Where to treat sciatica?

Written by Chen Hui
Orthopedic Surgery
Updated on September 02, 2024
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Sciatica is relatively common among the general population. Its symptoms manifest as numbness, swelling, and weakness in one leg. The most common cause is herniation of the lumbar intervertebral disc, which compresses the nerve roots resulting in these symptoms. Therefore, when such symptoms occur, it is necessary to seek treatment at a formal medical institution. One could visit the orthopedics department, or if the hospital has specialized departments, it is best to consult the department of spinal surgery.

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What causes sciatica?

The causes of sciatica generally fall into two categories. The first is primary sciatica, which is usually caused by inflammation of the sciatic nerve and is relatively rare in clinical practice. The second category is secondary sciatica, which occurs when the tissues and structures around the sciatic nerve undergo pathological changes, leading to stimulation and compression of the sciatic nerve, thus causing secondary sciatica. The majority of secondary sciatica cases are associated with lumbar spine disorders, such as lumbar disc herniation, tumors in the lumbar spinal canal, or degenerative joint disease of the lumbar spine, as well as sacroiliitis. A hospital examination is necessary to make a definitive diagnosis.

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How to treat sciatica?

Patients with sciatic nerve pain must rest in bed, especially those whose pain is caused by nerve compression. They must pay close attention to keeping warm and resting regularly, and use heat application on the waist and buttocks. For medicinal treatment, the drugs are mainly divided into Western medicine and traditional Chinese medicine. Western medicine primarily uses non-steroidal anti-inflammatory drugs and neurotrophic drugs. Traditional Chinese medicine mainly uses drugs that invigorate the blood to promote the repair of nerve edema and surrounding tissue swelling. Treatment can also include acupuncture and physical therapy, particularly ultrashort wave therapy and direct current iontophoresis during the acute phase, combined with acupuncture, which can effectively promote the alleviation of sciatic nerve pain.

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Orthopedics
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Which department should I register for sciatica?

Sciatica is divided into primary and secondary types. Primary sciatica is caused by inflammation of the sciatic nerve itself, thus one should visit the Department of Neurology. Secondary sciatica is more common and usually stems from spinal conditions, so initially one should visit the Department of Spinal Surgery. Alternatively, one can visit the Department of Orthopedics, which deals with broader orthopedic issues. If experiencing severe acute pain, a visit to the Pain Management Department can provide rapid and effective pain relief. For frequent episodes of sciatica and interest in rehabilitation, the Rehabilitation Department can be considered. Additionally, traditional Chinese medicine has unique approaches to treating sciatica, so visiting the Department of Traditional Chinese Medicine to try treatments with Chinese herbs and methods is also an option.

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Orthopedics
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Sciatica obvious symptoms

Sciatica is divided into primary sciatica, which is sciatic neuritis, and secondary sciatica. This is due to other causes leading to swelling and pain. Clinically, it generally manifests in the following six aspects: First, pain that is primarily limited to the distribution area of the sciatic nerve, including the back of the thigh, the back of the calf, the outer side, and the sole of the foot, as well as the lateral side of the dorsum of the foot. Second, muscle strength governed by the sciatic nerve begins to diminish. Third, there are fixed tender points. Tender points are located at the ischial notch or could also be at the exit of the piriformis muscle. Fourth, there are symptoms of sciatic nerve traction, such as positive limb elevation, or positive straight leg raise test and enhancement test. Fifth, the Achilles tendon reflex is weakened or absent, while the muscle penetrative reflex is abnormally heightened due to stimulation. Sixth pertains to abnormal sensations in the areas governed by the sciatic nerve, including reduced or absent sensations, reduced absolute vibration at the external ankle, and some very mild sensory disturbances.

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Can sciatica be cured completely?

Sciatica is difficult to cure completely. If it is primary sciatica, which is caused by inflammation of the sciatic nerve, there is a possibility of complete cure after medical treatment. However, secondary sciatica is generally difficult to completely cure because it is usually caused by spinal diseases, such as herniated discs, spinal stenosis, or even spondylolisthesis. In such cases, even after solving the primary disease, some problems may persist, continuing to stimulate the sciatic nerve, making it difficult to cure completely. If the sciatica is caused by spinal tuberculosis or a spinal tumor, the situation is even more complicated. Even if the primary lesion is resolved, it cannot guarantee that it will not recur. Therefore, sciatica is difficult to cure completely.