Have you ever experienced pain starting in the buttock and radiating to the back of the thigh and down to the calf or foot? That pain could be sciatica. The sciatic nerve is the thickest nerve in the body. Sciatica is described as the pain developed due to irritation and compression of the sciatic nerve. It radiates along the path from your lower back and buttocks down to each leg. The pain can vary from moderate to severe and weakness and numbness can be experienced in these areas. About 40 percent of people suffer from sciatica at some point in their lives.
Sciatica Diagnosis
Physical Examination: During the physical examination, the doctor might check for localized pain in the lower back, buttocks and legs. Clinical Tests: • Straight leg raise test: The patient is asked to lie on their back and lift one leg at a time with the other bent at the knee. If the pain occurs and radiates along the course of the sciatic nerve, the pain is related to sciatica. • Dynamic X-rays of the lumbar spine in AP, lateral flexion and lateral extension views: This helps understand alignment of the spine and detect if there is abnormal movement between the bones of the spine. • MRI of the lumbar spine: This helps understand the exact condition of the bones, discs, nerves, joints and ligaments of the spine.
Causes of Sciatica
- Disc herniation or slip disc: It presses and irritates the lumbar nerve roots giving rise to sciatica pain
- Spondylolisthesis (condition which occurs when one vertebra slips over another) leading to compression of the nerves in the spine
- Degenerative disk disease
- Being overweight
- Aging (aging spine compresses lower back nerves)
- Lumbar spinal stenosis
- Piriformis syndrome (inflammation can cause muscle to compress sciatic nerves)
- Spinal tumors (tumor in the lumbar spine can cause nerve compression)
- Spine Infections: Spine infection can lead to abscess formation that creates pressure on the nerve roots
Risk Factors
- Diabetes increases the risk of nerve damage
- Heavy lifting and prolonged sitting can cause strain on your back
- With age, the body parts tend to experience wear and tear
- Smoking can cause the outer layer of spinal discs to break down
- Obesity increases stress on the spine which triggers sciatica
- Vitamin B12 deficiency
- Poor work ergonomics
- Genetic susceptibility
Non-Surgical Sciatica Treatment
Acute sciatic nerve conditions are generally treated by non-surgical treatments. Non-surgical sciatica treatment is a combination of physical therapy, medications, therapeutic injections and alternative therapies which provides a cure in about 4 to 6 weeks. Trained physiotherapists formulate an effective treatment plan which includes certain exercises that provide relief from sciatic pain and increase core strength. Medications: Nonsteroidal anti-inflammatory drugs, oral steroids, anticonvulsant medications, antidepressants and opioid analgesics may be prescribed for a short duration. Epidural steroid injections and selective nerve root blocks: These are administered for controlling the inflammatory response around the sciatic nerve and reduce the production of inflammatory cells in the body. They can provide instant relief from pain and inflammation.
Surgical Sciatica Treatment
Surgery for sciatica is needed if the pain persists for a long duration even after several non-surgical treatments. Microdiscectomy: A common approach used for treating sciatica caused by lumbar disc herniation. It is a minimally invasive technique done by making small incisions and causing minimal damage to the surrounding tissues. Minimally invasive Lumbar Decompression: Usually done to treat sciatica pain caused by lumbar spinal stenosis. In this, part of the lamina is removed making more space for the spinal nerves. It provides relief from nerve root compression and irritation.
Prevention
- Exercise regularly: Strengthening of core muscles and back muscles is essential for maintaining a healthy spine and proper posture
- Keep a check on weight you lift: Lift heavy objects properly by bending at your knees and keeping your back straight
- Change your positions: Don't stand or sit for too long — take breaks frequently
- Quit smoking: Nicotine weakens the spine and vertebral discs as it reduces blood supply to the bones
- Maintain bodyweight: Avoid consumption of high calories and fats — maintaining a healthy weight reduces pressure on the spine
Frequently Asked Questions
Q: What causes sciatic pain during pregnancy? A: During pregnancy, a bundle of nerves gets pressed between the growing baby and pelvic bones, causing sciatica. Q: When to see a doctor? A: If you experience severe pain in the lower back and numbness in your leg, or your symptoms have been present for more than 3 weeks, or you have trouble controlling the bowels or bladder — visit a doctor as these may be symptoms of worsening sciatica and impending nerve damage.