LUMBOSCIATICA: SYMPTOMS, CAUSES, TREATMENTS AND EXERCISES - MEDICINE - 2025

The lumbosciatica corresponds to the pain from the lumbar region following the path of the sciatic nerve. It is different from lumbago, limited to the lower back. While lumbago is caused by muscle contraction, lumbosciatica includes compression pain of the sciatic.

It is a condition that involves both bones and joints - lumbar spine - as well as the soft parts of the region. The nerve roots that make up the sciatic nerve are also affected, and together they determine the characteristic symptoms.

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The sciatic is the thickest and longest nerve in the human body. It is born from the union of the nerve roots L4 and L5 -in the lumbar region- as well as S1, S2 and S3 (posterior pelvis) running through the waist, gluteus and posterior aspect of the thigh. Its function is to give the sensitivity of the posterior aspect of the lower limb, in addition to the lateral aspect of the leg and foot.

Low back pain affects a large part of the world's population at least once in their life. Sciatic nerve compression is less common and yet represents one of the most common causes of absence from work.

On many occasions, the symptoms of lumbosciatica produce inability for the patient's daily activity, including work. That is why this condition has an impact on the economic activity of a country. Knowing, diagnosing and treating lumbosciatica is important because it is a disabling disease.

Symptoms

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Low back pain is a condition that affects the lumbar spine and involves the sciatic nerve. It is a condition whose cardinal symptom is pain, the reason for the disability that is observed. Other symptoms observed are derived from compression of the nerve roots coming from the lumbar spine.

Pain

The structures involved in lumbosciatica are the dorsal and paravertebral muscles, and the roots of the sciatic nerve. For this reason, pain is both somatic and neuritic.

Somatic pain

It corresponds to the symptom caused by reactive and sustained muscle contracture. This is usually the initial symptom of the disease and is related to trauma, improper posture or physical effort.

Muscle pain receptors are able to respond to mechanical stress, pressure, stab injuries, and stretching. Extreme physical exertion and trauma are the leading cause of muscle pain.

The intervertebral disc, a structure that separates two contiguous vertebrae, also has pain receptors. Direct compression of the disc due to herniation or displacement causes pain at this level.

The sacro-iliac joint is exposed to damage caused by physical effort, stretching and trauma, in addition to the pathologies of the joints. For this reason, the appearance of pain at this level is possible due to damage to this region.

Neuropathic pain

First of all, it must be considered that the structure of the nerve is sensitive to pain. Taking into account that lumbosciatica is the product of compression of the nerve, pain of nervous origin occurs for this reason.

The mechanism of production of neuropathic pain by compression is not yet clear. The existence of receptors for harmful stimuli capable of triggering the release of substances that cause inflammation and, consequently, pain is suggested.

An important characteristic of sciatic pain is its radiation to the gluteus and thigh on the side corresponding to the affected nerve. The nerve is formed by the union of nerve roots that emerge from the intervertebral spaces of the lumbar spine (L) and the sacrum (S).

From the intervertebral spaces L4 - L5, L5 - S1 and S1 - S2 emerge the main roots that form the sciatic. The radiation of pain depends on the affected root. If the affected portion, for example, is L4 - L5, the pain will radiate from the buttock to the posterior and outer thigh, even reaching the first toe.

Inflammation

Any aggression, trauma, or noxious stimulus received by a tissue produces inflammation. Inflammation involves the release of substances produced by the body that produce vasodilation and, thus, inflammatory manifestations: edema, local heat and pain.

In lumbosciatica the causative factor induces a localized inflammatory response that produces changes in the tissues and their consequent symptoms. It is a symptom capable of producing pain

Functional limitation

As with inflammation, limitation of movement or activity is related to pain. Functional limitation implies a reduction in activities that can lead to functional impotence.

The consequence of the limitation of movements is the decrease or cessation of the normal activities of the individual.

Paresthesias and sensory disturbances

Tingling, tingling, itching, a burning sensation, or the sensation of passing current are symptoms of paresthesia. When the sensory fibers of the peripheral nerves are affected, paresthesia appears as a manifestation of neurological alteration.

The areas where paresthesia are observed correspond to those innervated by the branches of the sciatic nerve that is affected.

Sensitivity is the ability to perceive different external stimuli, such as temperature, touch, pressure, and pain. This property can be altered as a result of compression of the nerve. It can manifest as numbness in a specific area of ​​the affected lower limb.

Parsia and d

When the motor fibers of a nerve are compressed by an external agent, muscle contraction is limited, reducing normal mobility. This alteration is called paresis, and is interpreted as weakness or "heaviness" of the affected limb.

Causes

The compression of the roots that form the sciatic nerve is the determining factor that causes lumbociatalgia. Various causes, mechanical or non-mechanical, act on the nerve causing inflammatory changes that lead to alteration of its function. Inflammation of a nerve root is called radiculopathy.

The most common cause of lumbosciatica is herniated disc, a structural alteration of the disc that separates two vertebrae. The intervertebral disc consists of a nucleus pulposus contained within a fibrous capsule. If the capsule wears out or weakens the nucleus pulposus comes out through the weakness producing the herniated disc.

Once the hernia occurs, the root compression mechanism can be both by the pressure exerted by the approach of the two contiguous vertebrae and by the mechanical effect of the same hernia.

