A BRIEF STUDY ON EFFICACY OF

HOMOEOPATHIC DRUGS IN TREATING

SCIATICA

By
Dr. GEETA H.

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment
of the requirements for the degree of

DOCTOR OF MEDICINE
IN HOMOEOPATHY
IN
HOMOEOPATHIC MATERIA MEDICA

Under the guidance of

Dr. S. S. JAMBALADINNI
M. D (Hom)

DEPARTMENT OF HOMOEOPATHIC MATERIA MEDICA

H.K.E. SOCIETY’S HOMOEOPATHIC MEDICAL COLLEGE
AND HOSPITAL, GULBARGA - 585105
KARNATAKA 2009-10
DR. SAMUEL HAHNEMANN
[1755 – 1843]
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled A BRIEF

STUDY ON EFFICACY OF HOMOEOPATHIC DRUGS IN TREATING
SCIATICA” is a bonafide and genuine research work carried out by me
under the guidance of Dr.S.S.JAMBALADINNI, Professor Department
of Materia Medica H.K.E’s Homoeopathic Medical College and Hospital
Gulbarga.

Date:
Place: Gulbarga Dr. Geeta H.
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A BRIEF STUDYON

EFFICACY OF HOMOEOPATHIC DRUGS IN TREATING

SCIATICA” is a bonafide research work done by Dr. GEETA H. in

partial fulfillment of the requirement for the degree of Doctor of

Medicine in Homoeopathy (Materia Medica).

Date:
Place: Gulbarga
Dr. S. S. JAMBALADINNI
M.D (Materia Medica)
Professor
Department of Materia Medica
H.K.E.’s Homoeopathic College
Gulbarga
 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

ENDORSEMENT BY THE HOD, PRINCIPAL/

HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A BRIEF STUDY ON

EFFICACY OF HOMOEOPATHIC DRUGS IN TREATING

SCIATICA” is a bonafide research work done by Dr. Geeta H. under the

guidance of Dr. S. S. Jambaladinni, Professor, Department of Materia

Medica H.K.E’s Homoeopathic Medical College, Gulbarga.

Dr.Rajeshwari.K Dr.P.Sampath Rao

M.D M.D
Professor & HOD Principal & HOD
Dept. of Materia Medica Dept. of Organon & Philosophy
H.K.E’s Homoeopathic Medical H.K.E’s Homoeopathic Medical
College, Gulbarga College, Gulbarga

Date: Date:
Place: Place:
 COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use

and disseminate this dissertation/ thesis in print or

electronic format for academic/ research purpose.

Date:
Place: Gulbarga Dr. Geeta H.

© Rajiv Gandhi University of Health Sciences, Karnataka

 ACKNOLWEDGEMENTS

If my mind can conceive it & my heart can believe it

I know I can achieve it

No endeavour can start, continue. I believe without him nothing would have

been possible.

To me, this acknowledgement present not only a ceremonial, but a real

opportunity to voice my gratitude for all those who have lent and complete without the

blessings of almighty god. And I thank him for always being by my side a helping

hand to make this work come to completion.

It is with supreme sincerity and deep sense of appreciation that I thank my

esteemed teacher and guide Dr. S. S. Jambaladinni, M.D. (Hom) Professor,

Department of Homoeopathic materia medica. A mere of word thanks is not sufficient

to express his unflinching support. Keen surveillance, inestimable aid and continued

inspiration during the preparation of this work. He has always given me excellent

guidance, encouragement and friendly help during the course of my entire post

graduation.

It is privilege to express my deep felt gratitude and thanks to our Principal

Dr.P.Sampth Rao, MD (HOM) Professor and H.O.D. Department of Organon of

medicine and Homoeopathic Philosophy.

It is with glorious veneration and intense gratitude, that I would like to thank

Dr. (Mrs) Rajeshwari Kinagi, M.D (Hom) Prof. and H.O.D. Depart of material

medica.
 Heartfelt thanks to our P. G. Co-ordinator Dr. Ashok Patil, M.D. (HOM)

Prof.

I heartfull thank Dr.Vijayalaxmi B. M. MD for their valuable help and support.

I express wholeheartedly great gratitude to my inlaws and parents with whose love,

support and constant encouragement for higher goals, my life has become

worthwhile, always been guide to me and his timely advise and guidance helped me to

take up M.D. Homoeopathy, analysis of situation is very important for Homoeopath,

the credit to develop such quality in my mind goes to none other than my husband

Krishna Kalaskar, her encouragement in all my works.

I will be failing in my duty if I fail to thank my mother for love, affection,

encouragement and constant support beyond my capacity throughout my studies since

my childhood.

My heartfull thanks to RGUHS for the consideration to sanction the MD

external program in Homoeopathy which has helped teaching staff achieve their goal

in completing a PG study which otherwise would remained a dream for the employed

staff.

My sincere thanks to librarians Mr. Deshmukh and Mr. Veeranna.

Last but not least, I thank to my patients and well wishers without whose

support this work could not have been completed.

Dr. Geeta H.
 ABBREVIATIONS USED

CT - Computed Tomography
C - Cured
F - Female
FA - Father
GF - Grand Father
GM - Grand Mother
H/o - History of
I - Improved
M - Male
MO - Mother
NI - No Improvement
NS - Nothing Significant
PP - Page No / Nos
R - Recovered
SLRT - Straight Leg Raising Test
HTN - Hypertension
DM - Diabetes Mellitus
TB - Pulmonary Tuberculosis
 ABSTRACT

BACKGROUND AND OBJECTIVES:

The secrets of good health include a good posture, efficient breathing and

pain-free mobility of joints. Backache is one of the most common ailments prevalent

today. Most of us suffer from it at some time during our lifetime. Backache is “a

given” in today’s stress-driven life. It is now generally accepted that between 60%

and 80% of the general population will suffer from low backpain someday, and that

between 20% and 30% are suffering from it any given time. Backpain is now an

international health issue of major significance. Sciatica is one commonest cause of

backache.

OBJECTIVES:

1. To know which are the drugs having more affinity towards sciatic nerve.

2. To know the group of drugs towards curative effect according to individual case.

3. To know the efficacy of the Homoeopathic drugs in treating sciatica

METHODS:

The present study consisted of 30 patients of sciatica who attended O.P.D. of

H.K.E.’s Homoeopathic Medical College and Hospital and village camps on the basis

of inclusion and exclusion criteria fixed. Case taking was done according to the

scheme of model case paper with a special emphasis on points needed for

Homoeopathic treatment. Selection of remedy was done on the basis of reportorial

result, characteristic symptoms and miasmatic diagnosis of the patient. Follow-up

criteria and parameters for evaluating the result for study were formulated.
INTERPRETATION AND CONCLUSION:

I arrive at the conclusion that Homoeopathic management of sciatica along

with the auxilary treatment show remarkable resulting most of the cases taken for my

study.

After prescribing indicated remedy patient started improving mentally and

physically as the indicated remedy corrected the patients constitution.

Proper auxilary treatment, were found effective in bringing significant

improvement in the patient.

The homoeopathic medicine seems to be efficacious in the treatment of

sciatica as it aims at the constitution of the patient which predisposes to sciatica

Predominance of Psora miasm was seen in most of the cases.

 TABLE OF CONTENTS

Sl. Page
TOPIC
No. No.

1. INTRODUCTION 1

2. OBJECTIVES 5

3. REVIEW OF LITERATURE 6

4. METHODOLOGY 100

5. RESULTS 108

6. DISCUSSIONS 109

7. CONCLUSION 114

8. SUMMARY 116

9. BIBLIOGRAPHY 118

10. ANNEXURES

11. ANNEXURE – I (Case Proforma) 121

12. ANNEXURE - II (Synopsis Of Cases) 131

13 ANNEXURE – III (Tables And Graphs) 144

14 ANNEXURE – IV (Master Chart) 162

 LIST OF TABLES

Sl.
Title Page No.
No.

1. AGE INCIDENCE 144

2. SEX INCIDENCE 146

3. PAST HISTORY 148

4. FAMILY HISTORY 150

5. INCIDENCE OF CONSTITUTIONAL 152

REMEDIES

6. INCIDENCE OF ACUTE REMEDIES 154

7. INCIDENCE OF INTERCURRENT REMEDIES 156

8. INCIDENCE OF AUXILARY MEASURES 158

9. RESULTS 160
 LIST OF FIGURES

Sl. Page
Figure
No. No.
1. Human Nervous System 22

2. Formation of Sacral Plexus 27

3. Anatomy of sciatic nerve 32

4. Sciatic Nerve And Its Branches 33

5. Diagram Showing Sciatica Pain And Its Radiation 50

6. Age Incidence 145

7. Sex Incidence 147

8. Past History 149

9. Family History 151

10. Constitutional Remedies 153

11. Intercurrent Remedies 157

12. Auxillary Treatment 159

13. Analysis results 161

 INTRODUCTION:

Since the beginning of life on earth human race has been afflicted by disease

in one form or other. The collective aim of medical profession throughout the ages

has been to fight disease with a view to relieving human suffering

While there are many diseases there is, in a sense, only one health.

The secrets of good health include a good posture, efficient breathing and

pain-free life. Backache is one of the most common ailments prevalent today. Most of

us suffer from it at sometime during our lifetime. Backache is “a given” in today’s

stress-driven life.

Backache is often a sign of poor posture, poor muscle tone largely poor self

respect. It has been estimated that over 3 quarters of the world’s population

experiences back pain at some time in their lives. More than 90% of these are

mechanical & resolve spontaneously within 1-2 weeks time.

Back pain is now an international health issue of major significance. The low

back is truly the foundation of our structure. While there are many general guidelines

for low back pain & proper maintenance, the truth is that our spine is like a

fingerprint- very unique & one of a kind. when we include genetic make-up, trauma’s,

habit’s (good & bad), footwear, lifestyle, job, quality of mattress, weight, diet etc.

We generally use “sciatica” to describe pain that radiates along the path of this

nerve from back to buttock & leg. The discomfort can be minimal or disabling may be

accompanied by tingling, numbness or obvious muscle weakness.

 Sciatica is not adisease in itself but a symptom of the sciatic nerve.

Sedentary life often complicates life one among them is sciatica. Sciatica is

commonly mis-spelled no for leg pain, but actually sciatica refers for the neuralgic

pain extending down the leg arising from the irritation, compression (pinched as one

may call in layman’s language) & inflammation of the sciatic nerve along its course.

Its intolerable intensity & recurrent nature make every sufferer most worried unless

one has suffered & conquered sciatica, they can not realize its frightening, lightening

pain.

Sciatic pain can make life miserable, walking, standing, bending over , driving

a car , working at a computer , catching up on household chores, sneezing or coughing

& many other activities of dailyliving can cause sudden & intense pain. Patients who

suffer sciatica, especially of a more acute nature, find the symptoms disrupt many

aspects of their life.

Sciatic pain generally improves within 4-6 weeks. Weakness and numbness

may take longer to resolve. Symptomatic treatment such as cold packs, anti-

inflammatory medications and physical therapy may help ease discomfort and

promote return to normal activities.

Pains are bane of human life,or looking at it in another way, we could say

pains are the saviours of human life; as pain is the only indicator of the inner milieu of

the body. It is an indicator that something wrong is going on within the system and

that remedial action needs to be taken.

 Pain is also bane of homoeopathy and saviours of allopathy. Allopathy can

give instant, albeit short lived relief from pain and this wins them an everlasting

following of patient. Here instant pain relief is used as a decoder. Inspite of relief

from pain the disease is progressing unaffected.

Unlike other schools, we don’t aim to cure a particular disease but we on more

towards the holistic approach of subjects i,e we consider the general symptoms

pertaining to mind. And also to the body i,e physical generals and derive a totality of

the individual.

Homoeopathy treats the whole person by addressing all aspects of individual

i.e. his physical constitution, mental & emotional make up influence of weather on his

health, past medical history, family medical history, desires & aversions for food,

appetite, thirst, bowel movement, sleeping pattern etc. homoeopathy recognizes that

symptoms of ill health are expression of imbalance in the whole person. It treats all

symptoms as one. A constitutional remedy removes an inherited tendency for

diseases. Homoeopathy has significant role not only in treating, but also in preventing

diseases.

We don’t claim the total cure by just giving the painkillers & steroids, we

homoeopaths claim the total cure because we believe in removing the disease from

the root. This is ascertained by clearing the obstacles, proper assessing of disease,

giving anti miasmatic remedy & thus processing towards the total cure.

The prevalence of sciatica is 1- 10% of the population. There is equal male-

female distribution. The 25-45 years age group is most commonly affected. Repeated
episodes of minor trauma, poor posture adopted at work obesity are contributory

factors in development of sciatica.

Homoeopathy can provide miraculous relief from this nervous pain without

any side effects by controlling the inflammation & infection of the nerves.

“The art of medicine consists in amusing the patient while, nature cure the

disease” said a physician by name Voltaire. So does homoeopathy which is based on

natures law of cure.

Hence the topic

“IT IS AN ATTEMPT TO STUDY TO KNOW THE EFFICACY OF

HOMOEOPATHIC DRUGS IN TREATING SCIATICA”.

 OBJECTIVES

1. To know which are the drugs having more affinity towards sciatic nerve.

2. To know the group of drugs towards curative effect according to individual case.

3. To know the efficacy of the homoeopathic drugs in treating sciatica.

 REVIEW OF LITERATURE

DEFINATION

Sciatica is the term for pain that radiates along the sciatic nerve, anywhere

from the lower back, buttocks, down the back of the leg, to the foot.

There may be weakness, numbness, tingling, in leg and/or foot.

Sciatica is not a disease in itself but a symptom of sciatic nerve.

The term sciatica dates back to 1398 A.D. appearing to originate from Latin

word ‘ischiadus’ meaning ‘of pain in the hip’ and from the Greek word

‘iskhiadiakos” meaning “pain in the hips”.

Historical Review

Humans have been plagued by back and leg pain since the beginning of

recorded history. Primitive cultures attributed such pain to the work of demons.

Though backache & sciatica have been symptoms recorded for centuries, their

common pathology & relationship have been recognized comparatively recently. The

facts related to them were known in isolation, due to the work of various

investigators, but it was left to Mixter & Barr in 1934, to correlate them & put them in

a comprehensive form.

Primitive Period

Considering the contemporary prevalence of sciatica, it is not unreasonable to

suppose that in earlier centuries this affliction also claimed its share of victims.

Unfortunately, in the most primitive circumstances therapeutic intervention was

seldom directed by anyone more competent than the local witch doctor. It is highly

unlikely that such a person had access to written language and, thus, we do not know

the general views of witch doctors on sciatica. Nevertheless, Sigerist,[16] has observed

that the sudden sharp nature of the sciatica attack struck primitive people as an evil

display of demon magic, such as the witch's shot (Hexenschuß) of the Germans or

the elf's arrow of the early British. Such demons could be defeated by a number of

rather stressful interventions, which, even if they were not physiologically justified,

did exert an important placebo effect. In some localities, such views have persisted

into our own century. Among Egyptians in very rural regions, for instance, the belief

that junin (devils) cause sciatica remains widespread.

Ancient Greece

Standing a step above such folk medicine, the more advanced scholars of

ancient Greece considered sickness a naturally occurring physical imbalance that was

identifiable by close observation and curable by rational treatment. Knowledgeable

commentators who compared the body with empirical observations and philosophical

concepts of reality systemized, if imperfectly, the broad dimensions of health and

disease. In such circles, some knowledge of medicine was believed to be an

obligatory portion of every scholar's intellectual life. In the face of this intellectual

leverage, by the fifth century BC sciatica was a widely recognized, if poorly

delineated, disease. Although there was at least one restrictive clinical description that

corresponded to the contemporary definition of sciatica, any complaint referable to

the general area of the hip was considered to be sciatica at that time.

Understandably, this overbroad definition confused the origin of the

syndrome; however, based on observed associations, several suspected causes of the

affliction were enumerated in the Hippocratic writings. Hippocrates believed that the

disorder was more prevalent during the summer and autumn months.

The increased incidence of sciatica during these seasons was probably related

to the more vigorous physical activity associated with farming and athletic training.

The Hippocratic writings, however, indicate that the increased seasonal powers of the

sun might "dry up" joint fluid and, thus, produce symptoms.

Alternatively, Hippocrates observed that the affliction was more common

among the upper classes and, especially, among those who could afford the luxury of

frequent horseback riding. He believed such excesses produced a "sexually very

weak" population that was much afflicted by a "swelling time of the joints, sciatica,

and gout." As a group done in by too much horseback riding, Hippocrates pointed to

the barbarous, saddlebound Scythians. These marauders, he believed, were effectively

sterilized by outdoor indulgence. The association of sterility and spinal disease can

only be appreciated by recognizing two essential Hippocratic beliefs. 1) The spinal

cord, considered to have a divine origin in ancient Greek medicine, communicates

with the kidneys and the genital organs of the male through the veins. 2) Sperm is

actually produced in the spinal cord

Roman Empire

As the Roman state expanded into other territories, wielding decisive military

and political power, the earlier Greek medical heritage became a prize for the

emerging Roman intellectual establishment. Encouraged by the ease at which they

could obtain Roman citizenship, Greek physicians were commonly found in imperial

domains and freely transmitted their opinions on sciatica. Indeed, although they
vociferously disapproved of Greek physicians, their natural intellectual competitors,

both Pliny and Cato made free reference to sciatica in their writings.

Like the Greeks, the Romans continued to confuse sciatica with diverse

pathological processes such as gout, osseous tuberculosis, dislocation of the hip, and

poliomyelitis. Nevertheless, the escalating clinical skills of the Romans did provide a

considerable insight into the manifestations and treatment of the disease.

In the fourth century after the birth of Christ, Caelius Aurelianus, repeating

many earlier observations made by Soranus, reported that sciatica commonly occurred

among all age groups, but its prevalence was highest among middle-aged persons.

The affliction he described was characterized by a strong, severe pain emanating from

the lower back and radiating into the buttocks, perineum, and even the popliteal fossa,

calf, foot, and toes. The pain was accompanied by a severe low-back spasm, sensory

disturbances, and in chronic cases, muscle wasting of the affected lower extremity.

Caelius Aurelianus observed that constipation and claudication appeared with such

complaints. He reported that such difficulties caused sciatica sufferers to alter their

posture during the act of defecation. Among one group he observed that such straining

provoked pain in the toes, whereas in another he noted a "woodenness," a crooked

posture, and the inability to bend forward. Confusing sciatica with osseous

tuberculosis, he stated that, at the height of the disease, a "humor" collected that

"corrupted" into pus and produced a multitude of abscesses, an association that

indicates a high incidence of tuberculosis in ancient times.

 Based on associations that he had observed, Caelius Aurelianus offered

numerous explanations of origin for the syndrome. A sudden jerk or movement during

exercise, unaccustomed digging in the ground, lifting a heavy object from a low place,

lying on the ground, a sudden shock, a fall, or continuous and immoderate sexual

intercourse could all produce the affliction. More remotely, he believed that

termination of hemorrhoidal bleeding, especially in a sexually active man, could

provoke an attack of sciatica.

Caelius Aurelianus also believed that a sciatica attack could be caused by a

"deep-seated congelation"—a view that somewhat mirrored an opinion stated in the

first century by Aretaeus of Cappadocia. Aretaeus had asserted that, although

squeezing or cutting off nerves was painless, intrinsic maladies of nervous tissue, such

as sciatica, could cause the most intense form of pain. It is important to note,

however, that for the early Romans the term "nerves" referred not only to nerves but

also to tendons and ligaments. Since the Hippocratic era, early Greek and Roman

physicians were unable to separate tendons from ligaments and nerves. All these

anatomical structures were thought to be parts of the muscular system and were often

collected under the term "nerves." Thus the assertions of Aretaeus were really directed

to "ligaments of the joint" and not to nerves.

Therapy for the affliction was varied. Reflecting the devotion to polypharmacy

common in ancient times, Octavia, the sister of Augustus and first wife of Mark

Antony, treated sciatica with a mixture of "sweet ma[r]joram, rosemary leaf, wine and

olive oil;" this concoction was combined with wax and stored in an earthen jar for

future use as a plaster. Caelius Aurelianus treated the syndrome with bed rest,
massage, heat, and passive range-of-motion exercises. For more difficult cases, he

recommended leeches, hot coals, skin hooks, and blood letting.

The East
Not long after the death of Caelius Aurelianus, the barbarian invasions of the

fifth and sixth centuries extinguished the erudition that had been prevalent in the

West. Fortunately, the Greco–Roman tradition of medical knowledge persisted in

the Byzantine Empire. Writing in the seventh century, Paul of Aegina repeatedly

confused sciatica with gout. He believed that symptoms of sciatica were caused by a

thick humor that disturbed the articulations of the hip joint. Sciatic pain extended

from regions "about the buttock and groin to the knee, often as far as the extremities

of the foot." Paul advised a trial of conservative therapy, but cautioned that, if the trial

were unsuccessful, the disease might terminate in suppuration or a relaxation of the

supporting ligaments and thigh dislocation. To avoid such complications, Paul

advocated burning the joint in "three or four places in chronic cases."

Coexisting with the Greco–Roman system of medicine, ancient Hebrew

medicine displayed some familiarity with both sciatica and the sciatic nerve. Jacob,

for instance, may have lost his well-known wrestling match (Genesis 32:25–32)

because of an injury to his sciatic nerve. Indeed, out of deference to Jacob's injury,

sciatic nerves of animals were declared unsuitable for human consumption.

Amplifying this point, the Talmud provides specific instructions for the removal of

the sciatic nerve from the flesh of slaughtered animals. In the Talmud sciatica is

identified as schigroma and it is suggested that fresh brine be rubbed in painful areas

60 times as a treatment.
 Geographically close to the Hebrews and also aware of the Greco–Roman

tradition of medicine, the ancient Arabs shared an awareness of sciatica. Indeed the

Arabic word for the sciatic nerve, irk ol-nasha, is quite close to the Hebrew, gid-ha-

nasks. Although he was constrained by a traditional Islamic reluctance toward the

invasive treatment of fellow believers, Serapion Senior, whose writings appeared in

the second half of the ninth century, used a hot cautery to treat sciatica. His

contemporary, Razes in Baghdad, claimed to have successfully treated 1000 cases of

sciatica, mostly by bleeding one of the lower extremities, a process for which he

developed four separate and rather elaborate methods. Avicenna, writing

approximately 150 years later, was less physically aggressive and recommended

meixaragl (picrotoxin) for the treatment of sciatica.

Somewhat outside this tradition, ancient Indian medicine underwent a largely

independent development. The concept of marmas was central to Indian medicine.

These are discrete areas of the body in which muscles, vessels, ligaments, bones, and

joints allegedly all join one another. Although clear descriptions of sciatica are

infrequent among early Indian texts, if the kakundram marma (located approximately

in the lumbosacral area) was injured, an early Indian physician would expect loss of

sensation and paralysis in one of the lower extremities.

