Sciatica

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Sciatica refers to a type  of pain that travels down the hips, through the buttocks and then radiates down the back of the leg. It is so named because it travels along the path of the sciatica nerve.

This is  one of the largest nerves in the body and is responsible for carrying pain and other signals  between the brain and the lower half of the body. Although the sciatic nerve splits into two branches after leaving the buttocks and travels down the back of each leg, sciatic nerve pain normally only occurs on one side of the body.

The most typical cause of sciatica is pinching of the nerve either in the spinal canal or at the point at which it exits the spine. The conditions that most commonly cause sciatic pain are herniated discs and spinal stenosis.

In addition to pain, the symptoms of sciatica include (in some cases) leg numbness and tingling.

Although sciatic pain can in some cases be sharp and unpleasant, the good news is that it is in most cases treatable and manageable by non-invasive approaches such as activity modification and pain relief medications.

In a few cases, however, it can cause problems with bowel or bladder control. When this happens, other serious medical conditions may be present and immediate medical attention may be indicated.

The Sciatic Nerve & The Causes Of Sciatica

The sciatic nerve is the longest and thickest nerve in the body. It has five roots – two in the lumbar spine (i.e. in the lower back) and three more at the bottom of the spine (known as the sacrum). As mentioned, it travels through the hips and buttocks and down the back of each leg, ending just below the knee.

Several smaller nerves in the calves, feet and toes, connect to the sciatic nerve and carry pain and other signals to and from it.

The most common cause of pain that travels along the sciatic nerve is pinching of the nerve roots in the lower back. This can be a result of:

  • Herniated disks that start to bulge and press on the roots of the sciatic nerve as the exit the spinal canal;
  • Lumbar spinal stenosis (or a narrowing of the spinal canal in the lower back that again compresses the nerve roots.

In a minority of cases, sciatica can be caused by either a tumour that attacks and damages the sciatic nerve, or by diabetes, in which excess blood sugar produces toxins that do the same.

Sciatica Risk Factors

The following things can increase the risk that you may develop sciatica at some point:

  • A previous traumatic injury to your lower back (e.g. from a fall or car accident);
  • Aging, which increases the likelihood of conditions like stenosis or disc herniation that can in turn lead to sciatica;
  • Excess body weight, which puts extra pressure on your lower back and increases the likelihood that a nerve can be compressed in the spinal column;
  • Having weak or underdeveloped core or back muscles, which leaves your spine to carry more weight than it otherwise would have to;
  • Having a job that requires lots of heavy lifting, especially if you lift with an improper technique (i.e. you lift with your knees straight and have your lower back support the load by itself);
  • Poor posture, especially while seated;
  • Diabetes – as mentioned before, this can lead to nerve damage (including the sciatic nerve) and thus to sciatica.

Symptoms Of Sciatica

The signature symptom of sciatica is pain in your lower back that may radiate down your lower body and as far as your knees;

In addition:

  • Sciatic nerve pain is usually felt on one side of the body, although in rare cases it can occur on both sides;
  • The pain can be a dull ache, a burning sensation or sharp shooting pain. Some patients compare it to the pain of an electric shock;
  • It can come and go over time;
  • In some patients, the pain seems to worsen if they sit or stand for extended periods;
  • It can also become more severe if you cough or sneeze, especially violently;
  • The pain can be accompanied by tingling or numbness in other parts of the affected leg.

One additional symptom experienced by some sciatica sufferers is loss of bowel or bladder control. This is a possible sign of a serious medical condition known as cauda equina syndrome. If you experience this difficulty (in addition to some or all of the other symptoms above), you should seek medical advice urgently.

Diagnosis Of Sciatica

In diagnosing the cause of your pain, your doctor will ask you about your medical history and particularly about any back injuries you may have experienced previously.

The next step will probably be a complete physical exam. During this stage, you may be asked to do a couple of simple tests that indicate whether or not the cause of your pain is sciatica:

  • Walking on your toes or heels;
  • Lying on your back and trying to lift your legs one at a time;
  • Rising unaided from a squatting position.

Pain experienced while trying to do any of these things is a possible indicator of the presence of sciatica.

Finally, your doctor may request an imaging scan of your lower back to identify signs of stenosis or disc herniation (conditions that could cause sciatic nerve pain). The scan may be a CT scan, MRI or X Ray.

Treatment Of Sciatica

Home Based Treatment

Sciatic pain may be severe and debilitating but it is usually treatable using simple conservative remedies that are accessible at home:

  • Apply an ice bag or cold compress to the painful area for 20 minutes every 2-3 hours. Once the pain has subsided, you may switch to using hot compresses to improve blood circulation;
  • Over the counter pain relief medications can help. Non steroidal anti inflammatory drugs such as Ibuprofen, aspirin or Naproxen can help to reduce pain, inflammation and swelling;
  • Sciatic stretches performed as part of a physical therapy program can help to strengthen back muscles and increase core strength.

Other Treatments

If the home based treatments discussed above are not successful, doctors can suggest other sciatica treatments:

  • Prescription medicines such as muscle relaxants, anti seizure drugs and narcotics may be more successful than the over the counter drugs listed above;
  • Cortisone injections close to the spine may help to reduce inflammation near the nerve roots and therefore ease sciatic nerve pain.
  • A physical therapy program under the supervision of a physical therapist may be suggested.

Surgery

As a final option, or if there are signs of potentially serious medical problems (such as fecal or urinary incontinence), doctors may suggest surgery to correct the cause of the sciatica.

Surgical treatment options may include:

  • Removal of a portion of a herniated disc to reduce pressure on an adjacent nerve;
  • Removal of portions of the spinal vertebrae that may be pressing on affected nerves.

Spinal surgery is a very risky procedure. It has many potential complications, including bleeding, infections, leaks of spinal fluid, blood clotting and even greater loss of bowel or bladder control. Discuss these risks thoroughly with your doctor before agreeing to any surgical procedures. And do not be afraid or reluctant to seek a second opinion.

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