMS EMG EP Mark-
II. For Motor nerve study, duration was kept at 200 μs, the
filter was between 2 Hz to 10 kHz and sweep speed was 5
ms/D for lower limb and at 100 μs, 2 Hz-5 kHz, 5 ms/D. Pa-
rameters studied for motor nerves were distal motor latency
(DML), amplitude and conduction velocity (CV).18
Straight Leg Rising Test (SLRT): This is the most impor-
tant diagnostic sign in the patients of Sciatica. The SLRT was
carried out with the patient at the supine position. The leg af-
fected with sciatica was raised passively, with the patient re-
laxed and the knee in full extension. When the patient started
to feel discomfort, the elevation of the leg was stopped, and
the elevation angle and amount of pelvic movement were
registered. The patient was then asked to indicate how the
pain and paraesthesia were distributed. The foot was dorsi-
flexed with the leg in the raised position, and the neck was
flexed and the effect of this was also documented. Another
side straight-leg raising was carried out.19 In this study, we
categorized the SLR in the following Grade
SLR Grade Degree of Angle
Normal 0 90-75
Mild 1 75-65
Moderate 2 65-55
Sever 3 55-45
Sever 4 45-35
RESULTS
The present work was carried out in the Physiology depart-
ment at Mahatma Gandhi Medical College to analyze the
role of overweight and obesity may affect sciatica.
Demographic characteristics of Subject
The total number of subjects recruited in this study was 104
among these three Patients’ dropout due to absenteeism and
One is not willing for performing the Nerve Conduction
Study. Total 100 patients were selected for this study, out of
that 68% population of patients (68) were female and 32%
population (32) were male in graph.1 In table 1 straight leg
raising test and its grades were categorised based on the de-
gree of angle. The number of patients was distributed in it.
Table 2 shows anthropometric values, the mean value of an-
thropometric parameters weight, height and BMI was 75.86
+ 8.80, 156.96 + 9.76 and 30.96 +4.04 respectively. Table 3