The term sciatica dates back to 1398 A.D. appearing to originate from Latin

word ‘ischiadus’ meaning ‘of pain in the hip’ and from the Greek word

‘iskhiadiakos” meaning “pain in the hips”.

The early Greeks recognized the symptoms as a disease and prescribed rest

and massage for the ailment.

 The Edwin Smith papyrus,the oldest surgical text dating to 1500 B.C.,includes

a case of back strain.unfortunately,the text doesnot include treatment rendered by the

ancients Egyptians.

In the 5th century A.D.,Aurelianus clearly described the symptoms of

sciatica.He noted that sciatica arose from either hidden causes of observable causes

such as a fall ,a violent blow,pulling or straining.

In 1555 Andreas Vesalius, described the diseases in his treatise “ Dehumani

Corporis Fabrica”

In 1854 Virchow found & described traumatic herniation of fibrocartilage of

the disc during an autopsy & it came to be known after him as a tumor.

In the 18th century Cotugnio[cotunnius] attributed the pain to the sciatic

nerve.Several physical maneuvers were devised to isolate the true problem in each

patient.The most notable of these is the Lasegue sign or SLR test ,described by Forst

in 1881but attributed to Lasegue, his teacher.This test was devised to distinguish hip

disease from sciatica.Although sciatica was wide spread as an ailment ,little was

known about it because only rarely did it result in death allowing examination at

autopsy.

In 1867, Lasegue first tried to associate sciatica with backache, describing the

posture & gait in sciatica & he also devised the “sciatic nerve stretch test” now

eponymous. In 1858, Von Luschka gave more detailed description of the disc.

In 1888, Charcot described the spinal deformity associated with sciatica , &

Brissot in 1890 , called it “sciatic scoliosis”. In 1896, Kocher described traumatic

rupture of the L1, L2 disc in the autopsy of a man who had fallen from a height of 100

feet on his feet.

In 1911, Goldthwait noticed a sudden devolpment of caudaequina lesion , in a

patient under treatment for lumbosacral strain . he investigated case & concluded that

it was due to subluxation of lumbosacral joint, that such subluxations were probably

due to congenital abnormalities & associated with posterior displacement of the disc.

In 1925, Viner published a small series of cases in whom sciatica was treated

by caudol extra dural injection of procaine followed 50 – 100 ml ringer solution .

In 1916, Sicard put forth his theory that sciatica was due to an interspinal

irritative lesion of its roots which he tremed “Neurodochitis”.

Mixter and Barr in their classic proper published in 1934 attributed sciatica to

lumbar disc herniation.

Mixter & Ayre also reported 30 cases to show that hernition of lumbar

intervertibral disc could produce unilateral sciatic symptoms.

Key in 1945 & Burns & Young in 1945 & 1947, pointed out that disc lesions

could produce low back pain without sciatica.

ANATOMY

The Central axis of human skeleton is formed by the vertebral column. At its

upper end through two modified vertebrae the atlas and axis it supports the skull. In

the thoracic region it articulates with the ribcage which in turn articulates with the

pectoral girdle and upper limbs finally through sacral vertebrae it articulates with the

pelvic girdle to which the lower limbs are attached to the column lend to its great

strength and ruggedness and also great flexibility, “The back bone is flexible because

it has so many joints so close together”. In its spinal canal is houses the spinal cord

and protects it to great extent from external violence.

The Vertebral Column

The vertebral column is the central bony pillar of the body it supports the

skull, pectoral girdle, upper limbs, and thoracic cage and, by way of the pelvic girdle,

transmits body weight to the lower limbs. Within its cavity lie the spinal cord.

COMPOSITION OF THE VERTEBRAL COLUMN

The vertebral column is composed of 33 vertebrae—7cervical, 5 lumbar, 5

sacral, and 4 coccygeal. Because it is segmented and made up of vertebrae, joints, and

pads of fibro cartilage called intervertebral discs, it is a flexible structure. The

intervertebral discs from about one-fourth the length of the column.

GENERAL CHARACTERISTICS OF A VERTEBRA

Although vertebrae show regional differences, they all possess a common

pattern.
 A typical vertebra consists of a rounded body anteriorly and a vertebral arch

posteriorly. These enclosed a space called the vertebral foramen, through which run

the spinal cord and its coverings. The vertebral arch consists of a pair of cylindrical

pedicles, which form the sides of the arch, and a pair of flattened laminae, which

complete the arch posteriorly.

The vertebral arch gives rise to seven process: one spinous, two transverse,

and four articular.

The spinous process, or spine, is directed posteriorly from the junction of the

two laminae. The transverse processes are directed laterally from the junction of the

laminae and the pedicles. Both the spinous and transverse processes serve as levers

and receive attachments of muscles and ligaments.

The articular processes are vertically arranged and consist of two superior and

two inferior processes. They arise from the junction of the laminae and the pedicles,

and their articular surfaces are covered with hyaline cartilage.

The two superior articular processes of one vertebral arch articulate with two

inferior articular processes of the arch above, forming two synovial joints.

The pedicles are notched on their upper and lower borders, forming the

superior and inferior vertebral notches, on each side. The superior notch of one

vertebra and the inferior notch an adjacent vertebra together form an intervertebral

foramen. These foramina in an articulated skeleton, serve to transmit the spinal nerves

and blood vessels. The anterior and posterior nerve roots of a spinal nerve unite

within these foramina with their coverings of dura to form segmental spinal nerves.
A typical lumbar vertebra has the following characteristics:

• The body is large and kidney shaped.

• The pedicles are strong and directed backwards.

• The laminae are thick

• The vertebral foramina are triangular.

• The transverse processes are long and slender.

• The spinous processes are short, flat, and quadrangular, and project

backward.

• The articular surfaces of the superior articular processes face medially,

and those of the inferior articular processes face laterally.

Joints between two vertebral bodies:

The upper and lower surfaces of the bodies of adjacent vertebrae are covered by

thin plates of hyaline cartilage. Sandwiched between the plates of hyaline

cartilage is an intervertebral disc of fibrocartilage. The collagen fibers of the

disc strongly unite the bodies of the two vertebrae.

Intervertebral Discs

The intervertebral discs are responsible for 1/4th of the length of the vertebral

column. They are thickest in the cervical and lumbar regions, where the

movements of the vertebral column are greatest. They may be regarded as

semielastic discs, which lie between the rigid bodies of adjacent vertebrae. Their

physical characteristics permit them to serve as shock absorbers when the load

on the vertebral column is suddenly increased, as when one is jumping from a

height. Their elasticity allows the rigid vertebrae to move one on the other.

Unfortunately, their resilience is gradually lost with advancing age.

 Each disc consists of a peripheral part, the annulus fibrosus, and a central

part, the nucleus pulposus.

The annulus fibrosus is composed of fibrocartilage, in which the collagen fibers

are arranged in concentric layers or sheets. The collagen bundles pass obliquely

between adjacent vertebral bodies and their inclination is reversed in alternate

sheets. The more peripheral fibers are strongly attached to the anterior and

posterior longitudinal ligaments of the vertebral column.

The nucleus pulposus in children and adolescents is an ovoid mass of

gelatinous material containing a large amount of water, a small amount of

collagen fibers, and a few cartilage cells. It is normally under pressure and

situated slightly nearer to the posterior than to the anterior margin of the disc.

The upper and lower surfaces of the bodies of adjacent vertebrae that abut onto

the disc are covered with thin plates of hyaline cartilage.

The semifluid nature of the nucleus pulposus allows it to change shape

and permits one vertebrae to rock forward or backward on another, as in flexion

and extension of the vertebral column.

A sudden increase in the compression load on the vertebral column causes

the semifluid nucleus pulposus to become flattened. The outward thrust of the

nucleus is accommodated by the resilience of the surrounding annulus fibrosus

and it ruptures, allowing the nucleus pulposus to herniate and protrude into the

vertebral canal, where it may press on the spinal nerve roots, the spinal nerve, or

even the spinal cord.

With advancing age the water content of the nucleus pulposus diminishes and is

replaced by fibrocartilage. The collagen fibers of the annulus degenerate and, as

a result, the annulus cannot always contain the nucleus pulposus under stress. In
old age the discs are thin and less elastic, and it is no longer possible to

distinguish the nucleus from the annulus.

No discs are found between the first two cervical vertebrae or in the

sacrum or coccyx.

Ligaments

The anterior and posterior longitudinal ligaments run as continuous bands down

the anterior and posterior surfaces of the vertebral column from the skull to the

sacrum. The anterior ligament is wide and is strongly attached to the front and

sides of the vertebral bodies and to the intervertebral discs. The posterior

ligament is weak and narrow and is attached to the posterior borders of the

discs. These ligaments hold the vertebrae firmly together but at the same time

permit a small amount of movement to take place between them.

Joints between two vertebral arches

The joints between vertebral arches consist of synovial joints between the

superior and inferior articular processes of adjacent vertebrae. The articular

facets are covered with hyaline cartilage, and the joints are surrounded by a

capsular ligament.

Ligaments

Supraspinous ligament: This runs between the tips of adjacent spines.

Interspinous ligament: This connects the adjacent spines.

Intertransverse ligaments: These run between adjacent transverse processes.

Ligamentum flavum: This connects the laminae of adjacent vertebrae.

Nerve supply of vertebral joints

The joints between the vertebral bodies are innervated by the small meningeal

branches of each spinal nerve. The nerve arises from the spinal nerve as it exits

from the intervertebral foramen. It then reenters the vertebral canal through

the intervertebral foramen and supplies the meninges, the ligaments, and the

intervertebral discs. The joints between the articular processes are innervated

by branches from the posterior rami of the spinal nerves. It should be noted that

the joints of any particular level receive nerve fibers from two adjacent spinal

nerves.

SPINAL CORD

The human nervous system is the most complex physical system known to

mankind: it consists of many billions of interactive cellular units shows constantly

changing patterns of activity are reflected in every aspect of human behavior and

experience.

The innerse complexity of organization of nervous systems is due to its vast

population of inter communicating cells. There are nerve cells or neurons, can encode

information conduct it and then transmit it to other neurons, or to various non newer

cells, besides neurons, there is also a great number of supporting cells (neuroglia) are

responsible for creating and maintaining an appropriate environment in which the

neurons can operate efficiently.

Neurons have a rounded central mass of cytoplasm enclosing the cells giving

off long, branched extensions collectively termed neuritis. In most instances, one of

these processes, the axon, is much longer, than of others, which are termed as

dendrites. Dendrites conduct electrical charges towards the soma, and axons conduct

away from if.

 The spinal cord a direct down word continuation of the medulla oblongata,

starts at the upper border of the atlas and ends at the lower border of the first lumbar

vertebra as the conus medullaris. Though cylindrical, it is slightly flattened in its

anteroposterior diameter. Corresponding to the large nerves supplying the upper and

the lower limbs. is a cervical enlargement from cervical 3 to thoracic 2 and a lumbar

enlargement from Thoracic 9 to 12. From the lowest end of the spinal cord-the conus

Medullaris-extends a delicate median prolongation, the filum terminale interna which

ends with the dural sac at the second sacral vertebra. Its extradural prolongation-filum

terminale externa-ends at the coccyx.

The Spinal cord is enveloped by the dura, the arachnoid and the pia

mater.External to the dura is the epidural space filled by a thin layer of fat, areolar

tissue and veins. The arachnoids and the subarachnoid spaces are filled with fluid

which cushion spinal cord. The pia mater intimately surrounding the spinal cord also

has lateral extensions to the inner dural surface. These are equally spaced between

nerve roots and are known as dentate ligaments.

The Spinal nerves emerge from the spinal cord in pairs; 8 in the cervical

region,12 in the thoracic region, 5 in the lumbar region, 5 in the sacral region, and 1

pair of coccygeal nerves, making a total of 31 pairs of spinal nerves. These also

correspond to varying segments of neuromeres of the spinal cord.

 Figure : 1

EXIT OF SPINAL NERVES

As the anterior root of the spinal cord emerges from the anterior and lateral

gray columns, it traverses the surrounding membranes of pia, arachnoid and dura. The

posterior root,which is attached to the posterlateral portion of the spinal cord,

orginates from two bundles of fibers the spinal ganglion. Both anterior and posterior

roots pierce the dura separately as they make their exit through their respective

intervertebral foramina. As a rule,the posterior root is thicker and larger than the

anterior root. They are enclosed in a common dural sheath just beyond the spinal

ganglion where they become the spinal nerve and are surrounded by epineurium.

The Spinal ganglia, which lie at the outer portion of the intervertebral

foramina, are oval shaped and vary in size corresponding to their nerve roots.

The spinal nerves lie horizontally in the cervical region, but below these

segments the spinal nerves assumes an increasingly oblique and downwara direction

as they approach the lumbar region where they are almost vertical, forming the caudal

equine. At the lower thoracic level there is a difference of two vertebral segments

between the origin of the spinal nerve and the level of exit.

From each sympathetic trunk ganglion, which lies on the posterolateral surface

of the vertebral body, a branch [gray ramus communicans] joins the adjacent spinal

nerve.
 Efferent, preganglionic sympathetic fibers [white ramus communicans] which

orginate in the lateral columns, pass along with the anterior root to the corresponding

sympathetic ganglion or along its trunk to sympathetic plexus.

Shortly after emerging from the intervertebral foramen, each spinal nerve

turns back through the same foramen to supply the spinal cord membranes, blood

vessels, intervertebral ligaments and joint surfaces.

The spinal nerve then divides into two branches, each with fibers from both

roots.

1. Anterior division supplies anterior and lateral portions of the trunk and the

limbs. In the thoracic region it spans the space between the pleura and the

intercostal membranes, runs below the lower rib margin and supplies runs

below the lower rib margin and supplies the intercostal muscles and adjacent

skin. In the cervical and lumbar regions the anterior divisions form plexuses.

2. Posterior division is directed backward shortly beyond the formation of the

spinal nerve. Its medial branch supplies the multifides, the longissimus the

semispinalis and trepizezius muscles, then proceeds along the spinous process

and supplies the skin.Its lateral branch traverses the longissimus muscle and

supplies the intercostal muscle and adjacent skin.

In the lumbar region the medial branches of the posterior divisions hug

the articular processes of the vertebrae and end in the multifides, and the

lateral branches supply the group of sacrospinalis muscles, adjacent fascia and

skin.

Sacral and coccygeal ventral vami

 The ventral rami of the sacral and coccygeal spinal nerves form the sacral and

coccygeal plexus. The upper four sacral ventral rami enter the pelvis by the anterior

sacral foramina, the fifth between the sacrum and coccyx, while that of the coccygeal

nerve curves forwards below the rudimentary transverse process of the first coccygeal

segment. The first and second sacral ventral rami are large, the third to fifth diminish

progressively and the coccygeal is the smallest. Each receives a grey ramus

communicans from a corresponding sympathetic ganglion, visceral efferent rami

leave the second to fourth sacral rami as pelvic splanchnic nerves containing

parasympathetic fibres which reach minute ganglia in the walls of the pelvic viscera.

Sacral Plexus

The sacral plexus is formed by the lumbosacral trunk, the first to third sacral

ventral rami and part of the fourth, the reminder of the last joining the coccygeal

plexus.

The lumbosacral trunk comprises part of the fourth and all the fifth lumbar

ventral rami; it appears at the medial margin of the psoas major, descending over the

pelvic brim anterior to the sacroiliac to join the first sacral ramus. These rami

converge to the greater sciatic foramen and unite with little intermingling to form

upper and lower bands.

The upper, larger one is the union of the lumbosacral trunk with the first,

second and greater part of the third sacral rami; it becomes the sciatic nerve. The

lower band, smaller and more plexiform, is mainly the junction of the smaller part of

the third sacral ramus with part of the fourth; it becomes the pudendal nerve; it has a

small contribution from the second sacral ramus. The sciatic comprises tibial and
common peroneal nerves. Which usually separate in the thigh but can be pulled a part

to their origins, when it can be demonstrated that the tibial is formed by the union of

the ventral divisions of the lumbosacral trunk and the first three sacral rami while the

common peroneal is formed by dorsal divisions of the lumbosacral trunk and the first

two sacral rami. The sacral nerve may however, divide anywhere, when division is at

the plexus the common peroneal nerve usually pierces the piriformis in the greater

sciatic foramen.
Figure-2
Relations of the sacral plexus

The sacral plexus adjoins the posterior pelvic wall anterior to the piriformis,

posterior to the internal iliac vessels and ureter and to the sigmoid colon on the left

and the terminal ileal coils on the right.

The superior gluteal vessels lie between the lumbosacral trunk and first sacral

ventral ramus or between the first and second sacral rami, while the inferior gluteal

vessels lie between the first and second or second and third sacral rami.

Nerves are complex fibres in our body which carry impulses from the

periphery to the central nervous system (brain and spinal cord )and vice versa. In

simple language, they are wire connections of our body which carry current

(impulses/signals) between brain and muscles, joints, skin , etc. without which

communication of impulses related with sensation, movement, reflex, control,

correlation, function cannot be performed and life will be coma. Till now, science has

not advanced to replace it.

The blood vessels supplying a nerve end in a capillary plexus whose members

pierce the perineurium and run largely parallel with the fibers, connected by short

transverse vessels, to form narrow, oblong meshes similar to those found in muscle.

The blood supply of peripheral nerves is highly unusual in several ways. First,

endoneurial capillaries have atypically large diameters and intercapillary distances

greater than those in many other tissues (Bell & Weddell 1984a. b). Second peripheral

nerves have two separate. functionally independent vascular systems: an extrinsic

system (regional nutritive vessels and epineurial vessels) and intrinsic system

(longitudinally running microvessels in the endoneurium) (Lundborg & Branemark

1968; McManis et al 1993). There are rich anastomoses between the two systems,

resulting in considerable overlap between the territories of the segmental arteries.

Epineurial and perineurial vessels have a dense perivascular plexus of

peptidergic, serotoninergic and adrenergic nerves.

Sciatic nerve

The Sciatic nerve is the thickest nerve in the body. In its upper part is forms a

band about 2 cm wide. It begins in the pelvis and terminates at the superior angle of

the popliteal fossa by dividing into the tibial and common peroneal nerves.

Origin and Root value

This is the largest branch of the sacral plexus. The tibial part is formed by the

ventral divisions of the anterior primary rami of L4, 5, S1, 2, 3. The common peroneal

part is formed by the dorsal divisions of the anterior primary rami of L4, 5, S1,2.

Course and Relations

1. In the Pelvis

The nerve lies in front of the piriformis, under cover of its fascia.

2.in the Gluteal Region

The sciatic nerve enters the gluteal region through the greater sciatic foramen

(Below the piriformis). It runs downwards with a slight lateral convexity, passing

between the ischial tuberosity and the greater trochanter. It has the following relations

in the gluteal region

(A) superficial (Posterior). Gluteus maximums and sometimes the posterior

cutaneous nerve of the thigh.

 (B) Deep (Anterior). (1) body of the ischium, and nerve to quadratus femoris;

(2) tendon of the obturator internus with the gemelli (3) Quardatus femoris,

obturator externus, and ascending branch of the medial circumflex femoral

artery; (4) the capsule of the hip joint which lies deep to the forementioned

muscles; and (5) the upper, transverse fibers of the adductors magnus.

(C) Medial. (1) Inferior Gluteal nerve and vessels; and (2) Sometimes the

posterior cutaneous nerve of the thigh.

1. In the thigh

The sciatic nerve enters the back of the thigh at the lower border of the gluteus

maximums, and runs vertically downwards up to the superior angle of the

popliteal fossa, (at the junction of the upper 2/3 and lower 1/3 of the thigh), where

it terminates by dividing into the tibial and the common peroneal nerves. It has the

following relations in the thigh.

(A) Superficial (Posterior). The Sciatic nerve is crossed by the long head of the

biceps femoris.

(B) Deep (Anterior). The sciatic nerve lies on the adductor magnus.

(C) Medial. The posterior cutaneous nerve of the thigh, the semimembranosus,

and the semitendinosus.

(D) Lateral. Biceps femoris.

(E) The sciatic nerve is accompanied by a small companion artery which is a

branch of the inferior gluteal artery. The artery runs along the Sciatic nerve

for some distance before sinking into its substance.

The sciatic nerve may divide into terminal branches anywhere above the usual

level. When division occurs in the pelvis, the tibial nerve passes through the greater
sciatic foramen inferior to the piriformis, but the common peroneal nerve pierces the

piriformis to enter the gluteal region.

Branches

1. Articular branches to the hip joint arise in the gluteal region.

2. Muscular branches may arise lower part of the gluteal region or in the upper part of

the thigh. The tibial part of sciatic nerve supplies the semitendinosus,the

semimembranosus, the long head of the biceps femoris, and the ischial head of the

adductor magnus. The common peroneal part supplies only the short head of the

biceps femoris.
Figure-3
Applied Anatomy

1. Compression of the sciatic nerve against the femur, or unusual stretching, after

sitting for a long time, may give rise to a “sleeping foot”.

2. Shooting pain along the cutaneous distribution of the sciatic nerve and its terminal

branches (chiefly the common peroneal) is known as sciatica. Pain usually begins in

the gluteal region or even higher, and radiates along the back of the thigh, and the

lateral side of the leg, to the dorsum of the foot.

This is usually due to compression and irritation of one or more nerve roots

forming the sciatic nerve. (The cause may be osteoarthritis, lumbar disc prolapse,

spondylolisthesis, fibrositis, neuritis, etc.).

3. The sciatic nerve may be injured by penetrating wounds, dislocation of the hip, or

fracture of the pelvis. This result in loss of all movements below the knee (with foot

drop); sensory loss on the back of the thigh, the whole of the leg, and the foot except

the area innervated by the saphenous nerve.

4. In above-knee amputations, the companion artery of the sciatic nerve should be

carefully isolated and ligated separately to avoid sharp bleeding that otherwise

follows. Isolation of the artery from all nerve fibres must be perfect because ligation

of nerve fibres with the artery would be followed by severe pain in the stump.

Basic Structure of peripheral nerve fibers.

Each nerve fibre has a central core formed by the axon. This core is called the

axis cylinder. The plasma membrane surrounding the axis cylinder is surrounded by a

myelin sheath. This sheath is in the form of short segments that are separated at short

intervals called the nodes of Ranvier.

 The part of the nerve fibre between two consecutive node is the internode.

Each segment of the myelin sheath layer is formed by one schwann cell outside the

myelin sheath there is a thin layer of schwann cell cytoplasm, this layer of cytoplasm

is called the neurilemma.

Peripheral Nerves

Peripheral nerves are collections of nerve fibres. These are of two types.

2. Some nerve fibres carry impulses form the spinal cord or brain to peripheral

structures like muscle or gland; they are called efferent or motor fibres.

Efferent fibres are axons of neurons located in the gray mater of the spinal

cord or of brainstem.

