What is sciatica?
Sciatic refers to pain that branches along the path of the sciatic nerve from the lower half of the back in the pelvis and thigh and down each leg.
Usually, sciatica affects only one side of your body.
Sciatica usually occurs when a disc is herniated (protruded), a bony appendage is placed on the spine and puts pressure on the sciatica, or there is a narrowing of the spinal cord in the spine (spinal stenosis). These problems cause stress on the part of the sciatic nerve.
This leads to inflammation, pain, and often some numbness in the affected leg. Although the pain associated with sciatica can be severe, most cases resolve within a few weeks with non-surgical treatments.
People with severe sciatica pain, significant leg weakness, or bowel or bladder changes may need surgery.
Symptoms of Sciatica
Pain that radiates from the lower half of the spine (lumbar) to the thigh and down the back of the leg is a symptom of sciatica. You can feel discomfort almost anywhere along the sciatic nerve path, but it is especially likely when it runs from the lower back to the hip and back of the thigh and leg. Sciatica pain can range from a mild ache to an intense burning or excruciating pain.
Sometimes it can feel like shaking or an electric shock.
It can get worse when you cough or sneeze, and sitting for long periods can worsen sciatica symptoms. In sciatic nerve involvement, only one side of your body is usually involved.
Some people also feel numbness, itching, or muscle weakness in the affected leg. You may have pain in one part of the leg and numbness in the other part.
When to see a Doctor
Mild sciatica usually goes away over time. If your self-care measures fail to alleviate the symptoms of sciatica, or if your pain persists for more than a week or becomes severe and gradually worsens, be sure to see a doctor.
Sciatica in pregnancy
Pregnancy sciatica can occur if the growing fetus in your uterus puts pressure on your sciatic nerve. Pressure on this nerve can cause inflammation, irritation, and pain. You have sciatica if you experience shooting pains that start in your lower back and travel down your legs.
The cause of sciatica pain
Sciatica occurs when the sciatic nerve is compressed by a herniated disc inside the spine or due to the overgrowth of bone in the vertebrae. Rarely can a nerve be squeezed by a tumour or damaged by a disease such as diabetes.
Diagnosis and Treatment
Risk Factors for Sciatica
Risk factors for sciatica include:
- Age. Age-related changes in the spine, such as herniated discs and bone spurs, are the most common causes of sciatica.
- Obesity. By increasing the pressure on the spine, extra weight can contribute to changes in the spine that trigger sciatica.
- Job. A job that requires you to twist your back, carry heavy loads, or drive a vehicle for long periods can contribute to sciatica, but there is no conclusive evidence of this connection.
- long sitting. People who sit for long periods or lead a sedentary lifestyle are more likely to develop sciatica than active people.
- Diabetes. This condition, which affects how your body uses blood sugar, increases the risk of nerve damage.
Prevention of sciatica pains
The following can play a crucial role in protecting your back:
Exercise regularly
To keep your back strong, pay special attention to your central muscles, Muscles in your abdomen and lower back that are essential for posture and balance. Ask your neurologist or physiotherapist to introduce special activities.
Maintain proper posture when sitting.
Choose a chair with proper support for the lower half of the back, with a swivel handle and base.
Consider placing a pillow or rolled-up towel in the hollow of your back to maintain its natural curve. Keep your knees and hips on the same level.
Use correct body postures.
If you stand for long periods, place one foot on a stool or small box once in a while. When you lift something heavy, let your lower body do the work. Move directly up and down. Keep your back straight and only bend your knees. Keep the load close to your body. Avoid lifting and turning at the same time. If the object is heavy or clumsy, find a helper to lift it.
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Diagnosis of sciatica
During the physical exam, the doctor may check muscle strength and reflexes. For example, it may ask you to walk on your toes or heels, rise from a squatting position, and lift one leg at a time while lying on your back. Usually, the pain caused by sciatica intensifies during these activities.
- Imaging tests
Many people have a herniated disc or bony protrusion that can be seen on x-rays and other imaging but show no symptoms in everyday life.
- X-ray. An X-ray image of the spine can reveal bony overgrowth that is pressing on a nerve.
- MRI. This process uses a strong magnet and radio waves to create cross-sectional images of your back. MRI produces detailed images of bone and soft tissues such as herniated discs. During the test, you lie on a table that moves into the MRI machine.
- CT Scan. When a CT scan is used to image the spine, a contrast dye is injected into the spinal canal before the X-rays—a CT myelogram. The dye then circulates the spinal cord and spinal nerves, which appear white in the image.
- Neuromuscular (EMG) light. This test measures the electrical impulses produced by the nerves and the muscles’ response to them. This test can confirm nerve compression due to a herniated disc or narrowing of the spinal canal (spinal stenosis).
Treatment of sciatica
If the pain does not improve with self-care, your doctor may recommend some treatments.
Medication for Sciatica
Medications that may be prescribed for sciatica include:
- Anti-inflammatory
- Muscle relaxant
- Potent pain reliever for sciatica
- Tricyclic antidepressants
- Anticonvulsants
Physiotherapy for sciatica
Once the acute pain has resolved, the physical therapist can design a rehabilitation program to help prevent further injury. This program usually includes exercises to correct posture, strengthen the muscles that support the back, and improve flexibility. In some cases, the doctor may prescribe an injection of a corticosteroid medication into the area around the affected nerve root.
Corticosteroids help reduce pain by reducing inflammation around the damaged nerve. Usually, the effects disappear within a few months. The number of steroid injections is limited because repeated injections increase the risk of side effects.
Sciatica surgery
This option is usually reserved for when the pinched nerve is causing significant weakness, loss of bowel or bladder control, or when the pain worsens or does not improve with physical therapy and drug therapy. Surgeons can remove the bony appendage or part of the herniated disc that is pressing on the nerve.
