Sciatica

Sciatica is not a disease but rather a symptom because of complications with the sciatic nerve. The sciatic nerve is the longest nerve of our body and is also the main nerve of our leg. Medically, sciatica is known as lumbar radiculopathy. Sciatica refers to the pain originating from the sciatic nerve travelling to the lower back down till the legs. The sciatic nerve extends from the spine into the buttock and to the end of the thigh and leg.

The primary function of this nerve is to control the sensation and function in the leg and foot. When a person experiences symptoms of sciatica, the slipped discs tend to bulge and press against the intervertebral nerves. This pressure leads to pain.

What is Sciatica?

Sciatica refers to a group of symptoms arising due to trauma to the sciatic nerve. Symptoms include pain in the lower back which is accompanied by numbness in one leg. It happens to be a common occurrence for people who have inactive lifestyles. However, it can also be caused due to back injuries and sudden constraint on the sciatic nerve.

There are two main types of sciatica:

• Neurogenic
  The neurogenic sciatica is caused due to the compression of the sciatic nerve. The nerve may get compressed due to bulging discs, tight muscles or growth of a tumour. In the case of neurogenic sciatica, the person may experience loss of normal reflexes, numbness, and weakness in the leg.
• Referred
  The referred sciatica is due to muscular and joint problems in the spine or the pelvic region. This type of sciatica produces intense pain with or without any numbness.

The most commonly reported symptoms of sciatica include:

• Pain in the lower back, hip bone, back of the leg, and buttocks. (Read more - Back pain causes and treatment)
• Burning sensation in the legs. (Read more - Burning feet causes and home remedies) 
• Frequent numbness in one leg or foot.
• Weakness in one foot.
• Downward radiating pain.
• Difficulty in moving leg or foot, standing or walking.
• Tingling sensation in the feet which hinders movement.

There can be a few symptoms which need immediate medical attention. These include:

• Prolonged numbness in the legs.
• Loss of bladder and bowel control. (Read more - Urine incontinence treatment)
• Weakness in the leg.
• Pain on trying to move.

The symptoms of sciatica are mostly associated with limited functioning and severe pain accompanied by a tingling or burning sensation which goes away within a few minutes in the lower body including the back, leg, and foot.

However, the symptoms of sciatica may be similar to a condition such as sacroiliac joint dysfunction. Lower back pain may be experienced during conditions such as pregnancy. Hence, when such symptoms are experienced, it is crucial to undergo a thorough clinical evaluation to establish a proper diagnosis to rule out the possibility of other conditions.

Causes

The primary trigger for sciatic pain is the pressure exerted on the nerve. Any blunt trauma to the lower body or slipped disk could lead to the build-up of pressure on the nerve and cause severe pain. Other reasons which could irritate the sciatic nerve include:

• Blood clots. (Read more - Treatment of blood clotting disorder)
• Wrong sitting posture.
• Nerve disorders.
• Obesity.
• Presence of a tumour (in rare cases).

Risk Factors

Certain lifestyle choices can also increase the risk of sciatic nerve pain. These include:

• Prolonged inactivity.
• Sleeping on a surface which is too hard or rigid/not firm or too soft.
• Obesity.
• Smoking.
• Wearing high heels which exert pressure on the feet and lower back.
• Being under prolonged stress.
• Sitting in a poor posture.
• Working out excessively.
• Experiencing sudden pulls or tugs on the lower back.
• Heavy lifting.
• Driving for long durations of time.

Most people may report sciatic nerve pain after working out. For beginners, working out may exert pressure suddenly on the lower back and this can lead to pain. Some people may experience the pain temporarily after engaging in strenuous physical activities. When the cause is removed, the symptoms and the pain also reduce gradually. The elderly (above the age of 60) are at a higher risk of experiencing sciatic nerve pain. However, if the pain remains persistent and causes increasing difficulties, then medical treatment may be necessary.

One must consult a doctor immediately in cases regarding:

• An accident.
• Vertebral slips.
• Slipped disc.
• Sudden muscle spasms.
• Lumbar Spinal Stenosis.

It is wise not to ignore any kind of lower back pain and seek medical advice in extreme cases.

There are several steps one can take to reduce their risk of sciatica. These steps are:

• Avoiding smoking because smoking increases the chances of disc degeneration and hence increases the risk of sciatica as well.
• Being physically active and opting for a regular exercise regimen will strengthen the back and abdominal muscles.
• Maintaining a good pose while sitting, standing and even driving. A good posture helps in reducing the pressure put on the lower back and prevents spasms as well.
• Avoiding a sedentary lifestyle.
• Warming up before engaging in a workout routine to avoid straining the muscles.
• Not lifting heavy objects in any improper posture.

