Sciatica: Causes, Symptoms, Diagnosis & Treatment

A Detailed Overview of Sciatica- Medical & Health

Sciatica

A condition known as sciatica can result in leg and back pain. It occurs when pain follows the sciatic nerve's path. The main nerve in your leg is your sciatic nerve. Additionally, it is the largest nerve in your body. Leg pain, weakness, numbness, or tingling is known as sciatica. It is brought on by pressure or injury to the sciatic nerve. Sciatica is a sign of a health issue. It is not a disease in and of itself. Sciatica is also known as lumbar radiculopathy.

Sciatica pain originates in the lower back and spreads through the hip, buttocks, and back of the leg to the foot. A variety of factors can cause sciatica. The condition typically improves over time, whether on its own or after treatment.

Although the term "sciatica" is frequently used to refer to any pain that originates in the lower back and travels down the leg, true "sciatica" injuries to the sciatic nerve are extremely uncommon. An injury to a nerve—an irritation, inflammation, pinching, or compression of a lower back nerve—is what causes all of this pain.

Even though sciatica pain can be severe, most cases resolve with treatment within a few weeks. Surgery may be necessary for individuals with severe sciatica, severe leg weakness, or bowel or bladder changes.

Sciatic Nerve

The sciatic nerve is the main and largest nerve in the legs. There are five nerve roots in it: three from the final segment of the spine, known as the sacrum, and two from the lumbar spine in the lower back. The right and left sciatic nerves are made up of the five nerve roots that join together. One sciatic nerve runs through your buttocks, hips, and legs on each side, ending just below your knee. After that, the sciatic nerve splits off into other nerves, which run down your leg and into your foot and toes.

Causes Of Sciatica

Several different medical conditions can result in sciatica, including:

A Slipped or Herniated Disk: A disk that has slipped or herniated putting pressure on a nerve root can cause sciatic pain. The cushions that sit between each vertebra of the spine are called disks. A weakness in the disk's outer wall can cause the gel-like center to herniate under vertebral pressure.
Degenerative Disk Disease: It refers to the natural deterioration of the disk that connects the vertebrae of the spine. One of the most frequent causes of sciatic pain is it.
Spondylolisthesis: It is a condition in which one vertebra moves out of line with the one above it, narrowing the nerve exit hole. The sciatic nerve can become compressed by the extended spine.
Cauda Equina Syndrome: It is a serious but rare condition that affects the cauda equina, a bundle of nerves at the end of the spinal cord. Loss of control over the bowel and bladder, numbness around the anus, and leg pain are all symptoms of this syndrome.
Spinal Stenosis: It is the narrowing of the nerve passageways. The abnormal narrowing of the spinal canal causes the spinal cord and nerves to lose space.
Osteoarthritis: In aging spines, bone spurs, or jagged edges of bone, can form and compress nerves in the lower back.
Injury: Injury to the sciatic nerve or the lumbar spine from trauma.
Tumor: Compression of the sciatic nerve caused by tumors in the lumbar spinal canal.
Piriformis Syndrome: When the piriformis muscle, a small muscle deep in the buttocks, becomes tight or spastic, it causes piriformis syndrome. The sciatic nerve may become irritated and put under pressure as a result. An uncommon neuromuscular disorder is piriformis syndrome.

Risk Factors Of Sciatica

The following are risk factors for sciatica:

Age: The majority of cases of sciatica are caused by changes in the spine that come with age, such as bone spurs and herniated disks.
Obesity: Overweight people put more pressure on their spines.
Occupation: Sciatica may be caused by a job that requires twisting one's back, carrying heavy objects, or driving for long periods.
Sitting for too long
Diabetes

Symptoms Of Sciatica

Sciatica can cause mild discomfort or severe incapacitating symptoms. The symptoms are determined by the specific spinal nerve root that is irritated or compressed at the origin of the sciatic nerve. Multiple nerve roots can be affected simultaneously.

Typically, sciatica only affects one leg at a time, with symptoms radiating down the leg from the buttock or lower back to the thigh. Sciatica can cause pain in the front, back, or sides of the thigh and leg. Some of the most common symptoms of sciatica include:

Pain

The pain from sciatica can be constant or intermittent. Typically, the pain is described as burning or sharp and shooting. When compared to the back, the pain is typically more severe in the leg. When compared to other areas of the leg, pain in the calf below the knee typically occurs more frequently.

One-Sided Symptomatic Sciatica

One leg typically suffers from sciatica. The condition frequently causes the affected leg to feel heavy. Both legs may occasionally be affected simultaneously.

Sensation

The back of the leg may experience pins and needles, numbness, or tingling.

Weakness

Leg and foot weakness can be felt. Lifting the affected foot off the ground may be difficult if the leg feels heavy.

Altered Posture Symptoms

Altering posture can either aggravate or alleviate pain. Sciatica pain can be affected by certain body postures. Sciatica pain may become more severe while sitting, attempting to stand, standing for an extended period, bending or twisting the spine, coughing, or both.

While lying down, pain may intensify or persist, disrupting sleep. In these situations, lying on the side with a pillow between the legs or on the back with the knees slightly elevated may help alleviate pain.

Diagnosis Of Sciatica

In addition to a thorough physical examination and medical history, tests for sciatica may include,

X-Ray

The film is created by capturing images of internal tissues, bones, and organs using electromagnetic energy beams.

Electromyography (EMG) & Nerve Conduction Study (NCS)

These two procedures work together to record and analyze muscle electrical impulses. During an electromyography (EMG) procedure, thin needles are inserted into your muscle to record electrical activity. The NCS is frequently performed in conjunction with the EMG to determine whether a nerve is functioning normally. The electrodes are then inserted into various parts of the skin, following the nerve pathway.