3. Other nerve fibres carry impulses from peripheral organs to the brain or spinal

cord these are called efferent fibres. Many efferent fibres are concerned in

transmission of sensations like touch pain etc they are therefore called sensory

fibres. Afferent nerve fibres are processes of neurons that are located in

sensory ganglia in the case of spinal nerves these ganglia are located on the

dorsal neural roots.

Each nerve fibre is surrounded by a layer of connective tissue called the

endoneurium. The endoneurium holds adjoining nerve fibres together and facilitates

their aggregation to form bundles or fasciculi.

Each fasciculus is surrounded by a thicker layer of connective tissue called the

perineurium. The perineurium is made up of layers of flattened cells separated by

layers of collages fibres.

 The fasciculi are held together by a fairly dense layer of connective tissue that

surround the entire nerve and is called the epineurium. The epineurium contains fat

which cushions nerve fibres.

HISTOLOGY

Each nerve fascicle is surrounded by a connective tissue sheath,the

perineurium, which merges with surrounding interfascicular connective tissue. The

deeper part of epineurium contains adipose tissue and blood vessels.Extensions of

epineurium surround large nerve fascicles.Perineurium is the connective tissue sheath

that surrounds individual nerve fascicles.The numerous nuclei that are arranged along

nerve fibres are the schwann cell nuclei.The axon appear as slender threads.The

surrounding myelin sheath has been dissolved,leaving a distinct neurokeratin network

of protein.The sheath of schwann cell is seen as thin,peripheral boundary and at the

node of Ranvier.

PHYSIOLOGY

Classification of Back Pain

The causes of back pain are manifold, but they may be classified under following

headings.

The psychogenic, viscerogenic, vascular, neurogenic, and spondylogenic back pain.

Clinically the back pain falls into two broad categories: somatic and radicular.
Somatic Back Pain

Somatic back pain usually arises from an innervated nonneural tissue related

to the spine like annulus fibrosus, facet joints, etc. It presents either in the form of

local pain, at the pain source or referred pain, away form the pain source.

Radicular pain

Radicular pain from a particular nerve root complex or dorsal that radiates form

the spine to the peripheral tissue, along the concerned peripheral nerve. It usullaly

manifests in the form of paresthesia, pain and numbness. In radicular pain, the nerve

root can be clinically involved in two ways, i.e. nerve root compression and nerve

root irritation (Smithe and Wright 1959).

Pathogenesis of pain production

Various causes that can generate nociceptive impulses can be broadly grouped into

two types of pathologies: compressive or noncompressive

The compression causes neural deformation, which leads to cascade of events

in the form of altered microcirculation, intraneural edema, ischemia, demyelination,

radiculopathy and resultant nociception. The noncompressive pathology could be

inflammation, congestion and perineurial adhesions.

In case of perineurial adhesions, the referred pain is usually associated with

burning sensation and dysesthesiae. Loss of afferent neurons within the nerve root

could be a possible pathogenic mechanism involved in it.

In experimental studies by Macnab, same amount of compressive forces were

applied to normal nerve root as well as inflamed nerve root and different responses

were experienced by the subjects. Subjects with noninflamed nerve root experienced
numbness and paresthesia but did not complain of pain, whereas subjects with

inflamed nerve roots, experienced radiating pain as well as numbness and paresthesia.

Further studies revealed that the mechanic pressure alone is not the cause of

the nerve root pain, but it is an abnormal chemical environmental of the nerve root

that alters the excitability by lowering the depolarization threshold. In such an event,

even a smaller mechanical stress can be generate action potentials. This abnormal

chemical environmental is created by the tissue, degradation products, and they act

directly as well as indirectly on the nonciceptors. The indirect action is mainly

through the inflammatory response and immunological, when the degradation

products in protein in nature. After the annular injury, sometimes the normal

immunoglobulins of nucleus pulposus (IgG and Igm) can also behave like a foreign

protein and switch on the immune reaction.

Mccarron et al18 have shed further light on inflammation of the nerve roots.

Any inflammatory process can be show varying degrees of responses, ranging from

increased vascularity, venous congestion, edema and fibrin formation to regional,

edema and fibrin formation and regional fibrosis. This is turn leads to neuroischemia

of that particular root.

A study of chronically compressed roots by Watanabe and park,19 indicated

that if the intrinsic circulation of the nerve roots is impeded in either its arterial input

of its or its venous outflow, the net effect is the same, a neuroischemia of the

compressed root segments(s), and the generation of ectopic nerve impulses.

Perception of Pain

The Taxonomy committee of the international association for study of pain

chaired by Marskey in 1979 concluded that : pain is an unpleasant sensory and

emotional experience with actual or potential tissue damage or described in terms of

such damage”

The pain sensation is a subjective phenomenon, generally produced at cortical

and subcortical levels in response to a painful stimulus arriving from some peripheral

tissue. this pain perception is a complex process, and the actual quantitative pain

perception.

Prior experience of pain and the knowledge of its source tends to prevent

potential tissue injury in future, and is thus ‘Life-preserving” . in acute conditions

like trauma or inflammation, pain causes inhibition of functions of the affected part,

and general hyporesponsiveness to the affected part, and general hyporesponsiveness

to the surroundings. this gives a rest to the affected area and helps in the healing

process.

But the chronic pain which is caused by various disorders, serves no useful

function. on the contrary it can prove deleterious because, the secondary changes like

complex autonomic, hormonal and behavioral abnormalities, evolve the self-

perpetuating pain cycles and subsequent personality changes.

PATHWAYS OF PAIN SENSATION

FROM SKIN AND DEEPER STRUCTERS

Receptors

The receptors of both the components of pain are the free nerve endings. The

free nerve endings are distributed throughout the body.

First order neurons

First order neurons are the cells in the posterior nerve root ganglia. These

neurons receive impulses of pain sensation from the pain receptors through their

dendrites and their axons reach the spinal cord. The fibers of fast pain sensation are

carried by A & Afferent fibers. After reaching the spinal cord, the fibers synapse with

marginal cells in the posterior horn.

The fibers transmitting impulses of slow pain belong to C type and these

fibers synapse with substantia gelatinosa in the posterior gray horn.

Second order Neurons

The Marginal cells and the cells of substantia gelatinosa from the second order

neurons. Fiber from these cells ascend in the form of the lateral spinothalamic tract.

Fibers of the marginal cells for fast pain are long. Immediately after taking

origin, the fibers cross the midline via anterior gray commissure, reach the

anterolateral white column and ascend. These fibers from the neospinothalamic tract-a

part of lateral spinothalamic tract. These nerve fibers terminate in venteral

posterolateral nucleus of thalamus. Some of the fibers terminate in ascending reticular

system of brainstem.

The fibers of slow pain which arise from substaintia gelatinosa cross the

midline and run along with fibers of fast pain as paleospinothalamic fibers in lateral

spinothalamic tract. One with of these fibers terminate in vertebral posterolateral

nucleus of thalamus. The remaining fibers terminate in nuclei of reticular formation in

brainstem or in tectum of midbrain or in the gray matter surrounding aqueduct of

sylvius.

Third order Neurons

The third order neurons of pain pathway are the neurons of thalamic nucleus,

reticular formation, tectum and gray matter around aqueduct of sylvius. Axons from

these neurons reach the sensory area of cerebral cortex. Some fibers from reticular

formation reach hypothalamus.

Center for Pain Sensation

The center for pain sensation is in the post central gyrus of parietal cortex.

Fiber reaching hypothalamus are concerned with arousal mechanism due to pain

stimulus.
DEFINATION

Sciatica is a term for pain that radiates along the sciatic nerve,anywhere

from the lower back, buttocks, down the back of leg to the foot.

ETIOLOGY

Several different lumbar spine (low back) disorders can cause sciatica.

Sciatica is often described as mild to intense pain in the left or right leg. Sciatica is

caused by compression of one or more of the five sets of nerve roots in the lower

back. Sometimes doctors call sciatica a radiculopathy. Radiculopathy is a medical

term used to describe pain, numbness, tingling, and weakness in the arms or legs

caused by a nerve root problem. If the nerve problem is in the neck, it is called a

cervical radiculopathy. However, since sciatica affects the low back, it is called a

lumbar radiculopathy.

Sciatica may be the result of something as simple as bad posture,muscle strain

or spasm,pregnancy,being overweight,wearing high heels,or sleeping on a too-soft

mattress.In some cases,sciatica is due to nerve inflammation caused by a form of

arthritis,or is caused by the squeezing of the sciatic nerve by a tumor wrapped around

the spinal cord in the lower back.

EPIDEMIOLOGY: The prevalence of sciatica is 1-10% of the population.There is

equal male-female distribution.The 25-45 years age group is most commonly affected.

A number of environmental and inherent factors thought to influence the development

of sciatica , including gender, body habitus, parity, age, genetic factors, occupation,
and environmental factors . Gender nor body mass had an influence on the

development of sciatica, although body mass may have been associated with low back

pain. 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

INCIDENCE: The incidence of sciatica is related to age. Rarely seen before the age

of 20, incidence peaks in the fifth decade and declines thereafter. This age distribution

was also observed in those presenting for lumbar disc herniation surgery. 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. 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.

RISK FACTORS: risk factors for sciatica include trauma, unaccustomed activity,

age, smoking, obesity, vibration [e.g.driving a car], sedentary lifestyle and

psychosocial factors.

GENDER: Men are more frequently affected than women; individuals engaged in

occupations that require heavy physical labor are more often affected.

FAMILIAL: A genetic link with sciatica was first reported in a juvenile population.

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. A study of 9365 pairs of adult twins identified the lifetime
incidence of sciatica in monozygotic 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.

OCCUPATION: 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.

Retired (OR 0.15) or part-time (OR 0.16) farmers were less likely to develop sciatica

than full-time ones. Risk factors identified for sciatica associated with occupation

included awkward working position, working in a flexed or twisted trunk position

(OR 2.6), or with the hand above the shoulder. Driving is also positively associated

with sciatica or lumbar disc herniation. 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.

Pathways to Sciatic Nerve Pain Five sets of paired nerve roots in the lumbar spine

combine to create the sciatic nerve. Starting at the back of the pelvis (sacrum), the

sciatic nerve runs from the back, under the buttock, and downward through the hip

area into each leg. Nerve roots are not 'solitary' structures but are part of the body's

entire nervous system capable of transmitting pain and sensation to other parts of the

body. Radiculopathy occurs when compression of a nerve root from a disc rupture or

bone spur occurs in the lumbar spine prior to it joining the sciatic nerve.
CAUSES OF SCIATICA

1. True sciatic Neuritis-Leprosy,polyarteritis nodosa,nerve injury due to injections

or trauma,postherpetic neuralgia.

2. Mechanical pressure on nerves or roots or referred pain-

a. In the spinal cord-Tumors of cauda equine,arachnoditis, rarely thrombosis,

haemorrhage or infection irritating meninges of the cord.

b. In the cord space-Protruded intervertebral disc, extramedullary tumors.

c. In the vertebral column-Arthritis, tuberculosis, spondylolisthesis, ankylosing

spondylitis, primary bone tumors, secondary carcinoma.

d. In the back-Fibrositis of posterior sacral ligament.

e. In the thigh and buttock-Fibrositis, sacrosciatic band, neurofibroma,

haemorrhage within or adjacent to nerve sheath in blood dyscrasias and

anticoagulant therapy.

f. In the pelvis-Sacroiliac arthritis or strain,hip disease,infection of prostate or

female genital tract,rectal impactions.

Sciatic Nerve Compression Several different types of spinal disorders can cause

spinal nerve compression and sciatica or lumbar radiculopathy. The six most common

are:

• a bulging or herniated disc

• lumbar spinal stenosis

• spondylolisthesis

• trauma

• piriformis syndrome
 • spinal tumors

Each condition is briefly explained below.

Common Sciatica Cause #1: Lumbar Bulging or Herniated Disc A bulging disc is

also known as a contained disc disorder. This means the gel-like center (nucleus

pulposus) remains 'contained' within the tire-like outer wall (annulus fibrosus) of the

disc. A herniated disc occurs when the nucleus breaks through the annulus. It is called

a 'non-contained' disc disorder. Whether a disc bulges or herniates, disc material can

press against an adjacent nerve root and compress delicate nerve tissue and cause

sciatica. The consequences of a herniated disc are worse. Not only does the herniated

nucleus cause direct compression of the nerve root against the interior of the bony

spinal canal, but the disc material itself also contains an acidic, chemical irritant

(hyaluronic acid) that causes nerve inflammation. In both cases, nerve compression

and irritation cause inflammation and pain, often leading to extremity numbness,

tingling, and muscle weakness.

Common Sciatica Cause #2: Lumbar Spinal Stenosis Spinal stenosis is a nerve

compression disorder most often affecting mature people. Leg pain similar to sciatica

may occur as a result of lumbar spinal stenosis. The pain is usually positional, often

brought on by activities such as standing or walking and relieved by sitting down.

Spinal nerve roots branch outward from the spinal cord through passageways called

neural foramina comprised of bone and ligaments. Between each set of vertebral

bodies, located on the left and right sides, is a foramen. Nerve roots pass through

these openings and extend outward beyond the spinal column to innervate other parts

of the body. When these passageways become narrow or clogged causing nerve

compression, the term foraminal stenosis is used.

Common Sciatica Cause #3: Spondylolisthesis Spondylolisthesis is a disorder that

most often affects the lumbar spine. It is characterized by one vertebra slipping

forward over an adjacent vertebra. When a vertebra slips and is displaced, spinal

nerve root compression occurs and often causes sciatic leg pain. Spondylolisthesis is

categorized as developmental (found at birth, develops during childhood) or acquired

from spinal degeneration, trauma or physical stress (i.e. weightlifting).

Common Sciatica Cause #4: Trauma Sciatica can result from direct nerve

compression caused by external forces to the lumbar or sacral spinal nerve roots.

Examples include motor vehicle accidents, falling down, football and other sports.

The impact may injure the nerves or occasionally fragments of broken bone may

compress the nerves.

Common Sciatica Cause #6: Piriformis Syndrome Piriformis syndrome is named

for the piriformis muscle and the pain caused when the muscle irritates the sciatic

nerve. The piriformis muscle is located in the lower part of the spine, connects to the

thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis

muscle. Piriformis syndrome develops when muscle spasms develop in the piriformis

muscle thereby compressing the sciatic nerve. It may be difficult to diagnose and treat

due to the lack of x-ray or MRI findings.

(6) Spinal Tumors Spinal tumors are abnormal growths that are either benign or

cancerous (malignant). Fortunately, spinal tumors are rare. However, when a spinal

tumor develops in the lumbar region,there is a risk for sciatica to develop as a result

of nerve compression. 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 root and lung adenocarcinoma metastasis in

the pelvis.

OTHER NON-DISCOGENIC CAUSES: Infection also needs to be excluded in

cases of sciatica. A Staphylococcus aureus epidural abscess was reported to cause

sciatica.Caseating tuberculosis has been associated with sciatica.Chronic infection of

the lower lumbar intervertebral discs themselves with Propionibacterium acnes has

also been implicated in the pathogenesis of sciatica.

Vascular compression of lumbar nerve roots by abnormal epidural venous

plexi has been described. The appearance of these plexi was indistinguishable from

that of prolapsed intervertebral disc on MRI scan and only became apparent at

surgery. Pseudoaneurysm of the gluteal artery was also described as a rare cause of

lumbar nerve root compression and sciatica. Evacuation of the haematoma and

decompression of the lumbo-sacral plexus eliminated all sciatic type pain.

Mechanical compression of lumbar nerve roots by an osteophyte around the

sacro-iliac joint has been described as causing sciatic pain. Also described are sciatic

nerve impingement by epidural adhesions, uterine fibroids, and cyclic sciatica

associated with endometriosis in the area of the sciatic nerve.

In advanced osteoarthritis of spine,bits of cartilage may break off and float

around inside spinal joints.This causes irritation and inflammation and if it occurs in

the lower back may put pressure on the sciatic nerve.

Inflammation or abscess formation in spine[cold abscess-tuberculosis]

 Diseases-Nervous disorders, diabetes, etc.

Sciatica is a symptom. According to the causative factor it is classified as

1]REFLEX SCIATICA: This typeof neuralgia is due to visceral causes.eg:diseases

of bladder,prostate,uterus,ovaries,etc or sturtures like joints ligaments and

muscles.The main features of this type of neuralgia are that neurological disturbances

do not correspond to known patterns of nerve distribution and there are no objective

neurological signs.

A] Primary sciatic neuritis: In this form,it is a manifestation of either a general

systemic disease like diabetes or syphilis,or of a generalized toxemia like

alcoholism,lead and arsenic poisoning etc.It can be dignosed by other signs and

symptoms of underlying disease.

B] Secondary sciatica: This is due to a peripheral neuritis and is due to pressure on

the nerve,which may be

1] Outside the spinal canal as by pelvic tumours,

2] Non disc lesions inside the spinal canal;as by extra-or-intradural masses,

3] Intravertebral disc lesions.

In the words of Duplessis, ”It is becoming increasingly evident that nuclear

retropulsion is the villain of the place of sciatica and is with this form also called the

LUMBOSCIATIC SYNDROME”
Figure -5
PATHOPHYSIOLOGY

The aetiological factors as well as pathophysiology can be convienently

considered under the following headings:

1] Mechanical causes

2] Changes in the annulus fibrosus

3] Changes in nucleus pulposus

4] Changes in adjacent structures

1] Mechanical causes:Cyriax blames nature for the failure to redesign the spinal

column to suit the erect posture.This view is also held by Williams,who tracing the

evolution of biped man from his qudraped ancestors,compares anatomical details like

changes in spinal column,lumbosacral angle,shift in muscle attachment and

consequently a change in function and so on.According to him lumbar disc prolapse is

another penalty that man pays,like haemorroids,varicose veins for his erect

posture.This views again are disputed by Finneson,and others feel that unaccustomed

exercise is the culprit,as when a man of sedentary habits and a pampered.This

theory,however,seems to be inapplicable in so far as a large number of patients who

fall a prey to the lumbosciatic syndrome are those with well-developed

musculature.e,g:farmers,labourers.

During 1969 Kester has broadly divided the mechanical causes into

A] Static

B] Kinetic
2]Changes in the annulus fibrosus : When due to bad posture,abnormal stresses or

other mechanical cause,the line of weight bearing lies in the posterior part of the disc

and hence over the annulus instead of nucleaus as in the normal,the annulus is

weakened further.The nucleus being one-fourth of the total size of the disc in the

lower lumbar region makes matters worse.It may be that repeated minor stresses

result in small tears which form weak spots through which herniation of the disc is

later facilitated.A single trauma however violent is unlikely to cause rupture,as

evidenced by the fact that in trauma is sufficient to produce compression fracture-

dislocation of the vertebrae,the discs are very often intact.

3] Changes in nucleus pulposus :Pavlson,Sylven,and Snellman and Hirsch[1952]

from their clinical and anatomical,microscopic studies conclude that more than mere

mechanical stress is responsible for the nuclear degeneration.

The reduction in water content,there is a decrease in the mucopolysaccharides

and an increase in the proteins which leads to decrese in water binding capacity of the

disc.As the protein content increases,there is a loss of delineation between the annulus

and the nucleus.In such degenerated discs,pain perception increases.

4] Changes in adjacent structures :The intervertebral foramen may be reduced in

size by a literally placed nuclear protrusion as well as osteophytosis at the vertebral

body margins.

In either case, there is obstruction to the flow of venous blood and pressure on

the nerve roots with oedema and/or haemorrhage. As this exudates gets organized,

there is fibrosis around the nerve root and they gradually gets fixed. The protruding

disclying against the dura may produce dural irritation and reffered pain.
 All these changes,either singly or in permutation and combination can cause

irritation of pain sensitive structures,the stimuli operating through

chemical,mechanical or autoimmune mechanism producing the characteristic clinical

signs and symptoms of LUMBO-SCIATIC SYNDROME.

PATHOGENESIS

The intervertebral disc was implicated in the pathophysiology of sciatica, and

with the assumption that the protruding disc exerted pressure on sciatic nerve roots,

the treatment was surgical removal of the disc. Any subsequent improvement in

symptoms was attributed to relief of pressure on the nerve roots. Kelly, however,

suggested that pressure on a nerve results in loss of function and is rarely associated

with pain. There are several lines of evidence to support this. Disc pathology and

stenosis with apparent neural compromise have been shown to be a relatively common

finding in asymptomatic patients. Symptomatic patients with disc herniation may

experience marked improvement in symptoms without any alteration of the original

pathology, whereas the removal of herniated disc material or other causes of nerve

root compression does not always relieve pain.

A positive correlation was noted between contact pressure and preoperative

neurological impairment, suggesting that pressure led to loss of function rather than

pain, whereas chymopapain, a substance used for chemonucleolysis of herniated

lumbar discs, may cause a rapid relief of leg pain that precedes any change in the size

of the disc herniation or degree of nerve root impingement.

 These observations suggest that processes other than pressure on nerve roots

are involved in the development of sciatic neuralgia. The evidence suggests that a

complex interplay of inflammatory, immunological, and pressure-related processes

may be involved.

When Lindahl and Rexed found histological evidence of inflammation in

posterior nerve roots examined during laminectomy, they postulated that

inflammation rather than pressure was the source of nerve root pain. Support for this

theory was provided when injection of autologous nucleus pulposus into canine

epidural space provoked an intense inflammatory reaction involving the dura and

nerve roots, with signs of epidural fibrosis present from as early as 2 weeks. High

levels of phospholipase A2 (PLA2), an important enzyme in the inflammatory process,

were demonstrated in herniated nuclear material of patients with radicular pain,

whereas PLA2 isolated from human disc material was demonstrated to provoke an

intense inflammatory reaction. PLA2 activity was noted to be higher in cases of

sequestrated rather than bulging discs at the time of surgery, with a strong correlation

between disc and plasma PLA2 levels.

Immunological

There is some evidence to suggest that the immune system also may play a

part in the reaction between the nerve root and the exposed nucleus pulposus.

Glycosphingolipids (GSLs) are particularly abundant in cell types of the central and

peripheral nervous system. Titres of antibodies to these cell components are normally

very low but become elevated in auto-immune conditions of the nervous system such

as Guillan–Barré syndrome. Antibodies to GSLs were measured in patients with acute

and chronic sciatica and those who had lumbar discectomy for disc herniation. Raised

antibody levels to GSLs were detected in 71% of patients with acute sciatica, 61% at

4 yr follow-up, and 54% of those undergoing discectomy.

Markers of glial cell and nerve damage [neurofilament (NFL), glial fibrillary

acidic protein, S-100 protein, and neuron-specific enolase] were measured in the CSF

of patients presenting for lumbar disc surgery and compared with controls. CSF levels

of NFL protein and S-100 were significantly elevated in patients appearing for disc

surgery compared with controls. Patients with symptoms of sciatica for <3 months

duration had higher NFL protein levels than those with symptoms for longer. Patients

with persistent neurological findings at 3 months post-surgery had higher preoperative

NFL levels than those who did not develop sequelae. These studies suggest that an

immune reaction to nervous tissue may be involved in the pathogenesis of both acute

and chronic sciatica.

