Sciatica (say sigh-ATTA-cuh) is pain which originates in the sciatic nerve. This pain is sometimes quite severe and courses along the path of the sciatic nerve as it travels from the area of the spinal cord down to the lower limbs. Usually sciatica only affects one side of the body.
Nearly eighty-five percent of Americans will experience back pain at some point in their lives, but this does not necessarily mean involvement of the sciatic nerve. What makes the difference here is the pain tends to ‘travel’ or radiate down one leg. Sciatica tends to affect people most often when they are between the ages of thirty and fifty, with women more likely to develop symptoms in pregnancy due to pressure of the fetus and uterus on the sciatic nerve. People who have occupations which require prolonged sitting also seem to be more prone to getting sciatica as are people who have diabetes, because of the damaging effects elevated blood sugar has on the nerves.
To understand sciatica, knowing a little bit of anatomy is very helpful and you’ll understand why in just a minute. The sciatic nerve is the largest nerve in your body and is about as thick as a man’s thumb at one point in its travels. This nerve is also the longest nerve in your body, running from your lower back, where it branches through your hips and buttocks and then traveling down the back of each leg.
Let’s take an even closer look. The sciatic nerve actually begins in the lower spine where nerve fibers exit your spinal canal through openings in the spinal bones called foramen (say four-RAY-men) on each side of your lower spine. These nerve fibers, or ‘roots’ as they are called, then combine to form the large sciatic nerve.
The sciatic nerve exits the pelvis through another foramen and then runs beneath the piriformis muscle, a muscle located deep in the buttocks which helps to both rotate your hips and turn your leg and your foot outward. The nerve then travels down the back to each upper thigh to the back of each of your knees, branching once more into two nerves, the tibial and the common peroneal nerves which go into your feet.
The sciatic nerve functions in two ways. In general, nerves serve two functions: to supply sensation (sensory nerves) to a part of the body or to transmit signals that enable the muscles to move (motor nerves.) The sciatic nerve is what is known as a ‘mixed’ nerve, as it contains both sensory and motor nerve fibers. The sensory portion of the nerve enables you to have feeling in the back of your thigh, your whole lower leg, your ankle and the sole of your foot. The motor portion of the nerve enables the muscles of your lower leg (which includes the calf, ankle and the back of your knee) to move.
You can probably see by now that the anatomy of the sciatic nerve is quite complex, which means that pain from sciatica can vary from person to person, as it really depends on where the nerve irritation is occurring.
Before we get into the various causes of sciatic nerve pain, let’s discuss the symptoms. The classic symptom of sciatica is pain that begins in your lower back or buttock and radiates down into your buttock and down the back of one leg. Usually, sciatica affects only on one side of your body and pain can be quite mild or can be a more severe burning sensation, or electrical shock like sensations, or even worse, be almost excruciating in its severity.
Because the sciatic nerve carries both motor and sensory functions as we discussed above, some people can have numbness and tingling and even muscular weakness in the affected leg. Sciatic nerve pain tends to appear suddenly and can last from days to even weeks. You may find that coughing, sneezing or sitting makes the pain get worse.
Technically, sciatica is pain originating in the sciatic nerve itself and is typically caused by nerve inflammation or other irritation of the nerve. In many cases, no actual cause for the sciatica is ever found. It’s important to understand that other conditions besides sciatica can trigger pain and sciatica-like symptoms. These conditions include degenerative arthritis of the spine as well as a herniated disc. These discs, which are rounds of spongy tissue in between your vertebrae, act like cushions in between the spinal bones. Sometimes the discs can grow weak and protrude out of place and push on the sciatic nerve at its roots, causing pain to radiate down the leg.
Spinal stenosis, which is a narrowing of the spinal canal, can also put pressure on the sciatic nerve at its roots and cause similar pain. And while fortunately very rare, a tumor growing in the area can put pressure on the sciatic nerve and cause pain. Sometimes a person can develop a spasm of the piriformis muscle, which lies deep within the buttock and travels directly over the sciatic nerve. Such a spasm may irritate the nerve and cause pain. Piriformis syndrome is more commonly seen in women, but men who have a habit of carrying an overstuffed wallet in their back pants pocket can also develop piriformis syndrome due to pressure on the muscle, with subsequent irritation of the sciatic nerve. Inflammation of the sacroiliac (SI) joints due to injury, infection, pregnancy or arthritis can also cause sciatica-like pain. The SI joints are located where the lower back connects to your pelvis.
Not everyone with sciatica will need medical care, although if your symptoms are severe or do not go away after a few weeks you need to make an appointment with your medical provider. You also need to be seen immediately if you were to develop loss of bladder or bowel control, which is quite rare. Diagnosis starts with a thorough history and physical exam, in which your provider will likely check your reflexes as well as muscle strength and sensation in your legs and feet.
Provided your pain is not severe or you don’t have any alarming symptoms such as loss of bladder or bowel control or concerning signs on physical exam like muscle weakness, depressed reflexes and loss of sensation, your provider may elect to initially treat your symptoms and not order more tests right away.
If your symptoms persist, tests may include imaging studies such as an MRI or CT scan of your lower back. These scans show much more detail than an x-ray in relation to the spinal cord, lumbar discs and nerves, although an x-ray can identify abnormalities in the bones of the spine. Sometimes and EMG (electromyography) is done which measures the nerve impulses and the response of your muscles to those impulses. This test is useful to pinpoint compression of the nerve due to a herniated disc or spinal stenosis.
First of all, most people with sciatica find their symptoms go away after a few days or weeks and they have no lasting damage. You can try these remedies at home if your pain is not severe: try either an ice pack or a heating pad, whichever seems more appealing, applied to the painful area for about twenty minutes every two hours or so. Or you can try alternating between the two.
Over the counter medications available without a prescription can bring relief for mild to moderate pain. These medications include non-aspirin pain relievers like acetaminophen (such as Tylenol brand) or aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Be sure to carefully follow package directions when using these medications.
It’s almost always best to try to remain active when you have sciatica, as movement can actually lessen pain and inflammation. Gentle stretching, yoga and short walks may help. Your medical provider may order physical therapy if home remedies are not resolving your pain.
If your sciatica is severe, your doctor may inject the area around the nerve with a steroid medication, which will work to quickly reduce inflammation. Other conditions causing sciatica-like pain such as spinal stenosis or a herniated disc may require surgery. Some complementary therapies, such as acupuncture and massage, may bring some relief but evidence for their effectiveness is not entirely clear. Chiropractic manipulation can be effective for low back pain but may not work as well for pain that is radiating.
Your physician may also prescribe short term narcotic pain relievers and muscle relaxants. In some cases tricyclic antidepressants and even some anti-seizure medications can be helpful.
Unfortunately, if you have already suffered from an episode of sciatica, you are at risk for developing it again. But the good news is that you can be proactive and take steps to prevent the development of another bout of sciatica. First of all, you should exercise regularly. This will keep your muscles and joints in optimum shape and will go a long way in preventing another episode.
Remember to maintain good posture. Avoid slumping at your desk at work or at home and choose a chair with good back support. A small rolled towel placed in between the chair and your lower back can help to maintain your back’s proper curve. Also remember to lift heavy objects correctly by bending at your knees instead of from your waist.
If you have sciatica, don’t despair! Most cases resolve with minimal treatment and no long lasting difficulties. As always, if your symptoms are severe, see your medical provider right away.
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