Sciatica is the name given to any pain resulting from irritation of the sciatic nerve. Anything that irritates this nerve causes pain, which ranges from moderate to severe; it is usually due to compression of the nerve root in the lumbar (lower) region. The term "sciatica" is often confused with lower back pain. However, sciatica is not limited to the back.
The sciatic nerve is the longest and widest nerve in the human body. It runs from the lower back, through the buttocks, and down the legs to end just behind the knee. This nerve controls several muscles in the lower legs and makes that area sensitive to touch.
Sciatica is not actually a disease but rather a symptom of another problem involving the sciatic nerve.
According to the MediLexicon medical dictionary, sciatica means “Pain in the lower back and hip radiating down the back of the thigh into the leg; initially attributed to dysfunction of the sciatic nerve (hence the term), it is now known to be usually due to a herniated lumbar disk compressing a nerve root, most commonly the [5th lumbar vertebra] or [1st sacral vertebra] root.”
There are two types of sciatica
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Acute sciatica (short-term): Acute sciatica does not always require professional treatment; symptoms can be significantly reduced by using over-the-counter pain relievers, such as painkillers, combined with hot and cold compresses and exercise.
- Chronic (long-term) sciatica: Chronic sciatica, on the other hand, may require physical therapy, which may include exercises, heat application, and other techniques. In rare cases, surgery may be necessary.
Acute sciatica can last between four and eight weeks, while chronic sciatica persists longer.
What Causes Sciatica?
Sciatica is a common symptom of various medical conditions, the most common being a herniated disc.
The spine is made up of three parts:- Vertebrae (individual bones in the spine that protect the nerves)
- Nerves
- Discs
A disk is made of strong, resilient tissue (cartilage), which acts as a cushion between the vertebrae and allows the spine to flex. A herniated disk occurs when a disk temporarily slips out of position and puts pressure on the sciatic nerve.
Other causes of sciatica include:
- Lumbar spinal stenosis: A narrowing of the spinal cord (the canal inside the vertebrae that contains the nerves) in the lower back, which can compress the sciatic nerve.
- Spondylolisthesis: A medical problem in which the disk slips forward over the vertebra below it, pressing on the sciatic nerve.
- Tumors within the spine can compress the sciatic nerve root.
- Infection inside the spine.
- Injury within the spine.
- Cauda equina syndrome: A rare but very serious condition affecting the nerves in the lower spinal cord, it requires immediate medical attention. This syndrome can cause permanent damage to the nervous system and even lead to paralysis.
In many cases of sciatica there is no obvious reason, as anything that irritates the nerve can cause sciatica pain.
However, any combination of muscle, joint, and bone tension is thought to lead to sciatica, which explains why it is more common in patients over 40.
What are the risk factors?
- Age: Due to the deterioration of the discs, people in their 30s and 40s are at greater risk of developing sciatica.
- The profession: Jobs that involve lifting heavy weights for long periods.
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A sedentary lifestyle: People who sit for long periods and lack physical activity are more likely to develop sciatica, compared to physically active people.
What are the signs and symptoms?
The main symptom of sciatica is a stabbing pain anywhere along the sciatic nerve: from the lower back, along the buttocks, and down the back of each leg (usually only one leg is affected). This pain can range from a dull ache to a sharp pain or intense discomfort, and may be aggravated by sitting for long periods.
Other common symptoms of sciatica include:
- Loss of sensation in the leg along the nerve; occasionally, this numbness is accompanied by pain in another part of the leg.
- Tingling sensation in the feet and toes.
How is it diagnosed?
If your sciatica symptoms are moderate and last no more than 4 to 8 weeks, you are likely suffering from what is known as acute sciatica and will probably not need medical attention as this problem will resolve on its own.
Doctors will also ask you to do certain basic exercises (focusing on your legs) to stretch your sciatic nerve.
A stabbing pain in the leg while performing these exercises is usually an indication of sciatica.
If pain persists for more than four to eight weeks, imaging studies such as X-rays and/or MRI may be necessary to help identify what is compressing the sciatic nerve and causing the symptoms.
What are the treatment options?
Most cases of acute sciatica respond well to self-care measures, which may include:
- Over-the-counter pain relievers: These relieve pain symptoms. Nonsteroidal anti-inflammatory medications, such as ibuprofen, are recommended. For long-term use, acetaminophen (Tylenol, paracetamol) is recommended. Not all pain relievers are suitable for all patients; be sure to review the options with your doctor.
- Exercises such as walking or light stretching.
- Hot and cold compresses: These help reduce pain. Alternating hot and cold compresses usually help more.
Treatments for chronic sciatica usually require a combination of self-care and medical treatment.
- Prescription pain relievers: Ametriptiline, gabapentin, codeine (a mild pain reliever with an opiate component), which are often prescribed with paracetamol, and if sciatica symptoms are very severe, with diazepam.
- Physical therapy: Can teach you exercises to strengthen your back muscles and improve flexibility, as well as to prevent back strain.
- Chiropractic treatments: These can help the spine return to the proper position, relieving pressure on the nerves and resulting pain relief.
- Cognitive behavioral therapy (CBT): Helps manage chronic pain by training the patient to react to their pain differently.
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Surgery may be the appropriate option in cases where no treatment has helped and symptoms have actually intensified.
Some options include:
- Lumbar Laminecectomy: This involves widening the spinal cord in the lower back to reduce pressure on the nerves.
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Discectomy: Partial or total removal of the herniated disc.
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Depending on the cause of the sciatica condition, a surgeon will assess and inform the patient about the risks and benefits of surgery, as well as suggest the best option.
How can sciatica be prevented?
There are several lifestyle changes that could reduce your chances, including:
- Exercise regularly: Focus on strengthening your muscles (abdomen and lower back) - this is also necessary for good posture.
- Maintain good posture: Stand and sit upright, lift objects correctly, and select a mattress and pillow that provide good support for your spine.