Mechanical compression

The evidence above strongly suggests that an inflammatory and immune

response is involved in the pathogenesis of nerve root irritation and sciatic type pain.

There is also some evidence to suggest that nerve root compression may also be

involved. Cauda equina compression with a non-irritant silicone tube in rats led to

significantly higher rates of sural nerve ectopic firing than control animals.

Administration of a nitroprusside infusion, a source of NO, led to increased ectopic

firing only in those animals with cauda equina compression.

An observational study, with magnetic resonance imaging (MRI) in 394

consecutive patients with leg pain, noted that 9.6% had no disc disease, 3.3% bulging,
11.4% protrusion, 68.5% extrusion, and 7.1% disc sequestration, respectively. A

statistically significant positive correlation between the severity of disc disease and leg

pain, and Roland-Morris and Prolo disability scales were observed, that is, those with

larger herniations had more leg (but not back) pain and disability. Another

observational study noted the prevalence of swelling of dorsal root ganglia and

impingement within the intervertebral foramina at the appropriate level and side in

patients with a unilateral monoradiculopathy. Again, the degree of swelling and

impingement correlated well with severity of leg pain.

As already noted, elevated CSF levels of NFL and S-100 were observed in

patients with verified disc herniations. These proteins are nervous system specific and

their presence indicates damage to central nervous system structures. When either an

ameroid constrictor or an autologous nucleus pulposus material was applied to porcine

S1 nerve root, it was noted only compression of the S1 nerve root significantly raised

levels of NFL and total protein concentrations in the CSF. This was not seen with

nucleus pulposus alone.

From the above evidence, it could be proposed that radicular pain in sciatic

nerve roots arises from a complex interaction of inflammatory, immune, and pressure-

related elements. This can most easily be appreciated in terms of intervertebral disc-

mediated pain where the majority of research has been conducted, although it is

probably equally applicable to all other forms of sciatic neuralgia. The high incidence

of asymptomatic individuals with disc abnormalities associated with neural

compromise shows that pressure alone does not cause pain in sciatic nerve roots.

Although disc bulging, to a varying degree is common, nucleus pulposus sequestration

or extrusion is rarely seen in asymptomatic individuals. The potent inflammatory

properties of nucleus pulposus have been outlined earlier and involve the major

inflammatory mediators. This causes an inflammatory reaction in sciatic nerve roots

which has been shown, in animal models, to lead to sustained ectopic discharge,

demyelination, decreased blood flow to the dorsal root ganglion, increased

endoneurial pressure, and decreased conduction velocity. An inflammatory reaction

normally leads to an immune response, but the above evidence suggests that an

abnormal response may occur, with antibodies being formed to normal neural

elements. Crucially, this may also be related to the development of chronic sciatica.

This inflammatory process seems to be exacerbated by the effects of nerve

root pressure. Lumbo-sacral nerve roots, possibly due to the vulnerability of its

venous drainage system, seem to be particularly susceptible to the effects of pressure.

This may explain why even minor compression may lead to nerve root oedema,

intraneural inflammation, and hypersensitivity. This theory is supported by Haddox,

who wrote that ‘Surgeons ... state that the nerve root that is causing the problem is

easily identifiable by its edematous inflammatory character’.

Although passive congestion does not necessarily cause inflammation, this

underlines the potential for lumbar nerve roots to become congested and swollen

which presumably exacerbates any underlying inflammation. This combination of

susceptibility to inflammation and pressure effects with subsequent oedema may be

what makes the lumbo-sacral nerve roots so particularly vulnerable to neuropathies.

PATHOLOGY

There is no definite changes. The inflammation may be confined to nerve

sheath[perineum],to the interstitial part, or to the axis cylinder. In the first condition

the nerve is swollen, red and infiltrated with leucocytes. In the last instance

degenerative changes of axis cylinder are seen. The degeneration may extend down

the nerve, because the fibers are cut off from the trophic cells, and the muscles may

undergo atrophy. If recovery takes place there is an increased fibrous tissue formed in

the nerve.

CLINICAL FEATURES

SYMPTOMS: Sciatica symptoms usually vary from person to person in type,

intensity and suffering period depending upon the nerve fibers involved and nature of

complaint or disease. Some patients tolerate the pain or condition with day-to-day

activities and some may be bedridden all of a sudden. It all depends upon the site of

affliction and intensity. Most often it occurs as a catch in the hip after a strain or fall.

Also, mostly, the complaint radiates down the leg in one side.

The main symptom of sciatica is pain that radiates through the buttock and

down the back of the thigh and leg. The common symptoms are:

1] Tightness and stiffness in the lower back

2] Difficulty in rising and standing immediately ater sitting on a chair for a long time

3] Violent sharp lightening/shooting down/flickering type pain in hip or buttock or leg

in all parts

4] Pain radiates from buttock down the leg to foot in the posterior and inner aspect of

leg
5] Numbness or tingling sensation with weakness in the parts involved

6] Restlessness due to pain

7] Difficulty in gait due to tight low back muscles and development of partial or

complete paralysis in muscles below knee which reflect as wasting of muscles

8] Development of paralysis may proceed further to hinder bladder and bowel control.

The symptoms are aggravated by flexion and rotation of the lumbar spine,

prolonged sitting or standing, lifting, coughing, sneezing, and laughing. The

symptoms may be relieved with rest and a recumbent positon.

The location of the symptoms varies according to the siye of impingement of

the sciatic nerve. For e. g, a L5 impingement can cause weakness in extension of the

big toe and ankle.

Objective and progressive weakness in legs or bladder/bowel incontinence are

unusual in sciatica, and warrant immediate investigation with a view to surgical

decompression to avoid permanent nerve injury.

SIGNS:

1] Patients may have an antalgic gait and may adopt an abnormal posture to prevent

pain

2] Inspection and palpation of the lower back are usually normal,but may identify

other causes of back pain

3] Straight leg-raise test is positive

4] There may be decreased lumbar range of motion

5] A neurological examination of legs[including perianal sensation and anal sphincter

tone]should be performed
6] A careful abdominal and vascular examination is mandatory,to identify AAA and

acute limb ischemia as cause of pain.

Special signs-

1. Tenderness of nerves.

2. Intensification of pain in back and leg during rotatory extension of lumbar spine

very suggestive of ruptured disc.

3. Popliteal compression-Radiating pain can often be aggravated by pressure over the

course of the tibial nerve through the popliteal fossa.It is additional finding in favour

of root compression.

4. Testing of sacroiliac joints –by pressure on two anterior superior iliac joints.

5. Estimation of range and painlessness of hip joint by passive stretching.

6. Sensations-Impairment of perception of pin-prick found on dorsum of foot if

implication of 5th lumbar and 1st sacral nerve roots.

7. Presence of tender nodules in paraspinal muscles and along iliac crest may be

found in sciatica.

8. Tone and size of gluteal muscles judged by asking patient to contract both

buttocks;in upper sacral root lesions marked wasting may be clearly seen.

9. Knee and ankle jerks-When L4root is involved knee jerk is depressed and thereis

weakness of tibialis anterior muscle.L5 root lesions,both knee and ankle jerks usually

brisk but there may be weakness of dorsiflexion of toes particularly of extensor

hallucis longus.S1 root ankle jerk lost and weakness,when present involves the calf

muscles.
CLINICAL EXAMINATION

Local examination:

There are three important components to the examination of the lumbar spine:

• To inspect for the presence of deformity.

• To assess the movements of spine.

• To assess the effects of lumbar spinal pathology on the spinal cord or nerve

roots.

Examination of the back:

I. Inspection: With the patient in standing position look for postural

abnormalities like scoliosis, lordosis or kyphosis.

II. Palpation:

a. Tenderness: Localized tender infiltrates of the skin and subcutaneous tissue.

Palpable tender induration of small intervertebral muscles. Tenderness at the level of

posterior articulation of the involved segment and pain on percussion of affected

intervertebral space.

b. Movements: All the movements of the spine are tested:

Flexion: Instruct the patient to bend forwards as much as possible at the waist.

Normal flexion is 80° or fingertips 3-4 inches from the floor.

Lateral flexion: Instruct the patient to bend to left and to the right as far as possible.

Normal range is 35° on each side.

Extension: Instruct the patient to bend at the waist as far backward as possible.

Normal range is 20 to 30°.

Rotation: Instruct the patient to rotate from the waist to the left and to the right as far

as possible. Normal range is 45° per side. Note: In all the movements of the spine the

neutral position is 0°.

III: Clinical tests: These tests are based on the stretching of sciatic nerve over the

prolapsed disc:

Straight leg raising test (SLRT): Patient is in supine position, the examiner raises

the leg straight one after the other. Upto 30° nerve is not put under stretch. Between

30-70° nerve comes into contact with the prolapsed disc and the patient complains of

pain. Beyond 70° if patient complains of pain it is usually not due to disc prolapse but

could be due to sacroiliac joint involvement.

Lasegue test: Here the hip is flexed, knee is flexed and the leg is slowly straightened.

The patient is supine. Flex the patient’s hip and knee to 90°. The nerve roots are not

under tension and no pain is elicited. Not extend the knee. If the patient complains of

pain, the test is positive and it indicates nerve root compression or inflammation.

Femoral nerve stretch test: Here the patient is in prone position and is asked to lift

the leg straight. This puts a stretch on the femoral nerve. If the patient complains of

pain it indicates a high level disc prolapse (L1, 2, 3).

Examination of the CNS:

Examination of the spine:

Inspection:

Inspection of back is carried out in standing position after the back is

adequately exposed. Inspect the skin for café-au-lait spots (neurofibromatosis),

lipoma and tuft of hair (meningocele) etc.

Posture: Does the patient have a normal posture or whether posture is altered due to

deformities. The well known deformities of spine are:

Kyphosis – usually refers to the increased normal posterior convexity of the thoracic

spine. Types of kyphosis are round back, Gibbus, flat back, Dowager’s hump.

Lordosis – increase in anterior convexity of the lumbar spine. Lordosis of spine is

best inspected from the sides.

Scoliosis – it is a lateral curvature of the spine.

Gait: Gait abnormalities if any?

Palpation:

For tenderness: The paraspinous muscles are palpated simultaneously for tenderness

and firmness. The bony structures are palpated for tenderness. In the standing

position, the patient is asked to bend forwards. From the root of the neck to the

sacrum, the spine is lightly percussed in an orderly fashion. Patient complains of pain

in TB, infections etc. In the other method, called rotation method, an attempt to rotate

the vertebra by firmly pushing at the spinous process from the side elicits pain.

Range of movements: The normal movements taking place at the spine are forward

flexion, extension, lateral bending and rotations. Most of the forward flexion and

extension takes place at the lumbar spine whereas most of the lateral flexion and

rotation takes place at the thoracic spine. The movements of the spine are best

examined in standing position.

Flexion – normal range is 105° (45° at thoracic spine; 60° at lumbar spine). Forward

flexion takes place mainly at the lumbar spine. It is just possible that normal flexion

takes place to the extent of obliteration of the normal convexity of the lumbar spine

causing a smooth C-shaped configuration on bending. If the lumbar lordosis remains

intact on bending forward, it suggests local lumbar disease. Ask the patient to bend

forward and note the distance between the fingers and the ground. This test indicates

the overall movements of the thoracic and lumbar segments ignoring the hip.

Extension – In the standing position, the patient is asked to arch his back while the

pelvis is steadied by the examiner and a pull is exerted on shoulder. The angle

between the long axis of the spine when erect and bend back is the angle of extension.

Alternatively, the distance between L1 and S1 is measured and is found to decrease in

extension. Normal range is 30°.

Lateral rotation - Normal range is 30°. Lateral rotation is examined in standing

position. Patient is asked to slide down the hands on each side of the leg. The

distance from the floor in cm or the position that the fingers reach in the legs is

measured. The angle formed between the vertical and the line joining T1 and S1 on

lateral flexion is measured.

Rotations – Normal range is 40-45°. The patient sits at the edge of the table and holds

it firmly to fix the pelvis. The patient is then asked to rotate on either side. The

rotation is then measured between the plane of the shoulder and the pelvis.

Tests for nerve root compression:

Straight leg raising test (SLRT): Patient is in supine position, the examiner raises

the leg straight one after the other. Upto 30° nerve is not put under stretch. Between

30-70° nerve comes into contact with the prolapsed disc and the patient complains of

pain. Beyond 70° if patient complains of pain it is usually not due to disc prolapse but

could be due to sacroiliac joint involvement.

Lasegue test: Here the hip is flexed, knee is flexed and the leg is slowly straightened.

The patient is supine. Flex the patient’s hip and knee to 90°. The nerve roots are not

under tension and no pain is elicited. Not extend the knee. If the patient complains of

pain, the test is positive and it indicates nerve root compression or inflammation.

Femoral nerve stretch test: Here the patient is in prone position and is asked to lift

the leg straight. This puts a stretch on the femoral nerve. If the patient complains of

pain it indicates a high level disc prolapse (L1, 2, 3).

Lewin supine test: The patient is in supine position. Support the patient’s legs on

the table and instruct him to sit up without using the hands. The test is positive if the

patient is unable to do so. This test is positive in lumbar spondylosis, arthritis and

degenerative disc disease.

Neurological signs:

Motor testing: Test the muscle strength of the following group of muscles and

compare it with the normal side.

Quadriceps group – test for the L2, L3 and L4 roots.

Extensor hallucis longus – test for L5 root.

Gastrocnemius – test for S1 and S2.

Peroneus longus and brevis – test for S1.

Sensation: There is considerable variation and overlap of the dermatomal patterns

and hence it is difficult to chart the dermatomes precisely.

L4 dermatome affected – medial aspect of foot and leg.

L5 dermatome affected – dorsum of foot and great toe.

S1 dermatome affected – lateral border of foot.

L2, L3, L4 dermatome affected – anterior aspect of thigh.

S1, S2, S3, S4 dermatome affected – perineum and rectal tone.

Reflexes: Knee reflex – to test L4 nerve root.

Ankle reflex – to test for S1 nerve root.

INVESTIGATIONS

1. Blood tests have no place, except if other diagnosis need to excluded, for example,

pain of a non-mechanical nature, atypical pain pattern, persistent symptoms, and age

older than 50 years. In these cases, consider FBC, U & E, ESR, LFT’S, serum

calcium and serum protein electrophoresis.

2. Imaging is not necessary unless the patient is immobilized completely by pain and

requires admission:

a] X-rays: X-rays will show if there are any abnormal bone spurs which might be in

close proximity toa spinal nerve root. Almost most of these osteophytes growth are

harmless & donot cause any pain,at least the x-ray film will give the doctor reason to

persue additional testing to determine if bone spur is indeed compressing a nerve.

Osteophytes are targeted for causing many pinched nerve conditions although most of

time,these products of spinal aging are typically coincidental and innocent.X-rays

help for detecting disc narrowing in lumbar spine or lesion of sacroiliac joint.

b] MRI:MRI results can help to show damage to various parts of your spine such as

discs and ligaments.

c] CT scan: gives detailed picture of inside your spine are. It is similar to MRI.

d] A bone scan is indicated to rule out tumors, trauma, or infection.

3] CSF: may show increased protein with normal cell count in large protruded

intervertebral disc.
4] EMG:may be used to confirm presence of denervation in affected muscles.

5] Procaine injection test:for dignosis of fibrositic pain;contact with needle

aggravates local pain and elicits referred pain;procaine suppresses both,and freedom

of leg and spine movement is restored.

DIFFERENTIAL DIAGNOSIS OF CONDITIONS CAUSING SCIATICA

• Disc lesion

• Spondylolisthesis

• Attrition of disc

• Sacroiliac arthritis

• Secondary deposits in spine

• Benign spinal tumor

• Dissecting aneurysm

• Ankylosing spondylitis

• Degenerative joint disease

• Renal calculi

• Fracture

• Muscular back pain

PREVENTION

Prevention is always better than cure.So it is better to avoid triggers.These self

measures can help to relieve the symptoms of sciatica and also prevent recurrence.

..
• Sleep on firm mattress on your side or back with knees bent.

• During bad attacks,sleep with pillow under or between your knees.

• Try not to sleep on your stomach.

• Adjust the height of chairs so your feet are flat on the floor and the knees are a

little higher than the hips.

• Keep your feet flat on the floor and do not cross your legs when sitting.

• Sit in chairs that have firm back support and sit up straight against the back of

chair.

• Weight reduction

• Always lift from a squatting position,using your hips and legs to do the heavy

work.Never bend over or lift with a straight back.

• Avoid sitting or standing for extended periods.

• Avoid wearing high heels.

• Do abdominal crunches :These exercises strengthen the abdominal muscles

that help to support your lower back.Lie with your back on the floor,hands

behind your head and knees bent.Press your lower back to floor,lift your

shoulders up about 10 inches off the floor,and then lower them.Repeat 10 to

20 times daily.

• Lay in the face down position and clasp your hands behind the lower

back,then raise the head and chest slightly against gravity while looking at the

floor.
 • In the above position with the head and chest lowered to the floor,lightly raise

an arm and opposite leg slowly.with the knee locked,2-3 inches from the floor.

• Stretch :Sit in a chair and bend down toward the floor,stop when you feel just

discomfort,hold for 30 sec then release.Repeat 6-8 times.

• Lay on the back and gently pull the knees to the chest until a comfortable

stretch is felt.

COMPLICATIONS

The severity of symptoms often make one fear to live.Paralysis of the leg

below the knee is the most common complication.Rarely,it may involve the bladder

and rectum.

MANAGEMENT

The routine mode of treatment is generally based on symptoms and its

intensity.

A] SYMPTOMATIC SCIATICA-

1.Acute stage-a. Rest in bed with boards under the mattress to support the back.

b. Analgesics such as Tylenol treat pain but not inflammation.

NSAIDs such as aspirin and ibuprofen treat both pain and inflammation. Muscle

relaxants provide short term benefit.

c. Heat.

d. Injection of 2% procaine or of lignocaine into the sciatic nerve or

epidural space or tender spots in sacroiliac region may give dramatic relief.

2. Chronic stage-Management will depend on the cause. conservative treatment-

a.High sciatica-a. Injection of tender spots with 5% procaine.

 b. Counter irritation, heat and massage.

c. Epidural injection: This minimally invasive procedure involves

injecting a combination of corticosteroids and a local anesthetic into the epidural

space.

b. Low sciatica-Stretching the sciatic nerve, and injection of novocaine into, or as near

as possible to the sheath of the nerve.

B] SCIATICA DUE TO HERNIATED INTERVERTEBRAL DISC-

1. Conservative treatment-Complete rest in bed in supine position with only one

pillow for 3-6 weeks.When pain is relieved ,plaster jacket to immobilize the lumbar

spine completely for 3-6 months.After this jacket is removed ,and lumbar corset worn

all the times during the day.

2. Operative treatment-Indications-

a] Acute and incapacitatingsymptoms not relieved by rest in bed or even

immobilization in plaster jacket.

b] Quick recurrence of symptoms.

c] Evidence of large prolapse causing pressure on cauda equine, or clinical evidence

of severe root compressions shown by marked motor and sensory changes. Operation

consists of hemilaminectomy, removal of the protrusion, and curetting out nuclear

material from the central part of the disc, microdecompression, open decompression,

chemonucleolysis, spinal fusion, and percutaneous interventions. It is the most

effective cure.

3. SCIATICA DUE TO INFLLAMATION OF MUSCULAR AND FASCIAL

STRUCTURES- Rest, local application of heat, and massage. If tender nodules,

injection with 2% procaine solution. Treatment of sepsis.

PHYSIOTHERAPY

Physiotherapy is directed at:

1. Relief of pain.

2. Restoration of movement.

3. Strengthening of muscles.

4. Education of posture.

5. Analysis of precipitating factors to reduce recurrences.

The examination of the patient with Lumbar spondylosis identifies:

1. The pain picture.

2. Precipitating factors at work or leisure.

3. Posture abnormalities.

4. Muscle spasm and tightness.

5. Limitation of movements and the limiting factors.

6. Loss of accessory movement and soft-tissue mobility by palpation.

The following treatments may be used:

1. Heat: A heat pad can help to relieve the aching which comes from prolonged

muscle spasm. The best position is lying with one pillow under the head and two or

three under the knees. Sometimes it is helpful to warm tight muscles in a stretched

position. The simpler methods of applying heat for eg. Hot packs, a hot water bottle

or a small electric heat pad, are often as effective as the more sophisticated methods.

They have the advantage of being safe and can be used at home prior to doing home

exercises or as a means of pain relief.

2. Corsets: In acute vertebral pain movement provokes more pain and therefore rest

for a few days should be advocated. A lumbar corset will help in restricting

movements and thereby relieve pain. In men who are employed in heavy work, a

corset may be supplied for working hours.

3. Posture education: Posture education involves teaching the patient the correct

position in sitting, standing and lying and then basing activity on these positions. As

in all postural deformities this includes training the patient in total body alignment.

Foot and leg positions affect pelvic balance and can often be the underlying problem

even when the patient insists that the pain is in the back and there is nothing wrong

with the legs. For eg. A habit of standing with the right knee slightly bent causes

shortening of the hamstrings which pull on the ischial tuberosity attachments tending

to cause backward rotation of the right hip bone which pulls on the quadratus

lumborum and these muscles start to ache. .

4. Traction: Vertebral traction should be the first choice of pain relief for patients

suffering nerve root pain. The initial examination will emphasize the acute irritable

nature of this type of pain as will the dermatomal distribution. Intermittent sustained

traction is carried out after careful positioning has localized the involved segment. In

such cases treatment at least once a day is essential; prolonged pain relief will take

several days to obtain. The more chronic aching pain of osteoarthritic changes in the

apophyseal joints may respond to regional intermittent traction used as a passive

mobilizing technique. Passive mobilizing techniques are valuable together with light,

general back exercise. If the muscles are in a state of spasm, pelvic traction is

sometimes helpful.
HOMOEOPATHIC APPROACH

According to Dr. Hahnemann, the sole mission of the physician is to restore

the sick to health and to cure, rapidity, gently, permanently.

1] (Aphorism 1, 2)

It is the sick person that is to be treated not the pathological name. The outer

manifestation are the outward expression of the disturbance in inner process of life.

Disease was first disturbance increased and became more intensified, it became

pathological and it is through the miasmatic influence that all disease change takes

place from slightest functional disturbance to most exaggerated pathological creation.

Al diseases arise from miasm.

