Sciatica

Sciatica
Overview

Sciatica (or sciatic pain) denotes to the pain that spreads along the length of sciatic nerve. It occurs due to the pressing or compression of the sciatic nerve in the backbone.

Sciatica diagram

Sciatic nerve is the longest nerve that branches out from both sides of the lower backbone travels down through the hips, thighs, back of the knees until the feet. It provides sensory feeling and some muscle control of the legs.

Typical pain of sciatica usually involves one side of lower body or one leg.  Sciatica pain could be mild to severe in the affected leg and may get worse while sitting for longer period of time.  Pain is more experience in the buttocks and legs and not that much in the back.

 

Signs and Symptoms

Common signs and symptoms include

Typically, sciatic pain radiates from lower spine to hips and down the back of the leg

  • Usually pain occurs on one side (rarely in both legs)
  • Pain increases when sitting
  • Sensation of numbness, tingling and burning pain in the affected foot or leg
  • Mild to severe pain – Pain could also be felt like an electric shock or jolt and get worst when sneeze or cough
  • Some patient may also feel muscle weakness in the affected leg
  • Shooting pain occurs when standing up
  • Sciatic pain may be mild and infrequent but in some patients it could be severe and continuous
  • Patients who have increasing weakness in lower limbs, loss of bowel or bladder control and numbness or tingling in feet, should seek immediate medical attention. Treatment depends on cause of problem. The doctor will confirm the diagnosis of sciatica based on signs and symptoms.
Causes and Risk Factors

Most commonly, sciatica occurs when part of sciatic nerve is compressed because of narrowing of spine, this is also termed as spinal stenosis.  There are some other causes of sciatica which includes:

  • Damage/ degradation of intervertebral discs, which act as cushions between the vertebras
    Spondylo-listhesis – A condition in which a vertebra slips forward or backward
  • Spasm of muscles in buttocks or back
  • Injury or fracture of pelvic bone
  • Any bony spur on spine
  • During pregnancy

Risk Factors of Sciatica

Following are some risk predisposing factors of sciatica

  • Obesity – Patients who are overweight.  Increase body weight raises stress on the spine causing changes in spine, which may lead to sciatica
  • Age –  There are age related changes in spine, such as protrusion of discs, these changes could also trigger sciatica.
  • Diabetes – When there is high blood sugar, risk of nerve damage increases causes sciatica
  • Occupational injury – People doing a job that requires twisting the back frequently, driving a car or riding a bike for longer duration or lifting heavy loads, may develop sciatica.
  • Sitting for Longer Duration – People who tend to sit for longer duration having inactive life style are more likely to develop sciatica as compared to active people.
Testing and Diagnosis

Sciatica is usually diagnosed clinically based on patient’ signs & symptoms.

It causes numbness, pain or tingling sensation which radiates from lower back, through hips down to one leg (mostly).

There is a simple test known as ‘passive straight leg raise test’. This test will help the doctor to identify the disease. In this test, patient is ask to lay down with legs straight lifting legs one at a time. If the patient experience pain in lifting one of the leg, it’s an indication of sciatica.

In addition to clinical diagnosis, there are various test for diagnosing sciatica that includes

  • Electromyography (EMG)
  • X-Ray spine
  • Computed tomography (CT) spine
  • Magnetic resonance imaging (MRI) spine

Sometimes, there are more serious causes of such symptoms, for instance an infection of spine, fracture of spine or cauda equine syndrome. Symptoms suggesting cauda equine syndrome are

  • Numbness or tingling in buttocks or legs
  • Recent loss of bowel or bladder control
  • Weakness in foot or leg

Symptoms suggesting a fracture in spine are

  • Severe pain, sudden in onset which is relieved by lying down
  • Minor trauma due to heavy load lifting in people having weak bones
  • Major trauma like a road traffic accident
  • Any deformity in structure of spine
Treatment

Generally, sciatic pain gets better itself without any treatment in around 2 months’ time.

Patients are suggested to self-help by staying active as much as they can, use compression packs (cold or hot) and take some painkiller medications, when pain is severe.

Patients suffering with constant severe pain may require regular medication and physiotherapy.

Doctors usually prescribe medications and physical therapy in combination. In the beginning, most patients are prescribed painkiller (anti-inflammatory) and muscle relaxant drugs. In case patient does not feel better, other stronger pain medications such as narcotic medications or steroid injections are used.

Steroid Injections

In some patients, corticosteroid injections are very helpful. They are injected in the area around nerve root which is involved. They suppress inflammation around nerve which is irritated, reducing pain and discomfort. Effects of steroid injections wear off after sometime. Steroid injections should not be used too frequently because they can cause serious side effects, therefore their quantity should be limited.

Physical Therapy

Once the pain improves, patient should join a physical therapy program to prevent from future injuries. In physical therapy, exercises are included to strengthen the muscles and correcting posture and improving flexibility of the body.

Surgery

When compressed nerve causes severe weakness, loss of bowel or bladder control, or progressive pain, surgery is the only option. Surgeons can remove the part of disc (protrusion of disc or bony spur) which is pressing on the nerve and causing pain.

Prevention

People who had sciatic pain, can reduce future episodes of it by avoiding practice that may hurt their back such as:

  • Do not lift heavy weights – or lift weight using proper techniques
  • Improve posture (sitting, walking) and do not twist back suddenly
  • Continue doing some simple stretching exercises on daily-basis
  • Sleep on bed which is not too soft

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