A CT-Scan

Before the X-rays are taken for a CT scan, a dye may be injected into the spinal canal (CT myelogram). After that, the dye moves through the spinal cord and spinal nerves, making it easier to see them in the images.

Magnetic Resonance Imaging (MRI)

Organs and structures in your body are captured in detail using large magnets, radiofrequency energy, and a computer.

Treatment Of Sciatica

To prevent the progression of symptoms, it is best to treat sciatica as soon as possible. There are both nonsurgical and surgical options for treating sciatica. Most of the time, nonsurgical treatments are tried first. When the underlying cause is severe and/or progressive neurological deficits, such as leg weakness, surgery may be necessary.

Nonsurgical Treatment For Sciatica

The first line of treatment for sciatica typically consists of physical therapy, medication, therapeutic injections, and other treatments.

After nonsurgical treatment for four to six weeks, acute sciatica typically improves. Treatment time may be longer for chronic sciatica with pain that persists for more than eight weeks, depending on the underlying cause.

Medications For Sciatica Pain

Prescription and OTC medications are both options for relieving sciatica pain. The commonly prescribed medications for sciatica are listed below,

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as prednisone and ibuprofen
Anticonvulsant medications (Gabapentin)
Tricyclic antidepressants (Amitriptyline and Tramadol)
Opioid analgesics (Oxycodone and tramadol)

These medications alleviate pain and enable patients to take part in physical therapy. Medicines like opioid analgesics are usually prescribed for brief periods to avoid addiction.

Physical Therapy For Sciatica

Physical therapy is an important part of almost every sciatica treatment plan. It includes stretching, strengthening, and aerobic conditioning. A physical therapy program may also include therapeutic exercises.

Physical therapy and exercises for sciatica have the following objectives:

Strengthen the muscles of the hip, buttocks, lower back, and abdomen.
Strengthen your core by stretching tight, rigid muscles like your hamstrings.
Light aerobic exercises like walking, swimming, or pool therapy help your body exchange fluids and nutrients.

Steroid Injections

Sometimes, a corticosteroid shot into the pain-causing area around the nerve root can help. Frequently, a single injection reduces pain. In a single year, up to three can be given.

Chiropractic Treatment

A chiropractor typically uses manual manipulation to improve the spine's alignment. Sciatic nerve pain can be caused by herniated discs or spinal stenosis, which can be treated with this method. Manual manipulation should not be painful because it can also improve the healing environment.

Massage Therapy

Some types of massage therapy, like deep tissue massage, may be good for relieving pain. Massage therapy has many advantages, including:

Relaxing tight muscles, which may be contributing to the pain, and releasing endorphins, which are hormones in the body that function as natural pain relievers, all contribute to a better healing response.

Acupuncture

At specific points on the body, the practitioner inserts thin needles into the skin. A few studies have found no benefit from acupuncture, while others have suggested that it may alleviate back pain. Choose a licensed acupuncturist if you decide to try it.

Surgical Treatment Of Sciatica

After non-surgical treatment for sciatica fails, surgical treatment is typically considered. Surgery may be considered if leg pain, weakness, or both continue for more than six to eight weeks despite nonsurgical treatments or if the pain interferes with daily activities.

Surgery may be the first option in some instances such as cauda equina syndrome, tumors, bilateral sciatica, and infection in the pelvic region.

Cauda equina syndrome is a medical emergency in which the lower body's motor and sensory functions are lost when the nerve roots of the cauda equina are compressed.

Multiple-level disc herniation, severe single-level herniation, or central spinal stenosis can all result in bilateral sciatica, or sciatica that affects both legs.

The goal of surgery is to control leg symptoms like pain and weakness and get rid of the cause of sciatica. However, sciatica-related back pain may not go away after surgery.

Microdiscectomy

For sciatica caused by a lumbar disc herniation, a common surgical procedure called a microdiscectomy is used to treat the condition. A small amount of the disc material beneath the nerve root and/or the bone over the nerve root is removed during this procedure. Although technically an open procedure, a microdiscectomy can be performed with a relatively small incision and minimal tissue damage using minimally invasive techniques.

Surgery For Lumbar Decompression

There are many options for treating nerve root irritation or compression, including:

Laminectomy

To make more room for the spinal nerves, this procedure involves removing some or all of the lamina. Lumbar spinal stenosis-related sciatica pain is the most common indication for this treatment.

Foraminotomy

In foraminotomy, your surgeon removes the bony overgrowth. As a result, the neuroforamen enlarge, allowing the nerve root more room to exit the spinal column through this opening.

Facetectomy

This surgery alleviates nerve compression brought on by degenerated facet joints. To alleviate nerve pressure, the facet joints are typically trimmed, undercut, or removed. After a facetectomy, approximately 85 percent of patients will experience pain relief.

Home Remedies & Lifestyle Modifications For Sciatica Pain

Home remedies and lifestyle changes are helpful for the majority of people with sciatica.

For up to 20 minutes, apply a cold pack to the painful area.
Heat the hurting areas after two to three days. Use a heating pad, heat lamp, or hot pack for the heating purpose.
Try alternating between warm and cold packs for persistent pain.
Low-back stretching exercises may also be effective. Make an effort to maintain the stretch for at least 30 seconds. During the stretch, avoid twisting, bouncing, or jerking.
For sciatica, painkillers like ibuprofen and naproxen sodium can sometimes be helpful. Use as directed by your doctor.