2] (Aphorism 5)

Explains, useful to the physician in assisting him to are the particulars of the

most probable exciting cause of the acute disease, to enable him to discover is

fundamental cause of the chronic disease, as also the most significant point in whole

history of chronic disease, to enable him to discover is fundamental cause, which is

general due to chronic miasm, in these investigation, the ascertainable physical

constitution of the patient (especially when the disease is chronic)

3] Hahnemann in § 7 states, “Now, as in a disease, from which no manifest exciting

or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing

but the morbid symptoms, it must (regard being had to the possibility of a miasm, and

attention paid to the accessory circumstances, § 5) be the symptoms alone by which

the disease demands and points to the remedy suited to relieve it - and, moreover, the

totality of its symptoms, of this outwardly reflected picture of the internal essence of

the disease, that is, of the affection of the vital force, must be the principal, or the sole
means, whereby the disease can make known what remedy it requires - the only thing

that can determine the choice of the most appropriate remedy - and thus, in a word,

the totality of the symptoms must be the principal, indeed the only thing the physician

has to take note of in every case of disease and to remove by means of his art, in order

that it shall be cured and transformed into health”.

4] A. K. Das writes, “Exciting causes are those which excite the acute conditions in

diseases. They are responsible for both acute diseases and acute exacerbation of

chronic diseases”.

5] A. K. Das writes, “The fundamental causes are those which are fundamental or

basically responsible for natural disease conditions in the human organism. They are

the three chronic miasms viz. Psora, Sycosis, and Syphilis”.

Exciting causes can act only because there is a fundamental cause, a miasm,

which has made the person morbidly susceptible to exciting causes

6] A. K. Das writes, “The maintaining causes are those which are responsible for

prolongation or maintenance of the disease process. It is one of the obstacles to cure.

The maintaining causes usually produce pseudo-chronic diseases”.

Without removal of causa occasionalis, permanent cure of the chronic disease

is not possible.

7] P. N. Banerjee writes, “One who understands Homoeopathy and has really

entered into its spirits knows, that the cause of the diseases is not outside the patient,

and that the so-called external circumstances that immediately precedes the disease
and looks like the cause is really an exciting cause only”. P. N. Banerjee writes,

“The true cause of the disease is in the patient himself”.

8] Hahnemann in §80 says that the Psora is the only real fundamental cause and

producer of innumerable forms of diseases.

9] Kent writes, “The active cause is within and the apparent cause of the sickness is

without”.

10]Allen opines, “The discovery of the chronic miasms by Hahnemann was a

deathblow to the erroneous conception of the etiology of disease, in his day, and it is

none the less true in our day, although a century of years lies between, and an army of

thinkers and investigators, along these lines have arisen, and many of them departed

this life since Hahnemann said that psora was the parent, or the basic element of all

that is known as disease. Since his day many an etiological structure has arisen, but to

fall with its own weight, or to be torn down and its debris removed to make room for

other structures no less endurable”.

11] Ortega states” It is a well-known fact that the master, after erecting the doctrinal

monument of Homoeopathy together with its corresponding curative technique,

observed in his own practice (which surely followed the principles of his method) that

the results, while relatively satisfactory, clearly preferable and superior to those of

old-school medicine, still left a large question mark with respect to relapses or the

emergence of new diseased states in the apparently cured patient That is, the later

persisted in a condition of relatively good health but had a tendency to manifest

periodic or successive syndrome or pathological states with a certain similarity or

relationship with one another. In other words, the really sick patients were seem to
pass through periodic or states of illness which appear distinct to the superficial

observer but in which careful examination disclosed a nexus of identity, a

characteristic connecting link; thus the apparently different illnesses presented by the

same sick person, as judged by his bio pathology, where infact linked by a

background which constituted predisposition to a characteristic form in respect both

to dysfunction and to the lesions themselves. This predisposition, whether

constitutional or merely a constant aspect of organic man which persists in the form of

its expression, was called by Hahnemann: MIASM OR CHRONIC DISEASE.

12] P. N. Banerjee writes, “The true cause of the disease is in the patient himself”.

Hahnemann in §80 says that the Psora is the only real fundamental cause and

producer of innumerable forms of diseases.

Kent writes, “The active cause is within and the apparent cause of the sickness is

without”.

13] Dr. J. T. Kent: In his philosophy explains that Psora is the beginning of all

physical sickness. Had psora never been established as a miasm upon the human race,

the other two chronic diseases would have been impossible, and susceptibility to acute

diseases would have been impossible. All the diseases of man are built upon psora,

hence it is the foundation of sickness, all other sickness came afterwards.

In health vital force; the life principal rules with unbounded sway; animates

the materials body and is responsible for the normal sensation and function. But when

this expression is changed and there is a sense of discomfort; then the disease state

prevails. There are many things that cause diseased state.

14] Dr. N. Ghatak: States that, Samuel Hahnemann said that, “psora is the real cause

of all the diseases that all diseases are only temporary out burst of “latent psora”. But

what is psora what is essence It is a condition of the physical body, brought on by

evil thinking, and is the prime cause of all the varied illness of mankind. It is that

acquired condition which is now inherent in human life force and which gives that life

force the tendency for disease. There are two other things (miasm) besides psora. To

make man ill and they are sycosis and syphilis. They cannot attack the human body

and make man ill, unless psora is already there.

15] Allen adds, “Hahnemann has recognized 3 special forms of which Hahnemann

has designated as psora, syphilis and sycosis. This triune of the subconscious force

also called chronic miasmatic are the vicarious embodiment of the internal disease,

each having its own peculiar type or character by which its sole purpose and effect is

to confirm the organism to its nature. Each of these forces becomes a creative force

and at no time is the life force able to free itself from the bond of any of them (either

alone or in combination with others), without some other assistance.

16] Stuart close quotes, Hahnemann regarding psora says” for thousands of years, it

has disfigured and tortured mankind; and, during the last centuries, it has become the

cause of thousands of incredibly different acute as well as chronic non- venereal

diseases with which the civilized portion of mankind becomes more and more

infected upon the whole inhabited globe”. He estimated that seven-eighths of the

chronic disease of his day was du to psora, the remaining eighth being due to syphilis

and sycosis.

17] Ortega explains “psora is undoubtedly the constitutional state of deficiency or

lack, in the sense of less, of inhibition, and with consequences as a deduced by

Roberts and confirmed by physiopathology. When the individual human, like the

individual cell, is inhibited, its modes of expressions are reduced it is poorly

nourished and becomes debilitated; we could also transpose these words and state that

what is debilitated and inhibited is poorly nourished. Deficiency or inhibition will

bring on a disposition to various immediate disturbances such as excess (in an attempt

to compensate deficiency) and perversion (intermingled with these alternations). ).

This is why Hahnemann had every reason to assure that psora is the basis condition of

all human pathology.

18] Dr. J. T. Kent describes as psora is the underlying cause, and is the primitive

or primary disorder of the human race. This state expresses itself in the forms of

varying chronic diseases, a chronic manifestations. If the human race had remained in

a state of perfect order, psora could not have existed. The susceptibility to psora opens

out a question altogether too broad to study among the sciences in a medical college.

It is altogether too extensive for it goes to very primitive wrong of human race, the

very first sickness of human race, that is spiritual, sickness from which first state the

race progressed into what may be called the true susceptibility to psora, when in turn

laid the foundation for other diseases. He further says, ‘as the life of man or as the

will of man so is the body of man, and as the two make one in this world, there is

evolved from him as aura which is vicious in proportion to his departure from virtue

and justice into evils, from thinking that which is false and making life one

continuous heredity of false things, and so this from of disease, psora is but an

outward manifestations of that which is prior in man’.

SUSCEPTIBILITY:

19] Dr. J. T. Kent: Explains ‘In contagion there is particularly but one dose

administered, or at least that which is sufficient to cause a suspension of influx. When

cause ceases to flow in a particular direction it is because resistance is offered for

causes flow only in the direction of least resistance and so when resistance appears

influx ceases, the cause no longer flows in. Now in the beginning of the disease i.e. in

the stage of contagion, there is a limit to influx, for if man continued to receive the

cause of disease (if there is no limit to its influx) he would receive enough to kill him,

for it would run a continuous course until death. But when susceptibility is satisfied,

there is a cessation of cause, and when cause cease to flow into ultimate, not only do

the ultimately cease, but cause itself has already ceased. Hahnemann states that we

have more power over human being with drugs than disease cause, for man is only

susceptible to natural diseases are a certain plane. Disease causes existing as they do

as immaterial substance flow into man inspite of him. He can neither control nor resist

them and they make him sick. But certain changes occur in the economy that bar out

any more influx.

But cure and contagion are very similar and the principles applying to one to

the other. There is this difference, in the cure we have advantage of change of

potency, and this enables into suit the varying susceptibilities of sick man. Because of

these varying degree of susceptibility some are protected from disease cause and some

are made sick, the one who is made sick is susceptible to the disease cause accordance

with the plane he is in and the degree of attenuation that happens to be present at the

time of contagion. The degree of disease cause, fit his susceptibility at the moment he

is made sick. But it is not so with medicines. Man has all the degree of potentisation

and by these he can make a changes and there are by fit the medicine to the varying
susceptibility of man in varying qualities or degrees. Hence Hahnemann writes

‘Medicine appear to have greater power in affecting the state of health than the natural

morbific irritation for natural diseases are cured and subduced by appropriate

medicines’.

20] Dr. H. A. Roberts: Opines that, ‘In analyzing susceptibility, we find it is

very largely as expression of a vaccum in the individual. This is illustrated by the

desire for food. The vaccum attracts and pulls for the things most needed, that are on

the same plane of vibration as the want in the body.

Susceptibility varies in degree in different patients and at different times in the

same patient. Homoeopathic application of a remedy is an illustration of meeting the

susceptibility and filling the vaccum that is present in the sick individual call around

for something to meet the need. The proving of the remedy on a healthy individual

gives on the basis of similarity of remedies to sick individual because on a proving the

remedy produces an artificial susceptibility similar to the susceptibility of the sick

individual. The application of the homoeopathic remedy in sick men satisfies the

natural susceptibility. No matter how little reaction of the remedy develops in the

proving on a healthy individual, the susceptibility so that it fully satisfied the morbid

condition. This satisfaction is based on a universal law governing the symptomatically

similar remedy. A patient may be susceptible to a number of remedies, but the

greatest susceptibility is manifest in the most similar in other words, the similimum.

They would be influenced somewhat, however, by the nearly similar.

Susceptibility can be increased, diminished or destroyed. It therefore becomes

a state of lowered resistance or attraction.

21] Stuart close: “By susceptibility we general quality and capability of the living

organism of the receiving impressions, the power to react stimuli”

Susceptibility is an inherent capacity in all living things to react to stimuli in

the environment and represents a fundamental quality that distinguishes the living

from nonliving.

Susceptibility can be increased, diminished or destroy. It therefore becomes a

state of lowered resistance or attraction.

Normal susceptibility leads to a state of good healthy characterized by good

nutrition and a healthy outlook on life abnormal susceptibility, on the other hand,

affects them in the first instance and interferes with the processes of adaptation and

there by leads to development of disease. Thus signs and symptoms furnish the only

indication.

INDIVIDULISATION :

22] Robert Quotes. “No two individuals are alike, the development of the vital

energy in one differs from that in another. Each one possesses a special personality &

a special psychaphysical construction which is determined by the interplay of

hereditary tendencies & factors of disease.”

23] Gibson Miller Mention, “ Homoeopathic treatement is a much more specific

&personal matter than mere routine prescribing by label, which is based on common

symptoms without consideration of individual variability In response” According to

Kanjilal, “ The homoeopathic treatment must never be directed to any of these

isolated clinical entities, but to the whole totality of symptoms, individualized by

some peculiar characteristic symptom by which a particular disease condition of the

vital force of the individual patient manifests it self ”

The concept of totality of symptoms & the principle of individualization,

together, permit the Homoeopathic physician to perceive the disease in a manner

suitable for homoeopathic prescribing.

24] Totality of symptoms:

In aphorism 17 and 18 Hahnemann stresses the importance of totality of

symptoms. He says that physician only needs to remove the totality of symptoms in

order to cure the disease and totality of symptoms is the only indication and guide to

the selection of the remedy.

According to Hahnemann, the totality of symptoms in a case means a group of

related symptoms, not expressing the disease so much as expressing the individual

who suffers. Homeopathy takes more to account the patient that has the disease than

the disease affecting the individual. As every man is unique by reason of his

individuality so is every patient who is nothing but a diseased man. In medicine we

are concerned with the individuals, though we need the knowledge the general

concepts for the comprehension of the individual. An individual is never without his

universal or general aspects. Human beings are not found anywhere in nature; there

only individuals. The individuals differ from the human being because he is concrete

event. Individuality gives in our uniqueness. Individuality causes every man to be

himself and nobody else.

According to aphorism - 153 - “one should look for the more striking,

singular, uncommon and peculiar (characteristic) signs and symptoms of the case of
disease are chiefly and most solely to be kept in view; for it is more particularly these

that very similar ones in the list of symptoms of the selected medicine must

correspond to, in order to constitute it the most suitable for effecting the cure”.

Aph - 195 - In order to effect a radical cure in such cases, which are by no

means rare, after the acute state has pretty well subsided, an appropriate antipsoric

treatment (as is taught in my work on Chronic Diseases) must then be directed

against the symptoms that still remain and the morbid state of health to which the

patient was previously subject. In chronic local maladies that are not obviously

veneral. The antipsoric internal treatment is, moreover, alone requisite.

25] Dr. Stuart Close: Defines,‘The totality of symptoms means all the symptoms of

the case which are capable of being logically combined into a harmonious and

consistent whole, having form, coherency and individuality.

26] Dr. J. T. Kent:Describes, the totality of the symptoms means a good deal. It is

wonderfully broad thing. It may be considered to be all that is visible and represents

the disease in the disease in the disease in the natural world to the eyes, the touch and

external understanding of man. It is all that enable the physician to individualize

between disease and between remedies the entire representation of a disease is the

totality of the symptoms.

Direction of Cure:

27] Allen says, “ It is the sick persone that is to be treated, not the pathological name.

It is the disturbance of the inner processes of life to which we are to look, and not

alone to the outer processes; for the inner processes govern the outer, as the outer

manifestation is but an outward expression of the inward process ”.

28] Roberts writes, “Cure takes place from above downward, for within outward,

from an important to a less important organ; symptoms disappear I the reverse order

of their appearance, the first to appear being the last to disappear”.

29] Predisposition:

A predisposition is a bad habit and in habitual condition formed in a life force,

which has been under the prompting of some subversive force that has been for years,

often through generation of miasmatic action and the changes that are common to its

subversion.

To be predisposed to a thing is to have a weakness in that direction

beforehand, or in other words, we have within us a sort of attribute (perverted of

course) of weakness that predisposes us to certain diseases or conditions of life.’

“Homoeopathy considers the morbid vital process in living organisms which

are perceptibly represented by symptoms, irrespective of what caused them.

Homoeopathy is concerned only with disease per se. that is its primary, functional, or

dynamic aspect, not in its ultimate and so called pathological results. With this we

have nothing to do; these are not in any sense the disease hut are the result of disease

conditions. Therefore we must distinguish between the primary functional symptoms

which represent the morbid process itself, the secondary which represents the

pathological and products of disease.” “Functional symptom always precedes

structural changes”. In biology, “function creates and develops the organ”. In disease,

function, effort of vital energy to function under the adverse circumstances, precedes

and develops the pathological states.

 Homoeopathy is not concerned with the morbific agents any more than it is

with the tangible product or the individual and purely functional side disease, upon

disease itself, where we can perceive the sphere of homoeopathy. Thus from this view

disease is a constant change of functions and a transformation as long as life lasts.

Thus homoeopathy operates only in the dynamic sphere. Directly homoeopathy has

nothing in common with the physical cause or product of disease but secondarily it is

related.

We have learnt that disease works from centre to circumference, and that is

what starts the central wheels in motion, along lines contrary to law and in opposition

to life and health and to so persists as to include all there is in disease, even to

destruction and death of organism. It is this power that we claim is the true aetiology

of the disease; it is this power that we claim you become acquainted with when you

become familiar with the character and origin of the chronic miasms.

Disease endings are found in its pathology, but the beginnings of it no man

see, except as he sees it through law and knowledge of the nature of the chronic

miasms. Man as integral units the basic unit of life mind and body. Harmony between

these three is health and deviation leads to disease.’

The derangement of immaterial vital principle is the very beginning of the

disorder and that this beginning there are changes in sensation by which man know

this beginning, which occurs long before there is any visible change in the material

substance of the body.’

Homoeopathic Medicines Used Oftenly

Homoeopathy offers a better treatment for sciatica Homoeopathy is a truly

holistic medicine and seeks to restore the patient to health in the gentlest, most

efficient and permanent way possible. Homoeopathy treats the whole person by

addressing all aspects such as attitudes,mental state,behaviours,sleeping

patterns,lifestyles and symptoms of disease of the individual. Homoeopathy

recognizes that symptoms of ill health are expressions of imbalance in the whole

person. It treats all symptoms as one, which in practical terms means that it addresses

the cause, not just the symptoms.Homoeopathy can provide miraculous relief from

this nervous pain without sideeffects by controlling the inflammation and infection of

the nerves.It favours enhancement of neuron regeneration/reduction of disc

bulge/ruling out other causes to revive impinged nerve.Homoeopathy has numerous

remedies for treating sciatica.

1] ACONITE: The congestive variety of sciatica from exposure to colds,

dampness and from suppressed perspiration indicates Aconite. There is much

numbness, perverted sensation, pricking and a sense of coldness in the parts,

especially toes. The pains are very severe and worse at night; the patient is restless,

there is tingling along the affected nerves.

2] CALCAREA FLOUR: Lumbago from strains. Cracking in joints. Osseous

tumour on spine or scapula. Osseous growths and enlargements of bone with or

without caries, particularly of traumatic origin.

Backache simulating spinal irritation, with weak, dragging, down-bearing pain. Tired

feeling and pain in the lower part of the back (sacrum), with a sensation of fullness or

burning pain, and confined bowels. Chronic cases of lumbago; aggravated on

beginning to move and ameliorated by continued motion.

CALCAREA FLOUR: Chronic lumbago; aggravated on beginning to move, and

ameliorated on continued motion. Osseous tumours. Rachitic enlargement of femur

in infants. Pain lower part of back, with burning.

<during rest, changes of weather >heat, warm applications.

3] GNAPHALIUM: Gnaphalium is one of our great standbys in the treatment of

sciatica and lumbago. The pain along the course of the sciatic nerve and its larger

ramifications is intense. Numbness is generally associated with this pain. In

Gnaphalium, the leg feels cramped and has got to be drawn up. The pain is worse in

cold and damp weather.

4] KALI CARB: We must not forget the backache in Kali carb, a symptom worth its

weight in gold. The backache is associated with weakness and profuse sweating. The

patient constantly speaks of his back as giving out. This is so bad while walking that

he feels like lying down in street to obtain relief. It is pressing in character and is

relieved by rubbing. It feels like a heavy weight in pelvis. The pain shoots down the

glutei muscles into the buttocks and thence through the thigh into knee and even

downwards.

5] KALI CARB: The characteristic weakness of all potassium salts is seen in this

with soft pulse, coldness, general depression, characteristic stitches, which may be felt

in any part of the body, or in connection with any affection. Sensitive to atmospheric

changes and intolerance of cold. Sweat, backache and weakness. Tearing pain in

limbs with swelling. Limbs sensitive to pressure. Giving out sensation. Small of

back feels weak. Severe backache during pregnancy and after miscarriage. Lumbago
with sudden sharp pains extending up and down back and to the thighs. Back and

legs give out. Soles are very sensitive. Pain from hip to knee.

< after coition, in cold weather, in morning about 3 O’ clock, lying on left and painful

side. > in warm weather, though moist; during day, while moving about.

6] RUTA: Ruta is indicated in sciatica where pain is very deep seated and feels as if

it is in the marrow of the bone. There is generally a history of injury and contusion.

Dewey writes, Ruta also has shooting pains down the back, down the sciatic nerve on

first moving or on rising after sitting; the patient is obliged to walk about constantly

during the paroxysms of pain. The pains are felt most in the region of the knee. It is

worse during damp or cold weather and from cold application.

7] SILICEA: 'Caries of bone' in any part of the body, but especially of the small

bones of the ear, nose and mastoid process. In childhood the bones become softer and

even necrose or there is an inflammation of the periosteum and a consequent necrosis.

Caries of the shaft of the long bones, the head of the bones and the cartilagenous

portions; abscesses in the cartilages, enchodromata. Bones breakdown and form

fistulous openings. Necrosis of the jaw, the joints, the hip joint, the tibia, necrosis of

the spine, of the vertebrae, so that there is curvature of the spine, lateral

especially. The homoeopathic physicians may treat these affections of the bones with

the help of accessory contrivances or supports.

8] CALC CARB: There are spine symptoms; plenty of them. Weak; all degrees of

weakness. The calcarea patient is so weak in the back that he slides down in the chair

while sitting; cannot sit upright in his chair. A weak spine, a sensitive spine, and the

glands of the neck are swollen.

Again a marked condition of the spine is where the lime element is deficient, and we

soon get the deformity; curvature.

9] FLOURIC ACID: It is suitable after Silicea in the spinal affections that are

attended with paralysis, trembling and numbness in the soles of the feet. It will often

stop the progress of structural nervous diseases and prevent the cases from getting

worse.

10] RHUS TOX: Rhus tox acts particularly on fibrous, muscular and cellular tissues.

The muscles are stiff and sore. This may be of a rheumatic character or may have

been induced by straining, by heavy lifting or severe muscular exercise of any kind or

it may have been brought on by exposure to cold, especially wet cold. This strained

condition may not be confined to the muscles alone, but may involve the tendons,

ligaments and membranes of the joints. Several affections of the muscles of the back

and even the spinal membranes (myelitis) may come on from sprain, or by exposure,

by sleeping on damp ground or in bed with damp sheet or getting wet in a rain storm.

Indeed Rhus tox is one of our best remedies in lumbago. If the great characteristic

'Lameness and stiffness and pain on first moving after rest, or on getting up in the

morning, relieved by continued motion', is present Rhus is the first remedy to think of.

11] ARNICA: It is especially suited to cases when any injury, however remote,

seems to have caused the present trouble. After traumatic injuries, overuse of any

organ, strains. Sore, lame, bruised feeling. Pain in back and limbs, as if bruised or

beaten. Sprained and dislocated feeling. Soreness after overexhaustion. Everything

on which he lies seems to be hard. Rheumatism begins low down and works up.

< least touch, motion, rest, wine, damp cold. > lying down or with head low.
Dewey writes, Arnica is also remedy for sciatica due to over-exertion. The acute

pains are followed by a sensation as if bruised.

12] NAT MUR: Great debility; most weakness felt in the morning in the bed.

Coldness. Oversensitive to all sorts of influences. Pain in back with desire for

some firm support. Every movement accelerates the circulation. Palms hot and

perspiring. Numbness and tingling in fingers and lower extremities. Painful

contraction of hamstrings. Coldness of legs with congestion to head, chest and

stomach.

