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Sciatica is a type of pain that affects the sciatic nerve, which is the longest and thickest nerve in the body. It starts in the buttock/gluteal area and extends to the hips, buttocks, and leg, ending just below the knee. The sciatic nerve is made up of five nerve roots, two from the lumbar spine and three from the sacrum, which come together to form the right and left sciatic nerves. The sciatic nerve then branches into other nerves that continue down the leg and into the foot and toes.
The most common cause of sciatica is a herniated disk or bone spur that puts pressure on the nerve, causing inflammation, pain, and sometimes numbness in the affected leg.
Although sciatica can cause severe pain, most cases can be treated and resolved within a few weeks. In some cases, however, such as those with severe sciatica, significant leg weakness, or bowel or bladder changes, surgery may be necessary.
Symptoms
The following are the sign and symptoms of sciatica:
- Moderate to severe pain in the lower back, buttock and back of the leg.
- Weakness or numbness in the lower back, buttock, legs, or feet.
- Pain that worsens when coughing, sneezing, sitting, or standing for a long period of time.
- Loss control of bowel or bladder.
It is recommended to see a doctor if the symptoms persist, especially if the pain lasts longer than a week or worsens. If the condition is mild, it may improve on its own over time.
Causes
The following condition may lead to sciatica:
- Herniated or slipped disk: The most common cause of sciatica is herniated disk. The spine consists of vertebrae that are separated by cushioning pads called disks. A herniated disk occurs when the pressure from the vertebrae causes the gel-like center of the disk to protrude through a weak point in its outer wall. If this occurs in the lower back vertebrae, it can put pressure on the sciatic nerve.
- Spinal stenosis: This occurs when the spinal canal narrows abnormally, reducing the space for the spinal cord and nerves.
- Spondylolisthesis: Spondylolisthesis is a condition where one vertebra slides out of alignment with the vertebra above it, causing a narrowing of the nerve exit. This can lead to the sciatic nerve being compressed by the stretched spinal bone.
- Osteoarthritis: As spine age, bone spurs (jagged edges of bone) can form and put pressure on the lower back nerves.
- Tumors: If the tumor develop in the lumbar spine, it can cause compression at the sciatic nerve.
- Piriformis syndrome: Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle in the buttocks becomes tight or goes into spasm. This can result in pressure and irritation of the sciatic nerve.
- Cauda equina syndrome: Cauda equina syndrome is a serious and uncommon disorder that affects the cauda equina, a bundle of nerves located at the end of the spinal cord. Symptoms include leg pain that radiates down the leg, numbness around the anus, and loss of control over bowel and bladder functions.
Risk factors
Below are some factors that increase the risk of developing sciatica:
- Age: As people age, changes and movements in bone, disks, and ligaments may increase the risk of nerve injury or pinching due to aging-related changes in the spine, such as herniated disks and bone spurs.
- Obesity: The spine can be thought of as a vertical crane, with your muscles serving as the counterweights. The heavier the weight you carry in the front of your body, the harder your spine (crane) must work to lift it. This can put additional strain on your back muscles, potentially leading to back pain, strains, and other issues.
- Injury: Sciatica is more likely to occur following a lower back or spine injury.
- Physical work: Jobs that heavy lifting or prolonged sitting can increase the risk of low back issues.
- Pre-existing conditions: Pre-existing conditions such as diabetes and osteoarthritis can increase the risk of nerve damage and spinal damage.
- Lifestyle: A sedentary lifestyle and lack of exercise can increase the risk of sciatica, as well as smoking, which weakens bones, damages spinal discs, and accelerates disk degeneration due to the nicotine in cigarettes.
Diagnosis
The following procedures will help the healthcare providers properly diagnose sciatica.
- Physical examination: The healthcare provider will assess the patient’s the reflexes and muscle strength by having them perform various movement, such as standing up from a squatting position, performing a straight leg raise while lying on their back, walking on their toes or heels, and more. Sciatica pain typically worsens during these activity.
- Imaging test: If the patient experience severe pain that does not subside after a few weeks, they may need further imaging tests such as:
- X-ray: An overgrowth of bone that might be pressing on a nerve can be seen on a spine X-ray.
- Computed tomography (CT) scan: Before the CT myelogram, a dye may need to be injected into the spinal canal as part of a CT scan. The spinal cord and spinal nerves are then easier to spot on the images as the dye flows around them.
- Magnetic resonance imaging (MRI): Using a powerful magnet and radio waves, an MRI creates images of the back’s cross-section and can reveal disk herniation, nerve compression, and any arthritic conditions that may be putting pressure on the nerve. An MRI is often used to confirm a sciatica diagnosis.
- Electromyography (EMG): This test measures the electrical impulses produced by the nerves and muscles and can determine the extent of nerve root injury.
Treatment
The purpose of treatment is to lessen pain and improve mobility. Depending on the underlying cause, many sciatica patients improve gradually with a few simple self-care measures.
- Self-care: To reduce pain and swelling, start by using cold packs. Apply towel-wrapped ice packs to the affected area, multiple times a day for 20 minutes each time. After a few days, switch to using hot packs or a heating pad, applied for 20 minutes at a time. If pain persists, alternate between hot and cold packs, depending on which provides the most relief.
- Medications: Over-the-counter drugs may help to relieve pain, reduce inflammation, or reduce swelling. Some medicines may need to be prescribed by a healthcare provider. Anti-inflammatory drugs (NSAIDs), corticosteroids, opioids, anti-seizure medicines, or antidepressants may be used to treat sciatica pain.
- Physical therapy: A healthcare provider can develop a plan to help prevent future injuries after the pain has subsided. This includes exercises to improve range of motion, strengthen the core, and correct posture.
- Steroid injections: A corticosteroid injection into the region surrounding the painful nerve root may be helpful in some circumstances. One injection frequently alleviates pain.
- Surgery: A surgeon can remove a bone spur or a piece of a herniated disk that is pressing on the nerve. However, surgery is typically only used for cases of sciatica that result in extreme paralysis, loss of bowel or bladder control, or pain that does not respond to conventional treatments.
- Microdiscectomy: A herniated disk that is impinging on a nerve can be removed using a minimally invasive procedure called a microdiscectomy.
- Laminectomy: This treatment involves removing the lamina, which is a portion of the vertebral bone and the roof of the spinal canal, and which is pressing on the sciatic nerve.
