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Preventive Methods
-exercise regularly
-maintain proper posture
-use good body mechanics
-maintain a healthy body weight, Eat healthy foods
-Plenty of rest

Management
• Cold packs: Initially, using cold packs may be able to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least several times a day.
• Hot packs: After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
• Stretching: Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.
• Over-the-counter medication: Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and acetaminophen (Tylenol, others) can both be helpful for sciatica.
• Regular exercise: It may seem counterintuitive to exercise when you're in pain, but regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts your body to release endorphins — chemicals that prevent pain signals from reaching your brain.

http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=prevention
http://neurology.health-cares.net/sciatica-prevention.php
http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=lifestyle-and-home-remedies

EPIDEMIOLOGY

Epidemiology

A number of environmental and inherent factors thought to influence the development of sciatica have been studied, including gender, body habitus, parity, age, genetic factors, occupation, and environmental factors (Table 1).

A cross-sectional study of 2946 women and 2727 men showed neither gender nor body mass had an influence on the development of sciatica, although body mass may have been associated with low back pain.46 Body height may be a risk factor for sciatica, although this appears to be significant only in males in the 50–64 yr age group. Parity of up to six also has been identified as having no association with sciatica.46 – 48 The incidence of sciatica is related to age. Rarely seen before the age of 20, incidence peaks in the fifth decade and declines thereafter.35 This age distribution was also observed in those presenting for lumbar disc herniation surgery.98 The odds ratio (OR) of an episode of sciatica increased by 1.4 for every additional 10 yr of age, up to the age of 64.46 Interestingly, the site of disc herniation appears to change with age. Although the majority of disc herniations occur at the L4/5 or L5/S1 level, with advancing age, there appears to be a relatively increased incidence of herniation at the L3/4 or even L2/3 level.36

A genetic link with sciatica was first reported in a juvenile population.108 This has also been observed in the

adult population, where both retro- and prospective observational studies identified a higher incidence of sciatica or prolapsed disc among first-degree relatives than controls in a population of patients presenting for surgery on herniated lumbar discs.69 96 A study of 9365 pairs of adult twins identified the lifetime incidence of sciatica inmonozygotic and dizygotic twins as 17.7% and 12%, respectively. The estimated heritability was 20.8% for those reporting sciatica and 10.6% for those admitted to hospital with sciatica.45

Recreational activities, such as walking and jogging, may influence incidence of sciatica. Regular walking was

shown to almost double the incidence of sciatica in a group of 2077 workers who were pain free at baseline.

This study also showed that jogging had a dual effect on the incidence of sciatica. Although joggers who were pain free at baseline had a decreased incidence of sciatica, those with a previous history of sciatica were more likely to experience more episodes.73

Physical activity associated with occupation has also been shown to influence incidence of sciatica. Carpenters

(OR 1.7) and machine operators (OR 1.6) were shown to be more likely to develop sciatica than sedentary office

workers.88 89 Retired (OR 0.15) or part-time (OR 0.16) farmers were less likely to develop sciatica than full-time

ones.68 Risk factors identified for sciatica associated with occupation included awkward working position, working in a flexed or twisted trunk position (OR 2.6),73 or with the hand above the shoulder. Driving is also positively associated with sciatica or lumbar disc herniation.47 60 It is possible that driving causes exposure to vibration at around 4–5 Hz which may coincide with resonant frequency of the spine in the seated position and so leading to a direct mechanical effect on the lumbar disc.35 Smoking has been linked with sciatica35 and several hypotheses, such as tobacco disturbing the metabolic balance of intervertebral discs, coughing causing marked elevations of intra-disc pressures, or a possible fibrinolytic effect of tobacco, have been proposed. An analysis of eight studies of smoking and sciatica revealed a positive correlation in only four of eight studies in men and one of five studies in women. Although there was a weak association between smoking and sciatica, these studies were cross-sectional and it was impossible to say that smoking preceded the sciatica.39

CAUSES OF SCIATICA:

Disc herniation or degree of nerve root impingement

Impingement of the intervertebral disc on lumbar nerve

Roots Malignancy causing compression along the extra-spinal course of the sciatic nerve was noted in 32 cases of sciatica, which was constant, progressive, and

unresponsive to bed rest.

Eighteen of the cases were due to malignant tumours (six, metastatic; five, primary bone sarcoma; and seven, soft tissue sarcoma).

Two were tumours of the sciatic nerve itself.

Other rare malignant causes of sciatica include haemangioblastoma on a sacral root50 and lung adenocarcinoma metastasis in the pelvis

REFERENCE:

1)Hermier M, Cotton F, Saint-Pierre G, et al. Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma. Neuroradiology 2002; 44: 494–8

2)Thomas E, Abiad L, Cyteval C, et al. Metastatic pudendal nerve compression presenting as atypical sciatica. J Spinal Disord Tech 2002; 15: 324–5

A 10 yr observational study of 280 patients, hospitalized with sciatica and confirmed disc herniation, showed that most patients with sciatica could recall an episode of low back pain in their 20s, usually provoked by trauma.