< noise, music, warm room, lying down; about 10 am, at seashore, mental exertion,

consolation, heat, talking.

> open air, cold bathing, going without regular meals, lying on right side, pressure

against back, tight clothing.

13] SEPIA: It acts best on brunettes. Weakness, yellow complexion, bearing down

sensation, especially in women, upon whole organism it has most pronounced effect.

Pains extend down to back, chills easily. Feels cold even in warm room. Weakness

in small of back. Pains extend into back. Coldness between shoulders. Lower

extremities lame and stiff, tension as if too short. Heaviness and bruised feeling.

Restlessness in all limbs, twitching and jerkings night and day. Coldness of leg and

feet. < forenoons and evening, washings, laundry work, dampness, left side, after

sweat; cold air, before thunderstorm. > by exercise, warmth of bed, hot applications,

drawing limbs up, cold bathing, after sleep.

14] HYPERICUM: The great remedy for injuries to nerves, especially of fingers,

toes and nails. Excessive painfulness is a guiding symptom to its use. Punctured

wounds. Coccydynia. Neuritis, tingling, burning and numbness. Constant

drowsiness. Pressure over sacrum. Spinal concussion. Coccyx injury from fall, with

pain radiating up spine and down limbs. Cramps in calves. Neuritis with tingling

burning pain numbness and flossy skin. Traumatic neuralgia and neuritis.

< in cold, dampness, in a fog, in close room, least exposure, touch. > bending head

backward.

15] PHOSPHORUS: Tall, slender persons, narrow chested, with thin, transperant

skin, weakened by loss of animal fluids, with great nervous debility, emaciation,

amative tendencies, seem to be under the special influence of phosphorus. Great

sensitiveness to external impressions. Paralytic symptoms. Ataxia and adynamia.

Burning in back; pain as if broken. Heat between shoulder blades. Weak spine.

Weakness and trembling, from every exertion. Arms and hands become numb. Can

lie only on right side. Joints suddenly give way.

Burning in back; pain as if broken, heat between the shoulder blades. Weak spine.

< touch, physical and mental exertion, twilight, warm foods and drink, change of

weather, from getting wet in hot weather; evening; lying on left or painful side; during

a thunderstorm; ascending stairs. > in dark, lying on right side, cold food, open air,

washing with cold water; sleep.

16] COLOCYNTH: The most important remedy in sciatica, corresponding to worst

cases. There are pains in the sciatic nerve extending to knee or to the heel, worse

from any motion, and especially aggravated by cold. Pain is paroxysmal followed

by numbness and partial paralysis. There is a sensation which has been found

described as if thigh were bound with iron bands, or as thought screwed in a vise; the

muscles are fearfully tensed and fixed. Particularly is the right side involved.

Stitches during the walking. Sensation of constriction around the hip. Pains too may
come suddenly and leave suddenly, they may be sticking and burning, and all are

worse from cold and damp and at night, when the patient can find no easy position for

the limb. Colocynth typifies sciatica due to nerve changes with no special

inflammatory conditions attending it.

Sciatica left side drawing tearing pain better pressure and heat; worse gentle touch.

Pain down the right thigh; muscles and tendons feel too short; numbness with pains.

< from anger and indignation > doubling up, hard pressure, warmth, lying with head

bent forward.

17] AMMONIUM MURIATICUM: Sciatica with aggravation of pain while sitting,

somewhat relieved by walking and entirely relieved by lying down. Pain in left hip as

if the tendons were too short. Legs feel contracted. Painful jerks, feet feel as if

asleep.

Icy coldness between shoulders; not relieved by warm covering, followed by

itching. Bruised pain in coccyx when sitting. Backache as if in a vise when sitting.

Sciatica worse sitting better lying.

It is especially adapted to fat and sluggish patients who have respiratory troubles.

< head and chest symptoms in morning, abdominal symptoms in afternoon

> open air.

18] ARSENICUM ALBUM: Weakness in small of back. Pain and burning in back.

Among these the all-prevailing debility, exhaustion, and restlessness with nightly

aggravation are most important. Great exhaustion after slightest exertion. Irritable

weakness. Degenerative changes. Trembling, twitching, spasms, weakness,

heaviness, uneasiness. Cramps in calves. Sciatica. Peripheral neuritis. Paralysis of

lower limbs with debility.

< wet weather, after midnight, from cold drinks or food. Right side.

> from heat, from head elevated; warm drinks.

19] SYPHILINUM: Sciatica worse at night; better about daybreak. Severe pain in

long bones. Redness and rawness between toes. Always washing hands. Muscles

contracted in hard knots. Utter prostration and debility in the morning.

< at night, sundown to sunrise, seashore, in summer.

> inland and mountains, during day, moving about slowly.

20] MEDORRHINUM: Pain in back, with burning heat. Legs heavy ache all night;

cannot keep them still. Ankles easily turn when walking. Burning of hands and

feet. Heels and balls of feet tender. Soreness of soles. Restless; better clutching

hands. A powerful and deep acting medicine, often indicated for chronic ailments due

to suppressed gonorrhoea. Chronic rheumatism. Great disturbance and irritability of

nervous system. Pains intolerable; tensive; nerves quiver and tingle.

< when thinking of ailment, from daylight to sunset, heat inland.

> at seashore, lying on stomach, damp weather.

21] NUX VOMICA: From its action on the spinal cord. Nux is frequently the

remedy in sciatica. It has lightening like pain, with twitching of the parts. Violent

pains, has to change position; pains shoot down into the foot, the limb is stiff and

contracted and the parts feel paralyzed and cold. Better when lying on the affected

side and from the application of hot water. Constipated bowels and sedentary habits.

The typical Nux patient is rather thin, spare, quick, active, nervous, and irritable. He

does and great deal of mental work. Very irritable, sensitive to all impressions.
Cannot bear noises, odours, light etc. Backache in lumbar region. Burning in spine;

worse 3-4 am. Must sit up in order to turn in bed. Sitting is painful.

< morning, mental exertion, after eating, touch, dry weather, cold.

> from a nap, in evening, while at rest, in damp wet weather, strong pressure.

22] KALIHYDRIODICUM: Kali hydrioidicum is indicated when the pains are

worse at night, and from lying on the affected side, and when the trouble is of

mercurial or syphilitic origin. Dewey writes, The pains calling for this remedy are

worse at night and from lying on the affected side, better from motion. When of

mercurial or syphilitic origin, it is well indicated and may help, but it is not a very

reliable remedy.

23] PLUMBUM: Plumbum also has lightening-like pains and in paroxysms. Pain

and cramps along sciatic nerve, and especially where atrophy is present.

24] PULSATILLA: This remedy typifies sciatica due to venous stasis and is useful

in the milder forms where there is a sense of fatigue and heaviness, flying attacks,

aching in loins and hips. Uterine sciatica. Here it is akin to such remedies as Sepia,

Belladonna, Ferrum, Sulphur, Graphites and Merc sol. Boericke writes, the

disposition and mental state are the chief guiding symptoms to the selection of

Pulsatilla. It is preeminently a female remedy, especially for mild, gentle, yielding

disposition. Sad, cries easily; weeps when talking; changeable, contradictory. Patient

seeks open air, always feels better there even though he is chilly. Suffering worse

from letting the affected limb hang down. Drawing, tensive pain in thighs and legs,

with restlessness, sleeplessness and chilliness.

< from heat, rich fat food, after eating, towards evening, warm room, lying on left or

on painless side, when allowing feet to hang down.

> open air, motion, cold applications, cold food and drinks, though not thirsty.

25] CAUSTICUM: Manifests its action mainly in chronic rheumatic, arthritic and

paralytic affections, indicated by the tearing, drawing pains in the muscular and

fibrous tissues, with deformities about the joints; progressive loss of muscular

strength, tendinous contractures. Left-sided sciatica with numbness. Paralysis of

single parts. Heaviness and weakness. Unsteadiness of muscles of forearm and hand.

Cannot walk without suffering. Rheumatic tearing pain in limbs; better by warmth,

especially heat of bed. Restless legs at night.

< dry cold winds, in clear fine weather, cold air; from motion of carriage.

> in damp wet weather, warmth, heat of bed.

26] BELLADONNA: Here the inflammation is high and the pains come on

suddenly. There is a neuritis and the course of the nerve is sensitive; the pain is

especially severe at night, the parts are sensitive to the touch, the least concussion or a

draft of air aggravates. Severe lancinating pains coming on in the afternoon or

evening; has to change position often; worse from motion, noise, shock or contact;

cannot bear the clothing to touch him. Relieved by letting the limb hang down,

warmth and the erect posture.

27] VALERIANA: Rheumatic pain in limbs. Constant jerking. Heaviness.

Sciatica; pain worse standing and resting on floor; better walking. Pain in heels when

sitting. Hysteria, oversensitiveness, nervous affection, when apparently well chosen

remedies fail. Hysterical spasms and affections generally.

28] LYCOPODIUM: Pain in small of back. Numbness, also drawing and tearing in

limbs, especially while at rest or at night. Heaviness of arms. One foot hot and other

cold. Sciatica worse on right side cannot lie on painful side. Hands and feet numb.

Limbs go to sleep. In nearly all cases where Lycopodium is the remedy, some

evidence of urinary or digestive disturbance will be found. Lycopodium is adapted

more especially to ailments gradually developing functional power weakening with

failure of digestive powers. Worse 4-8 pm. Craves everything warm. Lycopodium

patient is thin withered full of gas and dry. Lacks vital heat; has poor circulation, cold

extremities. Pains come and go suddenly. Sensitive to noise and odours.

< right side, from right to left, from above downwards, 4-8 pm, from heat or warm

room, hot air, bed, warm applications.

> by motion, after midnight, from warm food and drink, on getting cold, from being

uncovered.

29] LACHESIS: Neuralgia of coccyx, worse rising from sitting posture; must sit

perfectly still. Pain in neck, worse cervical region. Sensation of threads stretched

from back to arms, legs, eyes etc. Sciatica right side better lying down. Pain in tibia.

Shortening of tendons. Great loquacity, amative, sad in the morning, restless and

uneasy. Jealous. Suspicious. Religious insanity.

< after sleep, lachesis sleeps into aggravation, ailments that come on during sleep, left

side, in the spring, warm bath, pressure or constriction, hot drinks.

> appearance of discharge, warm applications.

30] MAG. PHOS: The great anti-spasmodic remedy. Cramping of muscles with

radiating pains. Neuralgic pains relieved by warmth. Especially suited to tired,

languid, exhausted subjects. Paralysis agitans. Sciatica: feet very tender. Darting
pains. General muscular weakness. Weakness in arms and hands, finger-tips stiff and

numb.

< right side, cold, touch, night > warmth, bending double, pressure, friction.

Dewey writes if the sciatica be in those of a hemorrhoidal constitution, Sulphur may

be the remedy. If dependent on vertebral disease then such remedies as phosphorus,

Silicea, Natrum muriaticum, and Sulphur will need to be prescribed according to the

symptoms. Nor should the tissue remedies be forgotten as many undoubted cures

have been made with Mag. Phos and Kali phosphoricum.

REVIEW OF REPERTORIES
Kent’s repertory gives the following rubrics

Lumbar region: Aesc, Berb., Bry., Calc carb., Graph., Led., Nux v., Phos., Rhus

tox., Puls., Sep., Sulph., Vario. Etc.

Pain, Lumbar region, injury after: Kali carb.

Pain, Lumbar region, extending legs, down the: Agar,Berb,Kali carb,Lyc,Plat,Sil

Pain, Lower limbs, sciatica: Acon, amm-m, ars, bell, Bry., Bufo., calc, caust,

Coloc. gnaph, gels, Iris., Kali iod., lach, lyc, Mag phos, merc, Nux vom., phos, petr,

puls, Rhus tox., ruta, sepia, Tell. Etc.

Pain, Lower limbs, sciatica, morning: Arg-n, ars, bry, kali-bic,sulph.

With numbness: Gnaph, colo, phyt, rhus-t.

Injury,after: Arn, hyper

Motion,agg:Aco, Bry, calc, colo, cocc, gnaph, guaj, kali-c, lyc, Rhus-t,.

Motion, ame: Bry,calc, colo, cocc, Ferr, gnaph, guaj, kali-c ,lyc, Rhus-t,. ruta,sepia.

Move,on beginning to: Gels, Rhus-t, ruta, thuj.

Sitting,agg: Am-m, berb, bry, colo, Kali-bi, Lyc, merc, ruta, sep, valer.

Walking agg: Bar-c,berb,chin-s,colo,ign,lach,led,sulph.

Walking ame: Agar, am-m, colo, Ferr, kali-bi, kali-i, Lyc, Rhus-t.

Boger’s repertory gives following rubrics.

Lower extremities

Sciatica,ischias antica:Aco, ars, Bell, bry, canth, cham, coff, colo, gels, gnaph, Iris,

Kali-bi, Kali-s lach, led, lyc, nat-s, nux-v, phyt, puls, Rhus-t, ruta, sep, tel, Zinc.

Chronic:Am-m, gels, lyc, nat-m, plb.

Left: Am-m, cimi, colo, cup-p, iris, kali-b, led, pul, sulph.

Right: Bell,dios,graph,kali-io,lyc,phyt.
F.soles: Ars,calc-c,Kali-c,merc.
 METHODOLOGY

This Clinical study was undertaken at HKE Society’s Homoeopathic Medical

College & Hospital Gulbarga from 1 December 2007 to 30 November 2009.

Sciatica cases were been collected from the following source of data for study

1. H.K.E.Society’s Homoeopathic medical college, OPD.

2. H.K.E.Society’s Homoeopathic Medical College, District Government

Homoeopathic and Ayurvedic, OPD, IPD Gulbarga.

3. H.K.E.Society’s Homoeopathic Medical College, OPP Tirandaz Theatre

Gazipur OPD.

4. H.K.E.Society’s Homoeopathic Medical College, Gunj OPD.

5. H.K.E.Society’s Homoeopathic Medical College MayaMandir OPD Near

Prakash Theatre Super Market, Gulbarga.

6. H.K.E.Society’s Homoeopathic Medical College, Rural Campus, Gulbarga.

Thirty Sciatica patients from age group of above 40 years and both the sexes,

chosen by simple random sampling technique, were studied.

Advanced cases with extreme pain, wasting and/or bladder involvement, as

well as cases of lumbar canal stenosis needing surgical intervention are excluded.

Advanced cases with severe disc prolapse were also excluded.

The data was collected by interrogation and physical examination of the

patient and by X-ray of the Lumbosacral spine.

 Case taking was done according to the Case Proforma in Annexure-I with

special emphasis to ascertain the following points.

1. Preliminary data: The name, age, sex, religion, occupation, address,

socioeconomic status of the patient with date of first consultation were

recorded.

2. Chief complaints with duration: The chief or presenting complaints of the

patient were recorded in brief in chronological order.

3. History of presenting complaints: The complaints with exact duration have

been recorded with emphasis upon their probable causative factor, mode of

onset, modalities and concomitants

4. Past History: History of any similar complaints and their treatment was

recorded. Any other complaints were recorded in chronological order with the

nature, treatment and result of treatment to understand the miasmatic cleavage.

5. Family History: Detailed family history was taken to find the incidence of

similar complaints or any other acute or chronic diseases in the family to

evaluate the miasmatic cleavage

6. Personal History: All generalities of the patient, to relate as a whole were

recorded with special emphasis to thermals, mental reactions, desires and

aversions, aggravation with food and food habits, appetite, thirst, bowel

movements, perspiration, sleep, dreams, findings of observation and

examination . and more importantly history of any occupational hazard was

enquired.
7. Life space investigation: Life space of the patient was studied in detail. The

order of birth, parent’s occupation, financial status of parents, childhood life

including childhood illnesses and maladjustments, primary school life,

highschool life, college life, employment, marital life, major illnesses during

adolescence, setback in life, and other relevant information were noted.

8. General physical examination: The positive findings of the built,

nourishment and vital data were recorded.

9. Local examination: Examination of the back:

I. Inspection: Postural abnormalities Present / absent.

Any swelling Present / absent.

II. Palpation:

Tenderness: Tenderness over the paraspinous muscles Present / absent.

Tenderness over lumbar vertebrae Present / absent.

Movements: All the movements of the spine flexion, extension, lateral

flexion and rotation are tested:

III: Clinical tests: These tests are based on the stretching of sciatic nerve over

the prolapsed disc:

Straight leg raising test (SLRT): Positive / negative.

Lasegue test: Positive / negative.

Femoral nerve stretch test: Positive / negative.

10. Systemic examination:

Central nervous system:

Examination of the spine:

Inspection of the back: Café – au –lait spots Present / absent.

Any swelling Present / absent.

Posture: Normal / deformity present (if present, type)

Gait: Normal / altered.

Palpation:

For tenderness:

Tenderness over paraspinous muscles Present / absent.

Tenderness over the lumbar spinous processes Present / absent.

Range of movements:

Forward flexion Normal / restricted.

Extension Normal / restricted.

Lateral flexion Normal / restricted.

Rotations Normal / restricted.

Tests for nerve root compression:

Straight leg raising test (SLRT): Positive / negative.

Lasegue test: Positive / negative.

Femoral nerve stretch test: Positive / negative.

Lewin supine test: Positive / negative.

 Neurological signs:

Motor testing: Normal / abnormal.

[The muscle strength of the following group of muscles is tested.

Quadriceps group (L2, L3 and L4.)

Extensor hallucis longus (L5)

Gastrocnemius (S1 and S2)

Peroneus longus and brevis (S1)]

Sensation: Present / lost.

[Sensation over the following dermatomes is tested.

L4 dermatome– medial aspect of foot and leg.

L5 dermatome– dorsum of foot and great toe.

S1 dermatome– lateral border of foot.

L2, L3, L4 dermatome– anterior aspect of thigh.

S1, S2, S3, S4 dermatome– perineum and rectal tone.]

Reflexes: Knee reflex – to test L4 nerve root.

Ankle reflex – to test for S1 nerve root.

11. Laboratory investigations: The following investigations were done:

1. Blood: Hb, TC, DC, ESR.

2. Urine: Routine and microscopic examination.

3. X-ray of the lumbo-sacral spine (AP & Lateral view)

4. CT Scan & MRI Scan in cases if necessary.

12. Diagnosis:

a. Basic and absolute manifestations with determinative symptoms of the

disease.

b. Determinative symptoms of an individual on the basis of totality of

symptoms.

13. Management:

a. Auxiliary

The examination of the patient with Sciatica identifies the pain picture,

precipitating factors at work or leisure, posture abnormalities, muscle spasm

and tightness, limitation of movements and the limiting factors, loss of

accessory movement and soft-tissue mobility by palpation.

Some of the auxiliary measures like absolute bed rest, hot fomentation

for the back, sleeping on a firm mattress, back care exercises, lumbar corsets,

lumbar traction, proper postural habits, and avoidance of lifting heavy

weights were advised to the patients depending upon the need.

Physiotherapy is directed at relief of pain, restoration of movement,

strengthening of muscles, education of posture, and analysis of precipitating

factors to reduce recurrences.

b. Homoeopathic

The following steps were followed for homoeopathic prescription.

i. Analysis and evaluation: After detailed case taking, the symptoms of the

patient were grouped into various categories like mental generals, physical

generals and particulars. After analysis, the symptoms were evaluated

 according to the order of their importance like mental general I grade, II

grade, III grade, and particular I grade, II grade and III grade.

ii. Repertorization: The symptoms were then taken for repertorization and

were repertorized according to Kent’s method by Hompath or RADAR

software.

iii. Selection of the remedy: The selection of the remedy was done on totality

of symptoms of the patient and on repertorization.

iv. Acute remedy: The acute remedy was given whenever the patient presented

with acute symptoms and during acute exacerbation of chronic disease.

v. Intercurrent remedy: Intercurrent remedy was given when a miasmatic

block / constitutional block was suspected, indicating obstruction to the

action of the indicated remedy which was tried in various potencies and with

appropriate repetition

vi. Constitutional remedy: The constitutional remedy was determined from the

totality of the characteristic symptoms of the patient i.e., mental generals,

physical generals and characteristic particulars.

vii. Potency: Indicated medicine was prescribed in the 200th potency initially, it

was repeated in plus potency when there was no further improvement or

when there was a relapse of symptoms. Higher potencies were considered

when the lower potencies failed to give relief.

14. Follow up: All cases were reviewed once in 7/15 days and on as needed basis

over a period of six months.

15. Parameters: The following parameters were fixed according to the type of

response obtained after treatment .

a) Recovered: Feeling of mental and physical well being and if old

symptoms disappeard and no occurrence of new symptoms observed

for a period of 6th months.

b) Improved: Feeling, of mental and physical well being along with the

disappearance of the old symptoms and considerable reduction in the

appearances of new complaints.

c) Not improved: No response.No reduction of frequently of the episode

and further deterioration of the condition.

 RESULTS

The results of this clinical study are as follows:

The incidence of Sciatica was highest in the age group of 45-54 yrs 11

cases (36.66%); followed by age groups 35-44 yrs 7 cases (23.33%); 25-34 yrs 7

cases(23.33%) 55-64 yrs 3 cases (10%); 65-74 yrs 2 cases (6.66%);

In this study, the incidence of Sciatica was more in females 21 cases

(70%) than in males 9 cases (30%).

The acute remedies were given in 23 cases, Rhus tox in 11 cases (36.66%);

Gnaphalium 2 cases (6.66%); Calc flour 2 cases (6.66%); Hypericum 2 case (6.66%);

Ars alb 1 case (4.35%), Nat mur 1 case (4.35%);Cimcifuga 1 case(3.33%); Colocynth

1 case (3.33 %);Phosphorus 1 case (3.33%); Arnica 1 case (3.33%);

The constitutional remedies were prescribed in 19 cases:Calc carb 7

cases (23.33%);Nat mur 4 cases (13.33%);Sepia 3 cases (10% ); Kali carb 2 cases

(6.66%); Phosphorus 1 case(3.33%) ;Sulphur 1 case (3.33%);and Thuja 1 case

(3.33%).

The intercurrent remedies were used in 13 cases. Medorrhinum 2 cases

(15.38%); Carcinosin 3 cases (23.07%); Tuberculinum 4 cases (30.76%); Thuja 3 cases

(23.07%); Syphilinum 1 case (7.69%) .

Except in two cases, the auxiliary methods like application of hot

fomentation to the back, back care exercises, sleeping on a firm mattress, wearing a

lumbar corset were recommended in almost all cases.

Lastly, the outcome of this study was that out of 30 cases 10 cases recovered

(33.33%); 17 cases showed improvement (56.66%); and 3 cases did not show any

improvement (10%).
 DISCUSSIONS

The secrets of good health include a good posture, efficient breathing and

pain-free mobility of joints. Backache is one of the most common ailments prevalent

today. Most of us suffer from it at some time during our lifetime. Backache is “a

given” in today’s stress-driven life. It is now generally accepted that between 60%

and 80% of the general population will suffer from low backpain someday, and that

between 20% and 30% are suffering from it any given time. Backpain is now an

international health issue of major. significance.Sciatica is one commonest cause of

backache.

