WHAT IS SCIATICA?
Sciatica is the term we use to describe the pain that radiates through the sciatic nerve. This nerve exits the spinal column at the low back and travels down through the buttocks into the back of each leg.
WHAT CAUSES SCIATICA?
Sciatica pain results from compression on the sciatic nerve. Some people call this a “pinched nerve.” The compression on the sciatic nerve may occur for one of several possible reasons, including:
- Herniated disc – The most common cause of sciatica is the herniation of a disc in the low back. A herniated disc is one in which a crack has developed in the fibrous outer shell and which is leaking some of the inner gelatinous substance. The leaked gel irritates the nearby nerve.
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- Spinal stenosis – This condition involves the narrowing of the space inside the spinal column (the spinal canal). Compression occurs before the sciatic nerve branches off to the buttocks and legs.
- Spondylolisthesis – The opening through which the sciatic nerve exits may be narrowed by a slipped vertebra that is out of alignment with the vertebra above it.
- Piriformis syndrome – This condition originates in the piriformis muscle that is located deep within the buttocks. The piriformis may tighten or go into spasms, compression the sciatic nerve.
WHAT ARE THE COMMON SCIATICA SYMPTOMS?
The sciatic nerve is situated in the low lumbar area and is a combination of nerve roots sitting at the L4 and L5 lumbar segments as well as the S1, S2, and S3 segments below the lumbar spine. Symptoms may vary in terms of area based on the spinal segment in which compression has occurred.
THE MOST COMMON SYMPTOMS OF SCIATICA INCLUDE:
- Pain. Many people describe sciatica as sharp shooting pain or a burning sensation. The pain is usually worse in the back of the leg than in the back itself. Often, discomfort is localized in the calf below the knee. This area, or the back of the knee and the buttocks, may also feel more achy than painful.
- Tingling and numbness may occur, usually in the back of the leg.
- The affected leg may feel heavy and weak. It may be difficult to lift the foot off the floor.
- Pain or altered sensation may change with various body positions. Discomfort may occur only when lying down or may feel worse when sitting or moving from a seated to a standing position.
HOW DO YOU DIAGNOSE SCIATICA?
Sciatica may be diagnosed through a complete consultation and medical history. A review of symptoms provides telltale clues about the potential cause of pain. A physical exam is also performed to confirm sciatica. During this exam, the patient may lie flat on their back with their legs straight. The doctor then lifts one leg and notates when pain begins and where the pain is located. Both legs are lifted in the same manner to make a comparison. In addition to a medical history and thorough physical exam, a doctor may also order diagnostic imaging or testing to gain further information about the cause of sciatica pain. Potential diagnostics include:
- X-ray to observe the bony structure of the lower back.
- MRI or CT scan to observe bones and soft tissues, including the pinched nerve.
- Myelogram dye testing observes discs and vertebral structure.
- Nerve conduction velocity evaluates the electrical impulses through the nerve. This test may only be recommended for ongoing or frequently recurring sciatica that does not relate to spinal problems.
HOW DO YOU RELIEVE SCIATICA PAIN?
Sciatica pain can be somewhat difficult to manage. However, in many cases, the use of over-the-counter nonsteroidal anti-inflammatory medication can ease discomfort temporarily. Many people gradually improve over 4 to 6 weeks utilizing rest, stretching exercises, medication, and hot and cold therapy to reduce inflammation in their sciatic nerve. If pain persists, medical care should be sought.
WHAT ARE THE TREATMENTS FOR SCIATICA?
Medical intervention for sciatica is conducted to improve mobility and comfort. Nonsurgical therapies are the first-line of care administered and are often successful in resolving pain.
- Medical care may involve a prescription nonsteroidal anti-inflammatory or a muscle relaxant. The two may be prescribed as complementary modalities depending on the findings of the physical exam. In some cases, anti-inflammatory medication is injected into the low back to provide quick and lasting relief from sciatic pain.
- Physical therapy may coincide with the use of medication. Where medication eases pain and inflammation, physical therapy seeks to find the proper movements to reduce pressure on the nerve. Physical therapy may include stretching exercises, strength exercises, and even mild aerobics such as walking to improve mobility.
- Surgery is considered in situations where conservative treatments do not achieve the desired improvement. Surgery may also be needed when sciatica is severe or when pain progressively worsens. Because sciatica is often caused by a herniated disc, microdiscectomy is commonly performed to decrease pressure on the affected nerve.
HOW TO PREVENT SCIATICA?
Some studies suggest that sciatica cannot be prevented. This may be true only in some circumstances, such as an unexpected back injury or pressure on the spine during pregnancy. However, there are ways to protect the lower back and therefore decrease the risk of sciatica.
- Always lift using a straight back and bent knees and hips. When lifting, objects should be held close to the chest. This technique should be used even when lifting light items.
- Exercise regularly to maintain muscle strength in the back, legs, and also the abdomen. Always stretch before and after exercise.
- Avoid sitting for long periods. Change sitting position periodically.
- Be aware of posture and learn how to stand, sit, and sleep in ways that relieve pressure on the low back rather than cause it.
- Do not smoke. The chemicals in tobacco products promote disc degeneration.
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