Radicular symptoms usually appeared approximately 10 yr later, after an episode of low back pain lasting days

to weeks, usually without a definite precipitating factor. This led to a peak onset of sciatica occurring around the age of 40.112

REFERENCE: Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine 1983; 8: 131–40 113

Conclusion

Sciatica is a common condition that is a major cause of work absenteeism and a major financial burden to both

industry and health service provision. Although the intervertebral disc has been firmly implicated in the pathophysiology of this condition, the exact nature of the relationship to disc, nerve, and pain is not yet certain.

Current evidence suggests that the nucleus pulposus provokes a strong inflammatory response in sciatic nerve

roots and this is a likely source of pain. Evidence also exists which suggests that inflammation, abnormal

immune factors, and mechanical deformation of the nerve is required to produce pain, and this seems a likely combination. However, herniation of the nucleus pulposus is not the only cause of sciatica and other causes should not be forgotten. Fortunately, most cases of sciatica are self-limiting and pain tends to resolve within a matter of months. However, some cases progress to become chronic,and unfortunately, these can be difficult to treat.

Reference: Sciatica: a review of history, epidemiology, pathogenesis, and the

role of epidural steroid injection in management British Journal of Anaesthesia 99 (4): 461–73 (2007)

The physical demands of the work tasks were defined as follows: general physical strenuousness of work involved tasks

such as lifting or carrying heavy objects, excavating, digging, and pushing. Handling of heavy objects meant lifting, manually

carrying or pushing objects heavier than 20 kg on average at least 10 times per work day.

DEFINITION OF SCIATICA

Definition of sciatica:
Pain along the sciatic nerve usually caused by a herniated disk of the lumbar region of the spine and radiating to the buttocks and to the back of the thigh. (the free dictionary)
Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or compression of the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own. (medline plus)
Sciatic neuralgia is defined as ‘pain in the distribution of the sciatic nerve due to pathology of the nerve itself’.72 Radicular pain is defined as ‘pain perceived as arising in a limb or the trunk caused by ectopic activation of nociceptive afferent fibres in a spinal nerve or its roots or other neuropathic mechanisms’.72 According to these definitions, sciatic neuralgia is clearly a form of radicular pain, and is described as a disease of the peripheral nervous system.72

The use of the term sciatica, however, should only be in the context of the above definitions and as such, be distinguished from any or all other forms of pain felt in the leg, particularly referred pain.

According to Dorland's Medical Dictionary: Sciatica = neuralgia along the course of the sciatic nerve, most often with pain radiating into the buttock and lower limb, most commonly due to herniation of a lumbar disk (L5/S1 component)

Musculoskeletal history taking & Physical examination

Musculoskeletal history taking

— In addition to normal history taking, you will need to add for musculoskeletal disease risk factors and a system review.

— Risk factors:

- Occupation and sport

- Family history

- Infection

- Medication

- Overseas travel

- Past history of musculoskeletal injury or condition

Systemic review

— Assess pain use WWQQAA plus B

— Where – the location and radiation of a symptom

— When – when it began, fluctuation over time, duration

— Quality – what it feels like

— Quantity – intensity, degree of disability

— Aggravating and alleviating factors – what makes it worse, what makes it better

— Associated symptoms

— Beliefs – fractures, ligaments torn or sprains

Physical Examination

1.Look/Observe:

Swelling

Wasting of muscle

Erythema

Asymmetry

Traumatic bruises

Scar

2.Feel:

- Temperature

- Tenderness

- Synovitis

- Effusion

- Bony swelling (hard and immobile)

3.Move:

- Active

- Passive

- Stability(stress the joint in abnormal direction)

- Crepitus(feel or hear)

4.Measure:

- Range of motion (use goniometer, tape measure or ruler)

5.Special test:

- Straight leg raising

- Crossed straight leg raising

- Femoral stretch

- Trendelenburg test

- Apprehension test

- McMurray’s test

Herniated disc and Spinal stenosis

— Observe : Posture, gait

— Palpate : Spinous process and interspinous ligaments

— Move : Extension, Flexion, Lateral flexion, Rotation

— Special test:

1. Trendelenburg test

2. The straight-leg raising test

3. Crossed straight-leg raising test

4. Femoral stretch test

Piriformis syndrome

— Look : gait, posture

— Palpate: the piriformis muscle

— Internal rotation of the ipsilateral hip

— Move : Flexion, Rotation(internal & external), Abduction, Adduction, Extension

— Test :

1. Lasegue test

2. The beatty test