Sciatica is the term for pain that radiates along the sciatic nerve,anywhere

from the lower back,buttocks,down the back of the leg,to the foot. The discomfort can

be minimal or disabling may be accompanied by tingling, numbness or obvious

muscle weakness. Its intolerable intensity & recurrent nature make every sufferer

most worried unless one has suffered & conquered sciatica, they can not realize its

frightening, lightening pain.

The subjects of the study were selected from those patients with selected from

those patients with sciatica attending the OPD and village camps of H.K.E.’s

Homoeopathic medical college Gulbarga as per inclusion criteria.

A total of 30 cases were selected and presented in standardized case record. All the

cases were diagnosed based on the clinical history. Patients who had presented

conditions.Disc prolapse,trauma to the spine,spinal tumors,spondylolisthesis,lumbar

vertebral canal stenosis were excluded that of study.

1) Age incidence:

The maximum incidence was in the age group

45-54 yrs 11 (36.66%) cases

35-44 yrs 7 (23.33%) cases

25-34 yrs 7(23.33%) cases

55-64 yrs 3 (10%) cases

65-74 yrs 2 (6.66%) cases

As per the literature the incidence of sciatica is high in age group of above 30

yrs. This fact of literature was found to be correlating with that of this study.

2) Sex incidence:

Out of 30 cases the incidence of sciatica was more in females 21 (70%) cases

than in males 9 (30%) cases.As per literature,it was found to be correlating with that

of study.

3) Past History:

Gunvante says diseases in individuals remain latent exacerbate, change place,

from one organ to another or take a serious turn, depending upon their vital force,

susceptibility, environment, exciting cases, nutritional state, mode of living and

exposure to harmful influences and the wrong medical treatment undergone. In

chronic diseases all these, aspects must be carefully examined, susceptibility is shown

by hereditary influences as well as the various illnesses the patient has suffered from

childhood, the nature, course and progress of diseases vary from person to person.

Personal and family history of serious illnesses is very relevant for this purpose.

In the study of 30 cases,Injury 9(30%) cases,Headache 5(16.66%) cases,Sinusitis

3 (10%) cases, tonsillitis 2 (6.66%) cases,and Hysterectomy 2(6.66%) cases.

4) Family History:

Miller says “In many old standing chronic cases, especially those that have

been long under allopathy treatment, these peculiar and characteristic symptoms have

simplicity disappeared, or have been so utterly forgotten, and that our difficulties are

there by increased, may it is even the case at times that the characteristics symptoms

may never have existed except in the patients ancestors and under these circumstances

cure is practically impossible.

The study showed highest incidence of Hypertension 7(23.33%) cases,

Tuberculosis 5(16.66%) cases, Diabetes mellitus 4(13,33%) cases, Heart diseases 3

(10%) cases, and disc prolapse 1(3.33%) case in the family.

5) Constitutional remedies:

Dr. Elizabeth wright writes Homoeopathy regards acute disease as an

eliminative explosion if handled in the proper homoeopathic manner leaves the body

in a health their condition. This does not mean that the acute disease should be

allowed to run its course, for if the symptoms are met at its inception, by the

similimum the disease will be aborted and yet the economy will be purified.

Chronic disease is not self-limited and shows no tendency to ultimate recovery

if untreated. This is the unique sphere of homoeopathy. Practically every one has

some symptoms of latent chronic disease and to the homoeopath chronic disease is the

basis of susceptibility. By taking the totality of the symptoms from birth on, a deep

acting, chronic constitutional remedy can be chosen which will aid in finding off

future acute disease and remove many inherited and acquired encumbrances to the

vital force.

30 cases were taken up for study the constitutional remedies: Calc carb 7 cases

(23.33%); Nat mur 4 cases (13.33%); Sepia 3 cases (10% ); Kali carb 2 cases
(6.66%); Phosphorus 1 case(3.33%); Sulphur 1 case (3.33%); and Thuja 1 case

(3.33%) were used.

6) Miasmatic Background:

Ortega the miasm are mixed are always together in the individual so that even

when this attitude and appearance correspond more to one of these fundamental

nodulations, he will still inevitably contain traits and some or more manifestations of

the other two, although at each stage of his life one of the three. Psora, sycosis or

syphilis will dominate.

7) Intercurrent remedy:

It so happens occasionally that a patient dos not react to the best indicated

remedy, the administration of certain remedies, has been found to help the patient to

shake off this “lack of reaction”.

The intercurrent remedies were used in 13 cases. Medorrhinum 2 cases (15.38%);

Carcinosin 3 cases (23.07%); Tuberculinum 4 cases (30.76%); Thuja 3 cases (23.07%);

Syphilinum 1 case (7.69%) were required.

8) Miasmatic background of the constitutional remedies.

In this study of 30 cases. The prescribed constitutional remedies covered

almost all the miasms.

9) Result of treatment

In this study certain parameters (mentioned below) were put to proclaim the

cases as recovered, improved or not improved.

Statistical study was done to know the results of the treatment of 30 cases
 Out of 30 cases maximum number of cases i.e., 10 cases accounting (33.33%) of

total showed recovery; 17 cases (56.66%) showed improvement; and 3 cases (10%)

did not show any improvement.

a) Recovered, feeling of mental and physical well being and no recurrence of the

complaints for the period of 9 months.

b) Improved, feeling of mental as well as physical well being along with

disappearance of the complaints and considerable reduction in the frequency

of the attack.

c) Not improved: No response, no reduction of frequency of occurrence of th

complaints even after defined period of treatment.

 CONCLUSION

The study of remedy profile used in sciatica taken up by me has been an

enlighten one in terms of fulfilling the aim and objectives of study and it has

broadened my perspective of the holistic treatment of this condition.

The result of this prospective study has proved that Homoeopathic medicines

along with auxiliary treatment can definitely render immense benefit to helpless

victims of various sciatica, when employed logically and judiciously within the fabric

of Homoeopathy, it will no doubt, encourage homoeopathic professionals to take full

advantage of the material presented here.

I arrived at the conclusion that constitutional treatment is very helpful in the

treatment of sciatica and it is the only way to see total improvement and recovery.

Homoeopathic management along with auxillary treatment have shown tremendous

results in most of the cases taken up for my study. There was a pause in the progress

of the disease and reduction in the severity and frequency of the complaints thus

improving the quality of life preventing any further complication.

The beneficial results obtained from this clinical study not only establishes the

views of the pioneers in the field of homoeopathy but also further augments the

meager and inadequate knowledge in the field and there by ushering greater

involvement of the researcher workers in this neglected area of therapeutics.

It would be unrealistic to expect that sciatica would be eliminated by treatment

unless auxillary treatment and psychological support in combined with the treatment.

In fact cases of sciatica are decreasing spontaneously as a result of improved

psychological support which involves reassuring the all patient are selected for the

study.
 SUMMARY

The secrets of good health include a good posture, efficient breathing and

pain-free mobility of joints. Backache is one of the most common ailments prevalent

today. Most of us suffer from it at some time during our lifetime. Backache is “a

given” in today’s stress-driven life. It is now generally accepted that between 60%

and 80% of the general population will suffer from low backpain someday, and that

between 20% and 30% are suffering from it any given time. Backpain is now an

international health issue of major significance.Sciatica is one commonest cause of

backache.

Sciatica is the term for pain that radiates along the sciatic nerve, anywhere

from the lower back, buttocks, down the back of the leg, to the foot. The discomfort

can be minimal or disabling may be accompanied by tingling, numbness or obvious

muscle weakness. Its intolerable intensity & recurrent nature make every sufferer

most worried unless one has suffered & conquered sciatica, they can not realize its

frightening, lightening pain.

Sciatic pain can make life miserable, walking, standing, bending over , driving

a car , working at a computer , catching up on household chores, sneezing or coughing

& many other activities of dailyliving can cause sudden & intense pain. Patients who

suffer sciatica, esp of a more acute nature, find the symptoms disrupt many aspects of

their life.

The sciatic nerve is the longest and largest nerve in the body measuring three-

quarters of an inch in diameter. The sciatic nerve originates in the sacral plexus; a

network of nerves in the low back. The Sciatic nerve is the thickest nerve in the body.

In its upper part is forms a band about 2 cm wide. It begins in the pelvis and
terminates at the superior angle of the popliteal fossa by dividing into the tibial and

common peroneal nerves.

Homoeopathy can provide miraculous relief from this nervous pain without any side

effects by controlling the inflammation and infection of nerves. Homoeopathy offers

some of the most effective remedies for the disorder on any level, physiological,

psychological etc.

Some of the prominent medicines are:Aco,Bell,Colo,Gnaph,Guai.Kali-carb,Calc-

carb,Lyco,Merc,Rhus-t,Sepia,Puls etc.

The objectives of the study are as follows :

1. To know which are the drugs having more affinity towards sciatic nerve.

2. To know the group of drugs towards curative effect according to individual case.

3. To know the efficacy of the Homoeopathic drugs in treating sciatica.

The 30 cases of sciatica were treated on the basis of inclusion and exclusion

criteria all females cases. The cases were recorded keeping the holistic concept in

mind.

Constitutional remedies used were, Calc-carb, Kali-c,Sepia,Nat-

mur.Sulphur,Thuja,Phos.Maximum prevalence for constitution were found to be calc-

carb after analyzing the result, out 30 cases, 10 cases recovered and 17 cases

improved and 3 cases not improved.

I arrived at the conclusion that constitutional treatment is very helpful in the

treatment of sciatica.

Homoeopathic medicines when given on constitutional basis along with

auxillary treatment and psychological support would bring beneficial results in the

treatment of sciatica.
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 ANNEXURE – I

ANNEXURES

CASE PROFORMA-I

H.K.E’S HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,

GULBARGA

Dr. Geeta H.

A STUDY OF REMEDY PROFILE USED IN TREATMENT OF

Sciatica

Under the Guidance of

Dr. S.S. JAMBALADDINNI.

CASE PROFORMA

Preliminary data:

Name:

Age:
 Sex:

Religion:

Occupation:

Address:

Socioeconomic status:

Date:

Chief complaints with duration:

History of presenting complaints:

Complaint with duration:

Probable cause:

Mode of onset:

Location:

Extension:

Modalities:

Concomitants:

1) Complaints with duration:

ƒ When did the symptoms commence?

2) Mode of onset:
 ƒ Slow and insidious / rapid or sudden

3) Location:

ƒ Site: Localized / diffuse.

ƒ Unilateral / bilateral.

4) Nature of pain:

ƒ What is the pain like?

ƒ Is the pain always present or disappear at times?

ƒ Unilateral / bilateral.

5) Radiation:

ƒ Does the pain radiate to legs?

ƒ If so, exactly how far does the pain go, and what area is involved? (the

commonly affected roots of the sciatic nerve L4, L5, S1 supply the skin below

the knee).

ƒ Is there Paraesthesia.

6) Modalities (factors which aggravate or alleviate the pain):

ƒ With mechanical low back pain, bending or sudden movement may make the

patient worse, while lying flat, particularly on a hard surface, or applying local

heat, or even sitting may relieve the pain.

ƒ In case of backache associated with spinal pathology, particularly in the case

of tumour, infections or inflammatory disease, the patient may be unable to

 find a position of rest; constant night pain (as distinct from short-lived pain

when turning in bed) is a feature.

7) Concomitants:

ƒ Has there been any malaise / fever / involvement of other joints?

ƒ Morning stiffness?

ƒ Has there been any weight loss?

ƒ Has the patient had any GI problem?

ƒ Has there been any genitor-urinary symptoms especially retention or

incontinence?

ƒ Has the patient had any respiratory difficulty?

ƒ Has the patient any symptoms suggestive of a major neurological disturbance?

Past history:

ƒ Intrauterine life:

ƒ Milestones of life:

ƒ Vaccinations:

ƒ Exanthematous fevers (measles, chickenpox etc.):

ƒ Childhood disorders:
 ƒ Adolescent disorders:

Family history:

Personal history:

Life space investigation:

General physical examination:

ƒ Built:

ƒ Head:

ƒ Eyes:

ƒ Oral cavity:

ƒ Neck:

ƒ Upper limbs:

ƒ Lower limbs:
Vital signs:

PR:

RR:

BP:

Temp:

Local examination:

Examination of the back:

II. Inspection: Postural abnormalities Present / absent.

Any swelling Present / absent.

II. Palpation:

Tenderness: Tenderness over the paraspinous muscles Present / absent.

Tenderness over lumbar vertebrae Present / absent.

Movements: All the movements of the spine are tested:

Flexion: Instruct the patient to bend forwards as much as possible at the waist.

(Normal flexion is 80° or fingertips 3-4 inches from the floor.)

Lateral flexion: Instruct the patient to bend to left and to the right as far as

possible. (Normal range is 35° on each side.)

Extension: Instruct the patient to bend at the waist as far backward as

possible. (Normal range is 20 to 30°.)

Rotation: Instruct the patient to rotate from the waist to the left and to the

right as far as possible. (Normal range is 45° per side.)

III: Clinical tests: These tests are based on the stretching of sciatic nerve over the

prolapsed disc:

Straight leg raising test (SLRT): Positive / negative.

Lasegue test: Positive / negative.

Femoral nerve stretch test: Positive / negative.

Systemic examination:

ƒ Central nervous system:

Examination of the spine:

Inspection of the back: Café – au –lait spots Present / absent.

Any swelling Present / absent.

Posture: Does the patient have a normal posture or whether posture is altered

due to deformities?

Gait: Observe for gait abnormalities if any?

Palpation:

For tenderness:

Tenderness over paraspinous muscles Present / absent.

Tenderness over the lumbar spinous processes Present / absent.

Range of movements:
Forward flexion Normal / restricted.

Extension Normal / restricted.

Lateral flexion Normal / restricted.

Rotations Normal / restricted.

Tests for nerve root compression:

Straight leg raising test (SLRT): Positive / negative.

Lasegue test: Positive / negative.

Femoral nerve stretch test: Positive / negative.

Lewin supine test: Positive / negative.

Neurological signs:

Motor testing: Normal / abnormal.

[The muscle strength of the following group of muscles is tested.

Quadriceps group (L2, L3 and L4.)

Extensor hallucis longus (L5)

Gastrocnemius (S1 and S2)

Peroneus longus and brevis (S1)]

Sensation: Present / lost.

[Sensation over the following dermatomes is tested.

L4 dermatome– medial aspect of foot and leg.

L5 dermatome– dorsum of foot and great toe.

 S1 dermatome– lateral border of foot.

L2, L3, L4 dermatome– anterior aspect of thigh.

S1, S2, S3, S4 dermatome– perineum and rectal tone.]

Reflexes: Knee reflex – to test L4 nerve root.

Ankle reflex – to test for S1 nerve root.

ƒ Respiratory system:

ƒ Cardiovascular system:

ƒ Gastrointestinal system:

Laboratory investigations:

ƒ Blood examination for Hb, TC, DC, ESR:

ƒ X-ray of the lumbo-sacral spine (AP & Lat):

ƒ Any other special investigations like CT scan & MRI:

Probable diagnosis:

Classification of disease:

Symptoms for Repertorization:

Reportorial result analysis:

Indicated remedy and dose:

Follow up:

Drug &
Date Progress Instructions
dose
 ANNEXURE-2

SYNOPSIS OF CASES

1. Mrs. Mumtaz Begum aged about 32 years presented with pain in lumbosacral

region. Her complaint started after injury. She says her backpain is worse on

beginning to move and in the morning after waking. She also cannot sit for a long

time in one position. It radiated to feet and is better on warm application. She has

a past history of repeated attacks of headache. Bowels are constipated. In

general, she cannot withstand cold. She has thirst for large quantities of water.

She gets annoyed easily. On examination, her back was tender and SLR test was

positive.X-ray of LS spine revealed Lumbar spondylosis. As her complaints

started after injury, she was given Arnica followed by Kali carb as constitutional

remedy. She was advised hot fomentation for pain; sleep on firm mattress, and

not to lift heavy objects. She showed remarkable improvement.

2. Mr. Srinivas Reddy. aged about 33 years presented with repeated attacks of

pain in lumbar region since 3 years. Backpain aggravated on sitting,lifting and

walking and ameliorated by pressure and lying down on back. Mentally he is

introvert. He desires warm and spicy food.Pain in throat with cough.Frequent

attacks of sneezing worse after taking cold water.History of recurrent apthous

ulcers. In general he wants warm weather. He gives a past history of

hypertension and is on allopathic medication since 7 years. Mother died of

Ca. of uterus. Father also has hypertension.On examination,SLR test was

positive. X-ray of the back revealed Lumbar spondylosis. He was given Rhus

tox as acute remedy followed by Calc carb as constitutional remedy.

 Carcinosin was given as an intercurrent remedy. He was advised hot

fomentation, back exercises, and proper sitting posture with full back support

in the office. He recovered completely.

3. Mrs. Venkatamma aged about 45 years presented with pain in lumbosacral

region and numbness of both legs and feet. She met with an accident 5 years

back. Backpain radiated to both feet. Backpain aggravated at night, on

exposure to cold and sitting for a long time and ameliorated by walking and

hot application. Mentally she is restless and anxious because of the pain. She

desires highly seasoned foods and does not like sweets. In general, she cannot

withstand cold weather. She has a family history of HTN. On examination,

SLR test was positive. She was given Gnaphalium as an acute remedy

followed by Sepia as constitutional remedy. She was also advised hot

fomentation for pain, lumbar corset, not to lift heavy weights. She showed

remarkable improvement.

4. Mrs. Shantamma aged about 30 Yrs presented with pain in lumbosacral

region.Back pain radiates to right lower limb.Back pain aggravated from

prolonged sitting,Difficult to stand from sitting position.Pulsating type of

pain.Back pain ameliorated by walking. In general, she cannot withstand cold

weather. Mentally she is restless and anxious because of the pain.Past history

of hysterectomy 12 Yrs back. He was given Rhus tox as acute remedy

followed by Calc carb as constitutional remedy. . She was also advised hot

fomentation for pain, lumbar corset, not to lift heavy weights. She showed

remarkable improvement.
5. Mr. Basawaraj aged about 46 years presented with pain in the lumbar region

radiating to both legs and numbness in both legs. He also c/o pain in cervical

region radiating to both hands. Backpain is aggravated on lying down and on

exposure to cold and ameliorated by sitting, walking, and pressure. Patient

met with an accident 7 years back. Appetite is decreased; thirst is increased,

and frequently suffers from gastritis. He has a family history of pulmonary

tuberculosis. He has weakness for memory and likes to be in company.ON

examination,SLR test was positive. He was given Phosphorus as

constitutional remedy and calc flour 6x to dissolve osteophytes. He was given

Tuberculinum as intercurrent remedy. He was advised hot fomentation, back

stretching exercises, proper sitting posture. He recovered completely.

6. Mr. Zakir Mustafa aged about 47 years, tailor by occupation, complained of

pain in the lumbosacral region. Backpain aggravated on exertion and

ameliorated by taking rest, lying on back. Mentally patient is very irritable.

He likes sweets and thirst is much. In general, he cannot tolerate cold

weather. He gives past history of repeated attacks of headache with a family

history of pulmonary tuberculosis in grandmother. X-ray showed small

osteophytes. He was given Rhus tox as an acute remedy followed by Calc

carb as constitutional remedy. Calc flour 6x was given for osteophytes

formation. He was also given Tuberculinum as an intercurrent. He was

advised proper sitting posture. He recovered completely.

7. Mrs Nagamma.S.Kalburgi aged about 36 Yrs,complained of pain in

lumbosacral region.History of trauma 10 Yrs back.Drawing type of pain

 radiating to left foot.Pain associated with numbness of left foot.Pain

aggravated from walking for 5 minutes and ameolirated by pressure and

walking In general,can’t tolerate extreme cold or heat. Pain aggravated from

lying on left side.Past history of recurrent UTI.Appetite reduced.Family

history of ca of cervix in mother from which she died and Koch’s in father.On

examination,SLR test was positive.X-Ray showed postero-central disc

protrusion seen at L4-L5 compressing thecal sac and nerve roots associated

with ligamentum flavum hypertrophy causing canal stenosis at L5-S1 level.He

was given Kali Carb. . He was advised hot fomentation, back stretching

exercises, proper sitting posture. He showed improvement.

8. Mrs. Saidabegum aged about 40 years presented with pain in lumbar region.

Backpain is worse sitting and better by pressure. Stiffness of back in the

morning. Backpain is worse before menses and better after menses. Mentally

patient is anxious, sad and brooding. She also complained of sleeplessness at

night. She gives a past history of sinusitis and family history of heart disease.

In general, she cannot tolerate hot weather. On examination, back was tender.

SLR was positive. She was advised hot fomentation and to sleep on a firm

mattress. She was given Natrum mur as constitutional remedy. She recovered

completely.

9. Mrs Uma Joshi aged about 35 Yrs complained of pain in the lumbar

region.Stiffness of back.Drawing type of pain from hip to feet,numbness of

feet.Pain in the heels,pulsating or stitching type of pain.Aggravation by

bending,walking,and sitting for prolonged time.In general,cannot tolerate

cold.Bony pains all over the body aggravation by touch.Mensus are scanty.She
 gives past history of scabies and urticarial rashes for which she has taken

treatment.Family history of throat cancer in mother.She was given

Cimcifuga.She was advised hot fomentation and to sleep on a firm mattress.

She showed improvement.

10. Mrs. Zareenabee aged about 35 years presented with pain and stiffness in the

lumbosacral region. Backpain is worse in morning, on lying down and sitting,

and is better on walking. She is obese with dark complexion. Mentally

irritable. She has profuse perspiration. Thirst is extreme. Menses is copious

and dark. She is constipated. Desires meat. Family history of joint pains. X-

ray of lumbosacral spine revealed Disc prolapse. She was given Calc carb as

constitutional remedy followed by Medorrhinum as intercurrent. She was

advised hot fomentation and not to lift heavy weights. She was also advised

on weight reduction methods. She did not show improvement.

11. Mr. Umesh aged about 36 years presented with pain in lumbar region which is

aggravated on sitting for a long time and ameliorated by rest. Also c/o

stiffness of back in the morning. Mentally he is irritable and reserved and

prefers to be alone. In general he is thirstless. He cannot tolerate cold in

general. He gives past history of recurrent attacks of cold and obstruction of

nose. He gives family history of HTN. On examination, back is tender. SLR

test was positive. He was also advised hot fomentation, back care exercises.

He was given Lycopodium as constitutional remedy . He recovered

completely.

