Author: Dr Ranjeet Singh

Overview

Sciatica is a serious disease of the nervous system. It is a neuritic condition of the sciatic nerve. It refers to a severe pain running down the course of the sciatica nerve, which supplies sensation to the back of the leg and foot.

The sciatica nerve is the longest nerve in the body. It has branches in the thigh muscles, the knee joints, and down into the muscle of legs and feet. This nerve begins to the lower part of the back and passes down behind the thigh. It is more exposed to injury and inflammation than most other nerves.

In classical Ayurveda texts, sciatica is correlated with “Ghridhasi” which is characterized by vitiation of Vata afflicting the tendon/ ligament of the lower limbs. It is characterized by severe radiating pain starting from the lower back to gluteal, posterior aspect of thigh and dorsum of the foot of either one or both sides of lower limb. The condition makes raising of leg difficult. All types of lumbar radiculopathy also can be interpreted in terms of Ghridhasi.

Case definition

Ghridhasi (sciatica) is defined as stiffness, pain, pricking pain, in a radiating manner along with tingling sensation starting from lower back to back, knee joint, calf muscles and lateral aspect of feet of either one side of the lower limb or may involve both lower limb.

Clinical features

One who has sciatica feels severe pain in the buttock which may radiate down the posterior aspect of the thigh and calf to the outer border of the foot. In severe cases, he may feels weakness of calf muscle or foot drop. Sometimes the pain is so severe that the patient cannot stand and is crippled. In case of ruptured disc the pain is often aggravated by coughing, sneezing, bending forward, or straining at the stool. Often the pain disappears with bed rest, only to return days or weeks later after some slight injury or extra exertion.

Tenderness is present along the course of the sciatic nerve after it exist from the pelvis.

Pain is also intensified by manouvres that stretch sciatica nerve such as bending forward or the tests for sciatica like straight leg raising and Lasegue’s sign.

Causes

Sciatica may be caused by any type of injury to the spine, because of compression of the sciatic nerve at its roots. Any infection or toxic material near the area of the nerve may result in this disease. But in most cases, the trouble is due to either to a ruptured disc or else osteoarthritis of the lower spine. Other causes include pregnancy, tumors of the pelvis, deformities of the lower spine and exposures to cold and damp. The sciatic nerve may even be injured by walking or running or riding a bicycle. Prolonged standing or sitting on one side of the edge of a chair may also lead to this disease.

Differential diagnosis

The condition should be differentiated from ankylosing spondylitis, Marma abhighata (injury to vital spots) at any of the kukundara and nitambha marma.

  • If the pain is localized to sacroiliac joint it may be diagnosed as Katigraha a condition ankylosing should be ruled out.
  • Khanja and Pangu are characterized with weakness of lower limbs due to loss of motor power. Khanja affecting one limb and Pangu affecting both. These conditions may not have any pain associated.
  • Kukundara marma-abhighata is characterized by motor and sensory loss.
  • Nitambha marma-abhighata is characterized with wasting of lower limbs.

Diagnosis

  1. ESR- to rule out any inflammation ( males= 0-15 mm/h, females= 0-20 mm/h)
  2. X-rays of the lumbo Sacral spine
  3. USG- Abdomen & Pelvis- to rule out any visceral pathology or gynaecological issues related to uterus and adnexa and PID, leading to low back pain or pain in lower limbs.
  4. USG-KUB- to rule out renal calculi and obstructive lower urinary tract symptoms.
  5. CT scan-for better assessment of Bony canal.
  6. MRI- Lumbo-Sacral with whole spine screening.

Line of treatment according to Ayurveda

  • Nidana parivarjana should be first line of treatment.
  • Shodhana chikitsa- Virechana, Basti, Sirodhara.
  • Shamana chikitsa- pachana, snehana, swedana including various types of Pinda- sweda, agnikarma, balya.
  • External application- abhyagna, lepa, katibasti.
  • Rasayan chikitsa for asthi and vata.
  • Treatment according to doshik involvement.
  • General line of treatment prescribed for vatavyadhi.

Treatment

Treatment of sciatica by painkiller drugs my give temporary relief but it does not remove the trouble effectively. The pain is relieved for the time being at the cost of the health of other parts of the body, especially the heart and kidney and the sciatica remains.

The best way to commence the treatment is to take complete bed rest on firm mattress supported by fracture boards for a few days. Rest must be absolute and in no case, the patient should assume sitting position.

Panchakarma therapy

  1. Katibasti with Dhanvtaram oil and Strobilinthes oil.
  2. Abhyanga with Mahavatanka oil.
  3. Nadi sweda with Dhasmula, Eranda, Nirgundi and Shigru kasaya.
  4. Niruha Basti with Dhasmula or Erandamula kasaya and Anuvasa Basti with Prasarini oil.
  5. Patient may be advised Matra Basti with Dhanvantaram taila or Sahacharadi taila if found to be only vatika.
  6. In Kapha associated conditions, Rookshna lepa like Nagaradi lepa can be applied in the low back region.

Some Ayurvedic formulations

  1. Mahavata vidhwansini kasaya
  2. Vataganjakusha rasa
  3. Rasnadi gugglu
  4. Mahaprasarini taila
  5. Ashwagandha power
  6. Chopchini power
  7. Yograj gugglu

Other treatment measure

Certain home remedies have been found beneficial in the treatment of sciatica. The most important of these remedies is the use of garlic and garlic milk. This vegetable should be cut into small pieces and taken with a teaspoon of honey with each meal. Taken over a period of time, it will yield good results in relieving pain and suffering. Garlic milk can be prepared both in cooked and uncooked states. In raw state uncooked form is more powerful. This milk is prepared by adding the pulp of the crushed garlic in uncooked buffalo milk. The proportion is four cloves to 110 ml of milk. Another method is to boil the garlic in milk.

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Posted by:Ayur Plus