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Nisargandha et al.: Does obesity lead to sciatic pain: a comparative study
122
shows the mean values of Demographic parameters such as
pulse, systolic and diastolic blood pressure and Chest, Waist,
Hip Circumference and their ratio. The mean value of Motor
nerve conduction Velocity in the normal subject was 51.79 +
3.46 and the motor nerve conduction velocity of the sciatic
patient was 48.02 + 5.17 on the affected shows in decreased
value in table 4, which was statistically significant.
DISCUSSION
Electrodiagnostic tool used to test the functioning of nerves,
particularly the ability of transmission of the electrical stim-
ulus. NCV studies can understand the degree of demyelina-
tion and axonal loss in examined nerve segments. Demyeli-
nation of a nerve results in prolonged conductive duration
(decreased conductive velocity), while axonal impairment
typically results in impairment of nerve fibres and potential
strength of the muscle. The assessment of the electrodiag-
nostic study of nerve conduction is measured by four criteria,
i.e., latency, Amplitude, Duration and velocity of the evoked
potential. Out of which Motor nerve conduction Velocity is
the important parameter for the involvement of nerve. Table
1 shows the gender-wise distribution of Patients involved in
the Sciatica.
Table 2 shows the Straight Leg Rising Test with Grade and
number of Patient involved in Nerve conduction study as per
their severity. In another study by Michael et al (1974) ob-
served the form of pain induced by passive SLR fell into
three precise groups.19 Table No 2 shows Anthropometric
Parameters like weight, height and BMI of sciatic subjects
There is a likely causal relationship between body height and
sciatic risk, but height isn’t necessarily predictive of other
types of low back pain. Obesity, smoking, psychological dis-
tress and poor general health also carry an increased risk of
low back pain but is questionable about their possible as-
sociation. Although none of the suspected risk factors can be
identified as being scientifically well investigated.20
This study is aimed at deriving obesity lead to Nerve conduc-
tion velocity in a specific regional population that closely
correlates to the demographic outline of the patients of sci-
atica being considered. In this study, obesity leads to Sciatic
nerve conduction involvement found in conduction velocity
significantly decreases. NCV tests may recognize the level
of demyelination and neuronal loss in examined nerve parts.
Demyelination of a nerve leads to increased delivery times.
A similar finding was observed in “obese may also interfere
with the nutrition of the intervertebral discs, leading to an
impaired healing process. In a 3-year follow-up study of sci-
atica patients.21,22 BMI was the strongest interpreter of inci-
dent lumbar artery occlusion, which also suggests that im-
pairment of nutrition can be one of the pathways of obesity’s
relationship with sciatica.
Obesity supports establish chronic, low-grade inflamma-
tion by releasing inflammatory mediators from excess adi-
pose tissue.23 Chronic inflammation associated with obesity
may lead to the development of sciatica or to the develop
the symptoms of sciatic. Leptin is one of the major constitu-
ents of adipocyte-derived adipokines which raised the serum
leptin which is correlated to obesity and leads to BMI-inde-
pendent knee arthritis.24 Leptin is estimated of involving the
reorganization of nucleus pulposus cells cytoskeletons,25 but
the fat tissue-derived leptin in the association between sci-
atica and obesity. Leptine is the key substance for controlling
homeostasis of body weight and energy balance. The gene,
coding protein which consists of 165 amino acid is called
Leptine which produce adipocytes. The obese people often
show hyperleptinemia this may cause by the post-receptor
disorder. It is supposed to absolute and relative leptine defi-
ciency in obese people
CONCLUSION
An electrodiagnostic test is an important tool used to test
the functioning of nerves, speciallyto check the of conduc-
tion of electrical stimulus. NCV studies can early recognize
demyelination and neuronal loss. Due to demyelination
prolong conduction velocity observed. We concluded that,
early detection of demyelination and neuronal loss helpful
for avoiding sciatic pain in an obese person. This also shows
comparative data of the patient having sciatic pain with the
normal subject.
ACKNOWLEDGMENT
We the authors acknowledge help from the Dr. Pramod
Shinde and Dr. Sangeeta Phatale for their continuous sup-
port throughout the work. The authors are also a deep sense
of gratitude to Dr. Wankhede SG professor for his guidance
during entire work. We are thankful to all authors of journals
and articles from where the literature for the article was re-
viewed and discussed.
Source of funding: No
Conflict of Interest: There is no conflict in this article.
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Figure 1: Gender wise distribution of research participants.
Table 1: Straight Leg Rising Test with Grade and num-
ber of Patient involved in sciatica.
Sr. No. SLR GRADE No. of sciatica Patients (50)
1. Mild 3
2. Moderate 4
3. Sever Grade-1 25
4. Sever Grade-2 18
Figure 2: Straight Leg Rising Test with Grade and number of
Patient involved in Nerve conduction study.
Table 2: Anthropometric Parameters.
Weight Height BMI
75.86 + 8.80 156.96 + 9.76 30.96 + 4.04

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Nisargandha et al.: Does obesity lead to sciatic pain: a comparative study
124
Figure 3: Anthropometric Parameters
Table 3: Cardiovascular Parameters
1. 2. Blood Pressure 3. 4. 5. 6.
Pulse Systolic B P Diastolic B P Chest circumfer-
ence
Waist Circumfer-
ence
Hip circumfer-
ence
WHR
Mean + SD Mean + SD Mean + SD Mean + SD Mean + SD Mean + SD Mean + SD
83.88 + 4.79 121.4 + 6.66 80.16 + 6.68 35.38 + 3.90 39.28 + 3.73 38.32 + 3.67 1.033 + 0.13
Figure 4: Cardiac and chest, waist and Hip circumference.
Table 4: Nerve conduction velocity (m/s) of in the obese subject suffering from sciatica pain with normal
subjects.
Paired Samples Statistics
Mean N Std. Deviation Std. Error Mean
Pair 1 NCV in normal subject 51.7940 50 3.50489 0.49567
NCV in Obese subject 48.0200 50 5.23134 0.73982
Paired Samples Correlations
N Correlation Sig.
Pair 1 NCV in normal subject & NCV in Obese subject 100 -.007 0.961

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Nisargandha et al.: Does obesity lead to sciatic pain: a comparative study
125
Paired Samples Test
Paired Differences t df Sig.
(2-tailed)
Mean Std. Deviation Std.
Error
Mean
95% Confidence
Interval of the
Difference
Parameters Lower Upper
Pair 1 NCV in normal subject -
NCV in Obese subject
3.77400 6.31761 .89344 1.97856 5.56944 4.224 49 0.001*
Values < 0.05 is statistically significant * Highly significant 0.001
Figure 5: Comparison of Nerve conduction velocity of obese subject having sciatic pain as compared to normal subjects.