12. Mrs.Seema Naikal aged about 33 Yrs presented with pain in the back.History

of fall with injury over right back 1 Yr back.Pain in the right side of coccygeal
 region.Drawing type of pain in both lower limbs.aggravation from sitting,lying

over back.Pain increased after delivery.Pain started in winter season.Cannot

tolerate both extremes of weather.Unsatisfactory stools,has to wait a long time

to pass stools.mensus profuse and irregular.Family history of DM in father.On

examination,SLR test was positive.She was given Hypericum. She was

advised hot fomentation and not to lift heavy weights. She was also advised

on weight reduction methods. She recovered completely.

13. Mrs. Mehboob Bee aged about 65 years presented with pain in lumbosacral

region which radiated to left leg and stiffness of back. Backpain is aggravated

on sitting and by cold weather ameliorated by lying down and pressure. She

gives history of repeated attacks of tonsillitis and headache from exposure to

cold. She also has high blood pressure. Mentally patient is irritable, anxious

about health. Cannot tolerate cold weather in general. She gives family

history of hypertension in mother. She was given Rhus tox as acute and Calc

carb as constitutional remedy. She was given Thuja as intercurrent and she

was also advised hot fomentation, back care exercises.She recovered

completely.

14. Mr Sharan Gowda Patil aged about 45 Yrs complained of pain in lower

limbs.Pain is more in the right lower limb.Pain begins in the lumbar region

and hips radiating down to the limbs with drawing type of pain and associated

with numbness.Heaviness of limbs.Aggravation from motion and amelioration

by rest.Past history of some mental illness 7 Yrs back for which he had taken

treatment.He was a chronic smoker and alcoholic.H/o ? tubercular meningitis

in childhood.Past H/o of injury to hip in childhood.Mentally patient gets easily

 angered,religious,reads religious and philosophical books.Family history of

disc prolapse in father and grandfather.He was given Rhustox and

Tuberculinum as an intercurrent remedy.He showed improvement.He was also

advised hot fomentation, back care exercises.

15. Mrs. Lalita bai aged about 45 years presented with pain in lumbar region

which radiated to right foot. It aggravated on standing, exertion and in cloudy

weather and rainy season. It ameliorated upon pressure and warmth

application. She gives history of headache on exposure to cold and flatulency.

Thirst is more. She also c/o sleeplessness and constipation. She is introvert

doesn’t speak much. Family history of high blood pressure in father. On

examination, her back was tender. SLR positive. X-ray of lumbar spine

showed osteophytes. She was advised hot fomentation, lumbar corset, not to

lift heavy weights. She was given Rhus tox as acute and Calc carb as

complementary remedy. Calcarea flour 6x was given as X-ray showed

osteophytes. She showed improvement.

16. Mr Jagadevappa Malipatil aged about 52 Yrs presented with pain in lumbar

region.Intially pain started over right lower limb then to left.Stitching type of

pain.Aggravation from sitting for prolonged time,flexing

limbs,1pm.Amelioration around 11 pm and walking.Frequent attacks of cold

with generalized bodyache.cannot tolerate cold in general.On

examination,SLR test was positive.X-ray showed Lumbar Spondylosis. She

was given Rhus tox as acute and Calc carb as complementary remedy. He

showed improvement.
17. Mr. Sudhir Mehta aged about 66 years complained of pain in lumbar region

radiating to feet with numbness. It aggravated on walking and ameliorated by

lying on painful side. He gives past history of trauma. Desires sweets, thirst

is more and he also c/o constipation. In general, feels better in warmth. On

examination, back is tender. SLR positive. X-ray showed features of lumbar

spondylosis. He was advised hot fomentation and to sleep on a firm mattress.

Lumbar corset occasionally. He was given Gnaphalium as acute and Kali carb

as constitutional remedy. He showed improvement

18. Mr. Ravindra aged about 46 years, tailor by profession, presented with pain in

lumbar region with stiffness which aggravated by exertion and on standing.

He also c/o weak memory, frequent urge for urination and constipation. Thirst

is more. Family history of cancer in mother. Cannot withstand heat in

general. X-ray showed tumor of spine. He was advised back care exercises

and proper sitting posture with full back support. He was given Rhus tox as

acute followed by Sulphur as constitutional remedy. Carcinosin was given as

an intercurrent. He did not show improvement.

19. Mrs.Keshamma aged about 32 Yrs ,housemaid by profession,presented with

pain in the lumbosacral region,started during pregnancy.Pain radiates to right

side of foot.Aggravation from sitting on the floor,first motion, standing,

walking for long distance. Pain more in winter season. Amelioration by rest,

lying on back, pressure and lying on painful side. Cannot tolerate cold in

general. Mensus are irregular every 2-3 months. h/o dysmenorrhoea and

acidity. Eruption on face. She was given Colocynth. She was given
 Medorrhinum as intercurrent.She was advised hot fomentation, lumbar corset,

not to lift heavy weights.She showed improvement.

20. Mrs. Jameela Begum aged about 55 years presented with pain and stiffness of

the lower back which aggravated at night and was better on motion. Low back

pain was better by sleeping with back support. She gives past history of

hypertension, hysterectomy, and vertigo. Family history of heart diseases.

She also complained of easy perspiration and in general could not withstand

heat. Desires salty food items. SLR test was positive. She was advised hot

fomentation and to sleep on a firm mattress. She was given Natrum

muriaticum as constitutional remedy and Thuja as intercurrent remedy. She

showed improvement.

21. Mrs. Varsha Badsheshi aged about 35 years presented with pain in lumbar

region which aggravated on standing, walking and ameliorated on sitting erect.

She feels irritated easily. Gives history of grief. Past history of

hyperthyroidism. Family history of asthma. She cannot tolerate extremes of

temperature. On examination, SLR test was positive She was advised to sleep

on a firm mattress and some back care exercises. She was given Natrum

muriaticum as constitutional and Thuja as intercurrent remedy. She recovered

completely.

22. Mrs. Bhuvaneshwari aged about 40 years presented with pain along lumbo-

sacral spine and stiffness around the inguinal region. She gives past history of

malaria and tubectomy. She also c/o constipation. She prefers warmth in

general. Pain is aggravated by bending, sitting and ameliorated by sitting with

support to the back. She gives history of vertigo and pain in the breast before
 menses. She gives family history of allergic rhinitis in father and mother had

diabetes.SLR test was positive. She was advised hot fomentation and to sleep

on a firm mattress. She was given Hypericum as acute and Natrum

muriaticum as constitutional remedy. She showed improvement.

23. Mr Purushottam aged about 38 Yrs presented with pain in lower back.Pain is

caused probably due to overlifting a few years back.Pulsating type of

pain.Aggravation by lying on back.amelioration from continued motion,No

history of numbness.Mentally patient gets easily angered.Habit of biting

nails.H/o warts over back of the neck and arms.On examination,SLR test was

positive.X-ray of spine showed reduced L5 and S1 disc space.He was given

Thuja.He was advised hot fomentation, lumbar corset, not to lift heavy

weights.He showed improvement.

24. Mrs Parvati G Mahagaon aged about 55 Yrs presented with pain lumbosacral

region.Pulsating type of pain.No H/o injury or any fall.Pain in back aggravated

by sitting erect,exertion,and bending forward.Amelioration by sitting with

back rest,walking slowly.Low back feels strengthless and weak,as if it would

fall down.Pain radiating to thigh and legs with drawing pains.Cannot tolerate

cold in general.She attained menopause 14 Yrs back.Backache relived by

bending backwards.SLR test was positive.She was given Natrum

muriaticum.She showed improvement. She was advised hot fomentation and

to sleep on a firm mattress.

25. Mrs. Jagadevi aged about 54 years presented with pain along lumbo-sacral

spine and back of the neck with pain in both legs aggravated by exertion,

walking, standing and ameliorated by sitting with weakness in the limbs. Also
 c/o numbness of right hand. She is fair looking tall and slender. Mentally,

patient is irritable, worried and anxious. Sleep is disturbed. She does not

tolerate cold in general. She has weak memory. She has family history of

HTN in father. SLR test was positive. She was advised hot fomentation and to

sleep on a firm mattress, and back care exercises. She was given Ars alb

followed by Phosphorus and she recovered completely.

26. Mrs Padmavati Guttedar aged about 52 Yrs presented with pain in lumbar

region with numbness.Numbness starting from low back radiating to toes,pain

started first on right side then to left.Past h/o injury to the right thigh

Heaviness of the lower limbs.Pain is more in winter season.She is known

hypertensive.Cannot tolerate sour things,fridge water and cucumber.Desires

salt and chilles.Thirst increased.Father died of heart attack.Mother had

hypertensive.Repeated attacks of sneezing and vertigo.She had attempted

suicide by taking pills.She was given Phosphorus and Thuja as constitutional

remedy.She did not show improvement.

27. Mrs. Leela Ambalagi aged about 57 years presented with pain in lumbosacral

region radiating to right leg, wandering pains aggravated by standing,

ascending steps, exertion, and ameliorated by rest, sleep, lying on painless

side, sleeping with raised leg. She also complains of numbness of right leg.

She gives history of injury. Mentally, she takes tension. She has profuse

perspiration. She gives h/o diabetes and hypertension. Family history of high

BP, DM, and paralysis. She was advised bed rest, hot fomentation, and to

sleep on a firm mattress. She was given Rhus tox as an acute and Calc carb as
 constitutional remedy. She was given Syphilinum as intercurrent remedy.

She showed improvement.

28. Rajamma aged about 30 years presented with pain in lumbar region radiating

to left leg and slight oedema aggravated by sitting and standing for a long time

ameliorated by lying on back and pressure. She also c/o stiffness of back.

Past h/o recurrent headache and gastritis. Mentally, patient is irritable and

desires company. Thirst is more, desires spicy food. She cannot tolerate cold

in general. She gives family history of cancer, heart disease and tuberculosis.

X-ray revealed features of lumbar spondylosis. Back tenderness present. SLR

test was positive. She was advised hot fomentation and back care exercises.

She was given Rhus tox as acute and Calc carb as constitutional remedy. She

was also given Tuberculinum as intercurrent remedy. She recovered

completely.

29. Mrs. Indumati Basude aged about 50 years presented with pain in lumbar

region and pain in both limbs along with pain in neck which radiated to both

hands. Backpain is worse while sitting and lying on back and better by

pressure. Also c/o swelling of limbs on continuous walking. Sleep is

disturbed. Menses is scanty and irregular. She gives past history of abortion.

She cannot tolerate cold in general. She is a known case of DM. She was

given Rhus tox as acute followed by Sepia as constitutional remedy. She was

advised bedrest; sleep on a firm mattress, and hot fomentation. She showed

overall improvement.
30. Mrs. Vijayalaxmi K. aged about 46 years presented with pain and stiffness in

lumbar region and aggravated by standing, exertion, and ameliorated by rest

and pressure. History of injury present. Mentally worried, irritable,

loquacious, and religious. Also c/o indigestion and constipation. Past history

of tonsillectomy. Family history of cancer, TB, and heart complaints. She

cannot tolerate cold in general. Menses is copious. She gives history of grief.

She was advised hot fomentation and to sleep on a firm mattress. She was

given Natrum muriaticum followed by Sepia as constitutional remedy. She

was given Carcinosin as intercurrent remedy. She showed improvement.

 ANNEXURE - III

GRAPHS AND TABLES

1) Age Incidence:

Thirty patients, who attended H.K.E.s Homoeopathic medical collage OPD

and IPD, village camps.

Table.No. 1

S.No. Age group No. of cases Percentage (%)

1. 25-34 4 23.33

2. 35-44 7 23.33

3. 45-54 11 36.66

4. 55-64 3 10.00

5 65-74 2 6.66
 50
45
40
35
30 36.66
25
20 23.33
23.33
15
10 10
11 6.66
5 4 7
3 2
0
25-34 35-44 45-54 55-64 65-74

No. of cases Percentage (%)

As shown in the above chart The incidence of Sciatica was highest in the age group of

45-54 yrs 11 cases (36.66%); followed by age groups 35-44 yrs 7 cases (23.33%); 25-

34 yrs 7 cases(23.33%) 55-64 yrs 3 cases (10%); 65-74 yrs 2 cases (6.66%);
2) Sex Incidence

Table No. 2

Sl. No. Sex No. of cases Percentage

1. Female 21 70.00

2. Male 9 30.00
 No. of cases

Female
Male

21

As shown above the incidence of Sciatica was more in females 21 cases (70%)

than in males 9 cases (30%).

3) Past History

S.No. Past History No. of cases Percentage (%)

1. Injury 9 30.00

2. Headache 5 16.66

3. Sinusitis 3 10.00

4. Gastritis 3 6.66

5. Hysterectony 2 6.66

6. Tonsillectomy 2 6.66

7. Malaria 1 3.33

8. Scabies 1 3.33

9. Joint Pains 1 3.33

10. Hyperthyroidism 1 3.33

11. Dysomenorrhoea 1 3.33

12. Apthous ulcers 1 3.33

 40
35
30
25 30

20
15 16.66

10 10
6.66
6.66 6.66
5 9
5 3.33 3.33 3.33 3.33 3.33 3.33
3 3 2 2 1 1 1 1 1 1
0
Hysterectony

Malaria

Joint Pains
Scabies

Dysomenorrhoea
Sinusitis
Injury

Gastritis

Hyperthyroidism
Headache

Tonsillectomy

Apthous ulcers

No. of cases Percentage (%)

In the study of 30 cases,Injury 9(30%) cases,Headache 5(16.66%) cases,Sinusitis

3 (10%) cases, tonsillitis 2 (6.66%) cases,and Hysterectomy 2(6.66%) cases.

4) Family History

In the statistical study of 30 cases, the incidences of diseases in the family

were analyzed

Table.No.3

S.No. Family History No. of cases Percentage (%)

1. Hypertension 7 23.33

2. Tuberculosis 5 16.66

3. Diabetes mellitus 4 13.33

4. Heart Diseases 3 10.00

5. Cancer 3 10.00

6. Asthma 1 3.33

7. Disc prolapsc 1 3.33

8. Joint Pains 1 3.33

9. Allergic rhinitis 1 3.33

 35

30

25

20 23.33

15 16.66
13.33
10
10 10

5 7
5 4 3.33 3.33 3.33 3.33
3 3
1 1 1 1
0
Cancer

Allergic rhiniris
Hypertension

Diabetes

Joint Pains
Asthma
Tuberculosis

mellitus

Disc prolapsc
Diseases
Heart

No. of cases Percentage (%)

The study showed highest incidence of Hypertension

7(23.33%)cases,Tuberculosis 5(16.66%) cases,Diabetes mellitus 4(13,33%)

cases,Heart diseases 3 (10%) cases,and disc prolapse 1(3.33%) case in the family.
5) Constitutional Remedy

In 19 Cases, constitutional remedy was indicated

Table.No.3

Sl. No. Constitutional Remedies No. of cases Percentage (%)

1. Calc. Carb 7 23.33

2. Kali. Carb 2 6.66

3. Sepia 3 10

4. Natrum mur 4 13.33

5. Phosphorus 1 3.33

6. Sulphur 1 3.33

7. Thuja 1 3.33
 35

30

25

20 23.33

15

13.33
10
10
6.66
5
7
4 3.33 3.33 3.33
2 3
1 1 1
0
Sulphur
Natrum mur

Phospharus
Calc. Carb

Kali. Carb

Sepia

Thuja

No. of cases Percentage (%)

The constitutional remedies were prescribed in 19 cases:Calc carb 7 cases

(23.33%);Nat mur 4 cases (13.33%);Sepia 3 cases (10% ); Kali carb 2 cases (6.66%);

Phosphorus 1 case(3.33%) ;Sulphur 1 case (3.33%);and Thuja 1 case (3.33%).

6) Acute Remedies

Sl. No. Constitutional Remedies No. of cases Percentage (%)

1. Rhustox 11 36.66

2. Arnica 1 6.68

3. Gnaphaliun 2 6.66

4. Hypericum 2 6.66

5. Nat mur 1 3.33

6. Cumcifuga 1 3.33

7. Colocynth 1 3.33

8. Puls. 1 3.33

9. Ars alb 1 3.33

 50
45
40
35
30 36.66
25
20
15
10
5 11 6.68 6.66 6.66 3.33 3.33 3.33 3.33 3.33
1 2 2 1 1 1 1 1
0
Gnaphaliun
Rhustox

Colocynth
Nat mur

Cumcifuga

Puls.
Hypericum

Ars alb
Arnica

No. of cases Percentage (%)

The acute remedies were given in 23 cases, Rhus tox in 11 cases (36.66%);

Gnaphalium 2 cases (6.66%); Calc flour 2 cases (6.66%); Hypericum 2 case (6.66%);

Ars alb 1 case (4.35%), Nat mur 1 case (4.35%);Cimcifuga 1 case(3.33%); Colocynth

1 case (3.33 %);Phosphorus 1 case (3.33%); Arnica 1 case (3.33%);

7) Inter current Remedies

S.No. Intercurrent remedy No. of cases Percentage (%)

1. Tuberculinum 4 13.33

2. Carcinosin 3 10.1

3. Thuja 3 10.1

4. Medhorrinum 2 6.66

5. Syphillinum 1 3.33
 18
16
14
12 13.33
10
8 10.1 10.1
6 6.66
4 3.33
2 4 3 3 2 1
0
Tuberculinum

Syphllinum
Thuja

Medhorrinum
Carcinosin

No. of cases Percentage (%)

The intercurrent remedies were used in 13 cases. Medorrhinum 2 cases (15.38%);

Carcinosin 3 cases (23.07%); Tuberculinum 4 cases (30.76%); Thuja 3 cases (23.07%);

Syphilinum 1 case (7.69%) .

8. Auxillary Treatment

Sl no Particulars No. of Cases Percentage

1 Auxillary treatment Given 28 93.33

2. Not Given 2 6.66

 No. of Cases

28

Auxillary treatment Given Not Given

Except in two cases, the auxiliary methods like application of hot

fomentation to the back, back care exercises, sleeping on a firm mattress, wearing a

lumbar corset were recommended in almost all cases.

9. Recovered

S.No. Particulars No. of cases Percentage (%)

1. Recovered 10 33.33

2. Improvement 17 56.66

3. Not Recovered 3 10
 No. of cases

3
10

17

Recovered Improvement Not Recovered

Lastly, the outcome of this study was that out of 30 cases 10 cases recovered

(33.33%); 17 cases showed improvement (56.66%); and 3 cases did not show any

improvement (10%).
 Annexure - IV

MASTER CHART

Treatment
Auxiliar
Sl. Age in Past Family
Name Sex Occupation y Result
No yrs history history Constitution Inter
measure Acute
al current
Hot
fomentati
Traum on, sleep
1 Mumtaz Begum 32 F Tailor - Arnica Kali carb - Improved
a on
firmmatt
ers
Rhus
2 Mr.Srinivas 33 M Officer HTN - --do-- Calc carb Carcinocin Recovered
tox
Accide
nt,
Lumbar Gnaph
3 Mrs Venkatamma 45 F Housewife Traum HTN Sepia Improved
corset alium
a

Back
Hyster Care Rhusto
4 Mrs Shantamma 30 F Housewife - Calc carb -- Improved
ectomy exercises x

Not
Accide Calc Tuberculin
5 Mr Basawaraj 46 M Tailor TB advised Phosphorus Recovered
nt flour um
Back
Headac Care Rhusto Tuberculin
6 Mr Zakir 47 M Mechanic TB Calc carb Recovered
he exercises x um
 Traum Weight
Ca
a reduction
cervix,
7 Mrs Nagamma 36 F Housewife Recurr , Hot --- Kali carb --- Improved
&
ent fomentati
koch;s
UTI on
Back
Sinusiti Heart
8 Mrs Saida Begum 40 F Teacher Care --- Nat mur --- Improved
s disease
exercises
Scabies
& Throat Cimcif
9 Mrs Uma Joshi 35 F Accountant -- do -- --- - Recovered
Urticar cancer uga
ia
Joint Joint Not Medorrinu Not
10 Mrs Zareenabee 35 F Housewife --- Calc carb
pains pains advised m Improved
Sinusiti Lumbar
11 Mr Umesh 36 M Housewife HTN --- Lycopodium - Recovered
s corset
Back
Traum Hyperi
12 Mrs Seema Naikal 33 F Tailor DM Care --- ---- Recovered
a cum
exercises
Hot
Tonsoll
fomentati Rhus
13 Mrs Mehboobee 65 F Housewife itis,hea HTN Calc carb Thuja Recovered
on, hard tox
dache
matters
Lumbar
Disc corset,
Businessma Mental Rhus Tuberculin
14 Mr Sharan Gowda 45 M prolaps hot --- Improved
n illness tox um
e fomentati
on
Back
Care Rhusto
Headac exercises, x&
15 Mrs Lalitabai 45 F House Wife HTN Calc carb Improved
he hot Calc
fomentati flour
on
Sinusiti Rhusto
16 Mr Jagadevappa 52 M Farmer - -- do -- Calc carb - Improved
s x
 Rtd Traum Gnaph
17 Mr Sudir Mehta 66 M - -- do -- Kali carb - Improved
Engineer a alium
Rhus Not Improved
18 Mr Ravindra 46 M Lecturer - - -- do -- Sulphur Carcinosin
tox
Dysme Lumbar Colocy Medorrhin
19 Mrs Kashamma 32 F Farmer - --- improved
norhea corset nth um
Hyster Bed rest,
ectecto Heart Sleep on
20 Mrs Jameela 55 F Housewife --- Nat mur Thuja Improved
my,vert disease hard
igo matters
Hypert Hot
Asthm
21 Mrs Varsha 35 F Tailor yriodis fomentati ----- Natrum mur Thuja Recovered
a
m on
Allergi
Mrs Malari c Hyperi
22 40 F Housewife -- do -- Natrum mur - Improved
Bhuvaneshwari a rhinitis, cum
& DM
Lumbar
23 Mr Purushottam 38 M Labourer Warts - --- Thuja - Improved
corset
Back
care
exercise,
Improved
24 Mrs parvati 55 F Housewife - - sleep on --- Nat mur -
firm
matters

Ars
25 Mrs Jagadevi 54 F Housewife - HTN -- do -- Phosphorus --- Recovered
alb
HTN,H
Traum Phosp
26 Mrs Padmavati 52 F Clerk eart -- do -- Thuja - Not Improved
a horus
attack
Traum HTN,D Rhusto
27 Mrs Leela A. 57 F Teacher -- do -- Calc carb Syphilinum Improved
a M x
28 Mrs Rajamma 30 F Clerk Headac TB,Ca Hot Rhus Calc carb Tuberculin Recovered
 he & ncer fomentati tox um
Gastriti on, back
s care
exercise
Rhus
29 Mrs Indumati 50 F Housewife Grief DM -- do -- Sepia - Improved
tox
Injury, TB,He
Nat
30 Mrs Vijayalaxmi 46 F Lecturer Tonisil art -- do -- Sepia Carcinosin Improved
mur
ectomy disease