Sciatica

Sciatica is used to refer to the pain caused by the sciatic nerve. The sciatic nerve is the longest, widest, and one of the most important nerves in the body.

It begins at the spinal cord, runs through the hips and buttocks, and then branches down each leg, ending just below the knee. The nerve is responsible for the control and feel of the legs. Pain, ranging from mild to severe, can occur when this nerve is irritated. 

Sciatica is often used to describe general back pain. However, the condition is not just limited to the back. Sciatica can manifest itself as mild to severe pain that affects the back, buttocks, and legs. Weakness and numbness in those areas may also occur. 

Sciatica is not a condition but a symptom of a disease involving the sciatic nerve. Sciatica commonly occurs when there is a compression of the sciatic nerve by a herniated disk, bone spur on the spine, or spinal stenosis (narrowing of the spine). This causes inflammation, pain, and sometimes numbness in the affected leg. 

Experts believe that up to 40 percent of people will experience sciatica at least once in their lifetime. The pain caused by sciatica is described in different ways depending on the cause. In some patients, the pain is described as sharp or shooting pain. While in others, the pain is burning, stabbing, or electric. 

The pain may come and go, or it may be constant. The pain is often more severe in the leg than in the lower back. The pain may be exacerbated when sitting or standing for long periods. A forced and sudden body movements, such as a sneeze or cough, can worsen the pain. 

Although the pain caused by sciatica may be severe, most cases are resolved with non-operative treatment within a few weeks. Surgery may be necessary for patients with sciatica associated with bowel or bladder changes and significant weakness in the legs. 

Table of Contents

Causes and Risk Factors of Sciatica

Sciatica typically occurs when the sciatic nerve becomes compressed, usually by a bone spur in the vertebrae or a herniated disk in the spine. In rare cases, the nerve can be pinched by a tumor or damaged by a disease like diabetes. 

Risk factors of sciatica include:

  • Previous injury: An injury to your lower back or spine increases the risk of developing sciatica
  • Age: With normal aging comes a natural wearing down of bone tissue and disks in your spine. Normal aging can put the nerves at risk of being injured or pinched by the changes and shifts in bone, disks, and ligaments.
  • Obesity: Obesity puts a strain on the spine and back muscles. This can lead to back pains and other issues affecting the back.
  • Weak core muscles: The core muscles are the muscles of the back and abdomen. The stronger the core, the more support for the lower back.
  • Occupation: Jobs that require heavy lifting may increase the risk of low back problems and use of the back. Also, jobs with prolonged sitting may increase one’s risk of low back problems.
  • Improper posture during weightlifting: Even if you are physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting or other strength training exercises.
  • Diabetes: Diabetes increases the risk of nerve damage, which increases the chance of sciatica.
  • Osteoarthritis: Osteoarthritis can cause damage to the spine and put nerves at risk of injury.
  • Sedentary lifestyle: Sitting for an extended period of time and not exercising, and keeping the muscles moving, flexible, and toned can increase your risk of sciatica.
  • Smoking: The nicotine in tobacco can damage spinal tissue, weaken bones, and speed the wearing down of vertebral disks

Signs and Symptoms of Sciatica

Common symptoms of sciatica include:

  • Pain in the buttocks or leg that is worse when sitting or standing for long periods
  • Lower back pain
  • Hip pain
  • Chronic pain on one side of the buttocks
  • Weakness, numbness, or a hard time moving the leg or foot
  • Burning or tingling down the leg
  • Shooting pain that makes it hard to stand up

Sciatica typically affects only one side of the lower body. The pain often extends from the lower back through the back of the thigh and down through the leg.

Depending on where the sciatic nerve is affected, the pain from sciatica can be severe and also extend to the foot or toes. For others, the sciatica pain is irritating and might come at irregular times, but has the potential to get worse.

Seek medical attention right away if you have:

  • Fever and back pain
  • Pain that moves down the legs
  • Swelling or redness in the back or spine
  • Numbness or weakness in the upper thighs, legs, pelvis, or buttocks
  • Burning when you pee or blood in your pee
  • Loss of bladder or bowel control 

Diagnosis

The doctor may order a physical examination to check your reflexes and the strength of your muscles if they suspect sciatica. In severe cases, the doctor might order imaging tests to check for a herniated disk and bone spurs. These tests include:

  • X-ray, which makes pictures of the inside of your body, to check for bone spurs.
  • Magnetic Resonance Imaging (MRI) uses radio waves and magnets to create images of the insides to get a detailed look at the back and spine.
  • CT scan combines a series of X-rays to get a better look at your spinal cord and spinal nerves.
  • Electromyography (EMG) measures how fast nerve signals travel through your body to check for things like a herniated disk.

Treatment

Sciatica

At-home remedies and self-care activities can be used to treat sciatica. These include:

  • Stretching
  • Using cold or hot packs
  • Taking over-the-counter pain medication

But if the pain does not subside, your doctor might suggest other options.

Medication

Your doctor might recommend a few different types of medication, some of which include:

  • Anti-inflammatories
  • Muscle relaxants
  • Anti-seizure medications
  • Tricyclic antidepressants
  • Narcotics

Physical therapy

Certain exercises can improve posture and flexibility. They also help strengthen back muscles for improved support. 

Steroid injections

Your doctor might also recommend steroid injections, like a cortisone shot. They’ll give you a shot with medicine to help with inflammation around the nerve, which can help reduce pain. The effects usually last a few months, but they’ll wear off over time.

Surgery

Surgery may be necessary in cases of extreme pain that doesn’t get better, weakness, or a loss of bladder or bowel control. The surgery would involve taking the bone spur or herniated disk that’s pressing on the nerves and causing pain.

Sources;