The doctor will first inquire about the various physical activities one has been engaging in the past few days. Questions related to daily life routine may also be asked. The questioning sessions will help the doctor to understand if the condition is due to exertion or any other physical activity which is laying stress on the lower back. Physical exams can also help in the diagnosis of sciatica. Physical exams may be followed by other tests which include:

• X-ray
  An X-ray can assist in obtaining the images of the internal tissues and bones. It can help the doctor in identifying any abnormalities like a slipped disc or an outgrowth which may be straining the sciatic nerve.
• Computed Tomography Scan (CT)
  A CT scanning is a quick and non-invasive way of diagnosing any spinal column damage. It can help in the assessment of spine fractures, osteoporosis or abscesses. It helps in identifying the cause of sciatic nerve pain as well.
• Magnetic Resonance Imaging (MRI)
  Magnetic resonance imaging may be carried out if the person experiencing the symptoms does not respond to non-surgical treatment modalities even after a month. If the symptoms worsen during that time frame, MRI scanning could be helpful in obtaining clear information about the cause of sciatic pain.

If sciatica does not resolve on its own within 4-6 weeks, medical intervention may be needed. Treatment modalities include:

• Pain relief medications
  Pain relief medications which also help in reducing inflammation may be prescribed in combination with other forms of treatment. These medications provide temporary pain relief until the nerve heals.
• Epidural Injections
  These include medications which can be injected directly into the spine for pain relief.
• Physiotherapy
  Physiotherapy is very useful in improving the symptoms of the pain associated with sciatica. It also helps in gradual healing and will include exercise and massaging techniques. It is advised to seek physiotherapy consultation within the first week of being diagnosed with sciatica. This will help in easing the pain by effectively managing the symptoms as well.
• Surgery
  If the pain does not subside as expected and causes significant discomfort, a surgery may be suggested. Decompression surgery can help in providing relief from sciatica. The recovery time of this surgery is usually six weeks. When all non-surgical interventions fail, surgery can be beneficial in managing sciatic pain most effectively. The surgery for sciatica which is caused due to slipped disc is known as partial discectomy.

Lifestyle management

According to medical reports, sciatic nerve pain is not very difficult to manage and most of the times, the pain associated with it subsides within a few days. There are several ways in which the pain can be eased. These include:

• Engage in mild exercise and routine activities as much as possible.
• Go for brisk walk and back stretches to help in easing the pain.
• Use heating pads to relax the muscles in the lower back area. Heating pads are readily available and are very useful in enabling movement. A heating pad can be used several times a day.
• Apply pain relief ointments after the application of a heating pad. These ointments also relax the muscles and reduce inflammation. The heat from the heating pad will allow the cream to absorb better and work faster.
• If you experience numbness in your leg, try to tap the feet gently on the ground to get rid of the numbness. Rotate your feet. You may experience a tingling sensation as the numbness begins to go away. Keep moving your leg gently but do not make sudden movements as this may cause the leg to become stiff.  
• You can take painkillers occasionally to get immediate relief from the pain. However, you must consult the doctor before taking them especially if you are on other medications as well.
• Avoid eating processed foods and sugary treats as these can aggravate the inflammation in the body. It is best to consume anti-inflammatory foods like green vegetables. Drinking homemade ginger green tea can be very helpful in reducing inflammation.
• If heating pads make you uncomfortable, warm baths can be a good alternative.
• Sleep on a firm mattress but make sure that it is not too hard. At the same time, do not sleep on a bed which is too soft as it will not provide any support to your back and could aggravate the pain.

It is advised not to:

• Use a cold compress on areas where you are experiencing numbness.
• Sit or lie down for long durations of time.
• Stress too much as this can lead to muscle pain.
• Take paracetamol tablets as these will not help with back pain.

Prognosis

The approach to treating sciatica is less dependent on medications and more inclined towards maintaining proper physical health. The symptoms of sciatica can be managed effectively with the help of a few positive lifestyle changes as simple as engaging in regular exercise and maintaining a good posture. The symptoms subside within a few weeks and complications from sciatica are not very common. The elderly are at a higher risk of developing long-term damage, but with various medical interventions available such as physiotherapy and surgery for extreme cases, relief from sciatica is very much possible.

Complications

As mentioned before, sciatica usually resolves within a few weeks after which the person can function normally without experiencing any persistent pain. However, if the pain does not reduce and is accompanied by other symptoms regularly, then medical advice should be taken.

Complications can arise if the pressure on the sciatic nerve is not reduced. These complications include:

• Slipped disc.
• Permanent nerve damage.
• Loss of sensation in the affected leg.
• Inability to move the limb with ease.
• Increased pain.
• Problems in walking and remaining seated for more extended periods of time.
• Developing an improper posture.
• Loss of bowel and bladder function.