Sciatica is a medical term used to describe the pain, weakness, and numbness that radiates along the sciatic nerve. The sciatic nerve is located in the lower back, and when it becomes compressed or irritated, it causes symptoms to radiate in the buttock and travel down the leg. Sciatica can cause debilitating pain. Let's take a look at the symptoms, causes, risk factors, and treatment options for sciatica pain management
What are the symptoms of sciatica?
The primary complaint of sciatica is pain on one side of the body. The pain can be referred to as shooting or burning pain that begins in the low back or buttock. It can radiate down the leg and continue all the way down to the foot. Finally, the pain can be intermittent or constant.
Individuals may also complain of numbness, tingling, or weakness in the back of the leg. The symptoms may worsen with certain movements. It may feel worse when lying down, sitting, twisting, bending forward, or while trying to stand up. Many individuals find that applying heat to the low back/buttock region or walking relieves their sciatica.
Sciatica can be caused by an underlying medical condition
Sciatica is not a medical diagnosis. It is a medical term that describes a group of symptoms caused by an underlying medical condition. Some of the most common conditions that cause sciatica include:
- Herniated lumbar disc – A herniated disc can cause sciatica pain in two different ways – the herniated disc can press against the sciatic nerve, or the disc material called hyaluronan can leak out of the herniated disc and cause irritation or inflammation to the area surrounding the sciatic nerve.
- Lumbar degenerative disease – Degeneration of the vertebral bones can cause bone spurs or other abnormal growths to occur, which can cause compression of the sciatic nerve roots. Furthermore, degenerative disc disease can cause the discs to secrete proteins that can cause inflammation of the sciatic nerve.
- Lumbar spinal stenosis – Spinal stenosis often affects individuals older than 60. This medical condition causes narrowing of your spinal canal and is one of the common causes of sciatic in older adults.
- Piriformis syndrome – The piriformis muscle, located deep within the buttock, is used to rate the hip, leg, and foot outward. Irritation or injury to this area can cause irritation or inflammation of the sciatic nerve.
- Spondylolisthesis – Spondylolisthesis happens when a stress fracture of one vertebra slips forward over another vertebra. When this occurs, it compresses the sciatic nerve pain.
What are the risk factors for sciatica?
There are certain factors that can increase the risk of developing sciatic pain, including:
- Mental health conditions like depression
- Vitamin B12 deficiency
- Sedentary lifestyle
- Poor ergonomics
- Certain occupations like machine operators, truck drivers, or carpenters
How Is sciatica treated?
For best results, treatment should be sought as early as possible to help reduce the progression of symptoms. There are numerous treatment methods available, including nonsurgical and surgical treatment methods.
Nonsurgical treatment options for sciatica pain
If you are diagnosed with sciatica, your doctor will typically recommend nonsurgical treatment options.
These options include over the counter or prescription medications, physical therapy, alternative therapies, and therapeutic injections. The length of treatment depends on the severity of sciatica and the underlying cause of your sciatic pain.
- Alternative therapies – A variety of therapies can be used to relieve sciatic nerve pain, including chiropractic manipulations, massage therapy, acupuncture, herbal remedies.
- Medications – A number of medications can be used to relieve sciatica pain, including nonsteroidal anti-inflammatory drugs, steroids, antidepressants, anticonvulsant medications, and opioid analgesics.
- Physical therapy – Physical therapy uses a combination of massage, heat therapy, ultrasound therapy, electrical stimulation therapy, and therapeutic exercises to help relieve pain.
- Therapeutic injections – Injections like epidural steroid injections and selective nerve root blocks are used to relieve pain quickly and reduce inflammation in the sciatic nerve and surrounding tissues
Surgical treatment options for sciatica pain
Surgery may be considered when pain and weakness continue after several nonsurgical treatment options have been used or the pain has persisted for longer than 6 weeks and impacts your ability to functions and complete everyday tasks. Additionally, surgery may be considered if any of the following occur:
- Cauda equina syndrome – This medical emergency occurs when the cauda equina nerve roots become compressed and the sensory and motor functions in the lower areas of the body are lost.
- Tumors – Tumors in the lumbar spine, along with cysts and severe fractures warrant immediate surgical intervention.
- Bilateral sciatica – When sciatica affects both legs, surgery may be recommended. The common causes for this include central spinal stenosis, severe herniation, or multiple disc herniations.
- Infection – If an individual has developed a pelvic region infection that is not responding to medications, surgery may be required.
Understanding the anatomy of the sciatic nerve
The longest and largest nerve in the body is the sciatic nerve. This nerve begins at the base of your spine and runs down the back of your leg and ends in your foot. At its thickest point, it measures approximately 2 centimeters.
When the sciatic nerve reaches the back of the knee, it splits into two main branches called the peroneal nerve and the tibial nerve. In addition to this several small branches of nerves called collaterals branch off from the sciatic nerve.
The peroneal nerve travels along the outer area of the knee, down through the outer area lower leg, and ends at the outer area of the foot. The tibial nerve travels down the back of the calf and into the heel and sole of the foot. The smaller branches send signals to the muscles in the thigh, knee, hip, calf, and foot.
The sciatic nerve is responsible for most functions in the leg and is needed for a number of actions, including climbing, walking, running, standing, and lifting weights. When the nerve becomes impinged or inflamed, it can cause debilitating pain, tingling, and weakness in the low back, buttocks, and legs. Typically, these symptoms of sciatica only occur on one side of the body.
When to seek immediate medical attention
Sciatic nerve pain is not typically a cause for concern; however, if your sciatic nerve pain results from an injury or trauma, or other symptoms like loss of appetite or fever, contact your doctor immediately. Finally, medical attention should be sought if you experience any of the following symptoms:
- Bladder dysfunction
- Bowel dysfunction
- Leg weakness that progresses from mild to severe weakness
- Sexual dysfunction
- Symptoms occur in both legs
Sciatica typically develops over time. It often occurs after the age of 40 and is common in individuals who have occupations requiring them to bend sideways or forward or requires them to lift their arms above shoulder level frequently. This painful diagnosis often resolves on its own with nonsurgical treatment options. You can expect your sciatic nerve pain to resolve in around 4 to 6 weeks.
If your sciatica does not respond to treatment, surgery may be suggested. In addition to this, surgery is often recommended when the nerve has become severely compressed, there is an infection that is not responding to antibiotic treatment, or the symptoms of sciatica are interfering with a person's ability to function.