Other causes of sciatic radiculopathy act in a similar way: constant and sustained extrinsic pressure on the root and, consequently, neurological injury.

Mechanical causes

- Herniated disc.

- Muscle contracture.

- Myofascitis

- Disc degeneration

- Osteoarthritis or facet osteoarthritis.

- Vertebral stenosis.

- Lumbar trauma.

- Vertebral fracture.

- Spondylolisthesis or abnormal displacement of the vertebrae

- Spinal, extramedullary or vertebral body tumors.

- Abnormal scarring or fibrosis after lumbar puncture.

- Infections, such as vertebral osteomyelitis.

- Pregnancy.

- Obesity.

Non-mechanical causes

- Piriformis muscle syndrome.

- Sacroiliitis or dysfunction of the sacroiliac joint.

- Peripheral neuropathy

- Myositis and other myopathies.

- Neurological syndromes.

- Multiple myeloma.

- Metastasis.

- Ankylosing spondylitis.

- Osteopenia and osteoporosis.

- Defects or diseases of the hip.

- Psychogenic pain, in addition to other psychiatric or psychological disorders.

Treatments

-Pharmacological

Medication contributes to symptom relief and is sometimes sufficient as part of conservative treatment. The most commonly used medications include treatment of pain, inflammation, and neuropathies.

NSAIDs

Non-steroidal anti-inflammatory pain relievers - such as ibuprofen, ketoprofen, diclofenac, ketorolac, or naproxen - are renowned for their effects on pain. In addition, they have an effect on the inflammation of the soft tissues.

Steroids

This group includes dexamethasone, betamethasone, methylprednisolone. They act as anti-inflammatories and, for this reason, have effects on pain.

Opioids

Its effect is as a medium to high potency pain reliever, but without effects on inflammation. Opioid medications are codeine, nalbuphine, tramadol, buprenorphine, meperidine, and morphine. Its use is reserved in case of severe pain.

Muscle relaxants

Thiocolchicoside is one of the most widely used muscle relaxants. It acts on the skeletal muscle providing relief by reducing muscle contracture.

Drugs with antineuritic effect

First used as antiepileptic drugs, gabapentin and pregabalin are drugs used for the treatment of neuropathic pain.

They are synthetic forms with a structure similar to Gamma-amino-butyric acid (GABA). The mechanism of action is not precise but it is postulated that they intervene on calcium channels.

Complex B

The vitamins that make up the B complex (B1, B6 and B12) have been used in the treatment of neuropathies. Its efficacy and mechanism of action are still under study.

-Physiotherapy

Physical therapy includes exercises aimed at improving the symptoms of radiculopathy, as well as preventing disability. They must be indicated by specialists. It is a conservative therapeutic measure.

-Surgery

Surgical intervention is used in severe cases of radiculopathy. When conservative therapy, medications and physical therapy do not provide relief to the patient and he is incapacitated, surgery is performed.

The goal of surgery is to remove the cause of the nerve root compression. The release of nerve fibers suppresses symptoms and restores nerve function.

In vertebral disc disease, this treatment repairs the damaged disc, replaces it with a prosthesis, or fixes the vertebrae to stabilize the joint. It is also used for the excision of tumors or correction of other causes.

Recommended exercises

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Physical exercise and physical therapy provide relief for low back pain, while helping to improve mobility. All physical activity or exercise must be indicated and supervised by a physiotherapist and physical doctor. They will only be indicated and allowed when exercise does not worsen a pre-existing condition.

Considerations for opting for physical therapy and rehabilitation depend on the correct diagnosis of the cause of lumbosciatica. Some pathologies such as tumorous, infectious, severe trauma, or systemic disease require immediate medical attention in the first place.

The objectives of the exercise are based on three premises: stretching, strengthening the abdominal and paravertebral muscles, as well as adequate aerobic conditioning. It is important to note that physical therapy can be done before or after the surgery or treatment indicated.

There are countless types of exercises, however, the most common are based on the three premises mentioned.

Stretching

They are the first exercises that must be performed due to their simplicity. The best known is that of the cobra position, which consists of lifting the trunk with the arms from a lying position (prone or face down) keeping the hips resting on the ground.

A variant of this exercise is performed while standing and pushing the trunk back with the hands resting on the hips. The activity should start with little effort and gradually increase.

Strengthening the abdomen and back

To strengthen the lower back, the patient is placed in the prone position and begins by simultaneously raising the arm on one side and the leg on the opposite side with the knee extended.

The abdominal muscles are strengthened in groups. For the upper abdominals, the patient is placed supine (face up) and the head and shoulders are raised, maintaining the position for a certain time.

The lower abdominals require that, starting from the same position, the extended lower limbs are raised. This is done while keeping the lower abdomen contracted.

Aerobic exercises

They are all those whose purpose is to improve physical condition, resistance and cardiovascular work. Aerobic exercises include light jogging, stationary or conventional cycling, and swimming. Activities that involve aerobic conditioning must be allowed, indicated and supervised by specialists.

Well-used physical activity is beneficial for pathologies that produce lumbosciatica or chronic lumbago. There are specific exercises for each pathology separately, performed by indication or specialized guide.

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