Definition

The term sciatica describes a symptom rather than a specific disease. Some use it to mean any pain starting in the lower back and going down the leg. Others use the term more specifically to mean a nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. Pain typically occurs in the distribution of dermatome and goes below the knee to the foot. It may be associated with neurological dysfunction, such as weakness. The pain is characteristically of shooting type, quickly traveling along the course of the nerve.

As per Ayurveda, gridhrasi (sciatica) is explained as one among 80 types of Vata imbalance disorders (neurological / neuro-muscular disorder). The word ‘Gridhrasi’ is derived from the root word – ‘Gridhra’. Which means the bird ‘vulture’. It is observed that in this disease, the patient’s gait is altered as his legs become tense, and slightly curved due to pain. Ultimately, the patients walk similar to the walk of the vulture (gridhra). Hence the name Gridhrasi. According to another saying, sciatica is characterized by severe pain experienced by the patient and it is similar to the pain one experienced by the prey of vulture, while being eaten up.

Epidemiology

Depending on how it is defined, 2% to 40% of people have sciatica at some point in time. It is most common during peoples 40s and 50s and men are more frequently affected than women. The condition where back pain and radiating pain of the legs are found together it is called Sciatica syndrome. In older times, as per Ayurveda system of medicine, it was named as Gridhrasi.
 
Causes

1. About 90% of the time sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots.
2. The straight-leg-raising test is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. In most cases medical imaging is not needed.
3. Sciatica is generally caused by the compression of lumbar nerves L4, or L5 or sacral nerves S1, S2, or S3, or by compression of the sciatic nerve itself. Sciatica is typically caused by irritation of the sciatic nerve.
4. Spinal disc herniation.
5. Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the primary cause of sciatica, being present in about 90% of cases.
6. Spinal stenosis.
7. Piriformis syndrome.
8. Pregnancy.
9. Spondylolisthesis: If a vertebra slips forward over the vertebra below it, it’s called spondylolisthesis. This slip can pinch the nerve root and cause sciatica.
10. Trauma

Cardinal features:

Radiating pain in the affected leg/legs is the typical characteristic feature of this illness. Due to this, the patient walks with the gait of the bird, vulture.
 
Diagnosis

Straight Leg test sometimes used to help diagnose a lumbar herniated disc.

Imaging tests such as computerised tomography or magnetic resonance imagingcan help with the diagnosis of lumbar disc herniation.The utility of MR neurography in the diagnoses of piriformis syndrome is controversial.

Management

When the cause of sciatica is lumbar disc herniation, most cases resolve spontaneously over weeks to months. Initially treatment in the first 6–8 weeks should be conservative. There does not appear to be a significant difference in outcomes between advice to stay active and recommendations of bed rest. Similarly, physical therapy (exercises) has not been found better than bed rest.

Medication

Although medicines are commonly prescribed for the treatment of sciatica, evidence for analgesics is poor. Specifically, low-quality evidence indicates that NSAIDs do not appear to improve immediate pain and all NSAIDs appear about equivalent. Evidence is also lacking in use of opioids and muscle relaxants. In those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and or function. There is little evidence for steroids, either epidural or by pill. Low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica.

Ayurvedic view

Etiological factors:

All etiological factors of Vata imbalance disorders are the exclusive reasons of sciatica too.
 
Common causes for sciatica

•  Intake of Vata aggravating eatables like- adhaki (pigeon pea), chanaka (Bengal gram), kalaya (peanut), masura (red lentil), nishpava (flat bean), uddalaka etc
•  Excess intake of dry, light and cold food
• Excess intake of pungent, bitter and astringent food
• Heavy weight lifting, long walk, improper lie or sitting positions
• Suppression of urine, feces etc
• Improper practice of enema, purgation etc
•  Fall or injury etc.

Symptoms of Sciatica

Pain starting from hip area and radiating to the thigh, back, sacral region, popliteal area, calf muscles and foot.
Pricking sensation in those parts
Altered gait
Rarely stiffness or pulsation etc. are mainly found.

Types:

Sciatica (gridhrasi) is two type

1. Vataja Gridhrasi
2. Vata-kaphaja Gridhrasi

Vata sciatica

Curved posture (altered gait) due to pain . severe stiffness, pulsation in back, hip, thigh, knee and foreleg.

Vata-kaphaja sciatica

Along with the above features, indigestion, drowsiness, nausea, anorexia, heaviness of the leg and freezing sensation in the lower limbs are complained.
 
Line of treatment

Snehana -
Swedana - tub bath, pizichil, sudation with oil added medicated herbal pastes (patrapinda sweda), application of poultice (upanaha sweda) etc. are beneficial.
Mridu samshodhana– mild purgation (Mridu Virechana) is preferred.
Basti (medicated enema)
Shiravyadha/ Rakta-mokshana ( blood letting) – It is advised to perform 4 angula (3inch) above or below the knee joint.
Agni karma (cautery)-  is carried in the severe painful area or near the little toe of the leg, using a metallic rod.

Herbs useful in gridhrasi :

1. Nirgundi – Vitex negundo
2. Bala – Sida cordifolia
3. Punarnava – Boerhavia diffusa
4. Eranda – Castor root – Ricinus communis
5. Shigru – Moringa oleifera
6. Rasna –  Pluchea lanceolata
7. Masha – Black gram

Formulations useful in Gridhrasi (Sciatica)

1. Yogaraja guggulu                                                
2. Kaishora guggulu                               
3. Vishtinduk vati                 
4. Sahacharadi kashaya                                            
5. Punarnavashtaka kashaya                                       
6. Ekangaveera Rasa 
7. Dasmoola Kwatha
8. Ashwagandha Churna
9. Triyodashanga Guggulu
10. Rasnaerandadi kashaya
11. Rasnasaptaka kashaya etc

Panchkarma procedures
1- Matra Basti
2- Agni karma
3- Snehana Swedana
4- Vaman
5- Rakatmokchana
6- Basti karma
7- Kati Basti

Wholesome diet and habits in Sciatica

Masha (black gram)
Kulath (horse gram)
Godhuma (wheat)
Raktashali (red rice)
Amlaphala (sour fruits)
Dadima (pome granate)
Draksha (raisins)
Shigru (drum stick)
Patola (snake gourd)
Kshira (milk)
Ghrita (ghee)
Mamsarasa (meat soup)
Dhanyamla (sour gruel) 
Eranda taila (castor oil)
Tila taila (sesame oil)
Avagaha (tub bath)
Abhyanga (oil massage)
Ushnodakasweda (warm water bath) etc

Unwholesome diet and habits in Sciatica:

Kalaya –  peanut (Lathyrus sativus Linn.)
Chanaka  – Bengal gram (Cicer arietinum Linn)
Rajamasha (Raj maa)
Vegadharana (suppression of urges)
Vyavaya (sexual indulgence)
Vyayama (heavy exercise)
Diva swapna (day sleep)
Prajagarana (sleepless nights)