Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. The term sciatica is commonly used to describe any kind of pain that originates in the lower back and radiates down the leg.
The sciatic nerve is the longest and thickest nerve in the body. On each side of your body, one sciatic nerve runs through your hips, buttocks, down the leg and ends just below the knee. The sciatic nerve then branches into other nerves, which continue down your leg and into your foot and toes.
Symptoms of Sciatica
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is characteristic of sciatica. The discomfort can arise almost anywhere along the nerve pathway.
The pain can range from mild to severe. It may also result in muscle weakness in your leg, numbness in your leg or foot, or even an unpleasant tingling pins-and-needles sensation.
The extent of the pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes, it can feel like a jolt or electric shock and usually only one side of the body is affected. The pain may worsen with movement and even result in loss of movement entirely. In severe cases, there may be loss of bladder and bowel control.
Causes of Sciatica
Sciatica can be caused by several different conditions. Sometimes, pressure from vertebral movements can cause the intervertebral discs to bulge and rupture, this is called a herniation. A herniated disc can put pressure on a nerve and is the most common cause of sciatica.
Natural age-related wear and tear of the discs between vertebrae of the spine can shorten their height and cause the nerve passageways to become narrow. This results in spinal stenosis that can pinch the sciatic nerve roots as they leave the spine.
Spondylolisthesis is the slippage of one vertebra, so that it is out of alignment with the rest of the vertebrae. This misalignment can narrow the opening through which the nerve exits and pinch the sciatic nerve.
As a response to long periods of inflammation, spurs or bony protrusions may form in aging spine, these can sometimes compress the nerves of the lower back and cause sciatica.
An accident or trauma injury to the spine can damage or pinch the sciatic nerve and result in sciatica.
Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord. It causes pain down the leg, numbness around the anus and loss of bowel and bladder control.
Diagnosis of Sciatica
Sciatica is diagnosed based on medical history, physical examination and diagnostic imaging scans.
Physical examination: Physical examination involves determining the degree of motion, site of pain and evaluation of nerve and muscle using specific movements. Most cases of sciatica are diagnosed through these means.
Diagnostic imaging: Imaging studies are only necessary when the sciatica is severe or there is a possibility of cauda equina syndrome. These studies may include X-rays, CT scans and MRIs may be ordered to investigate extent of degenerative changes and helps visualise all involved tissues like bone, muscles, nerves, ligaments and cartilage.
A diagnosis is vital to determining a suitable course of action and treatment.
Treatment of Sciatica
The goal of treatment for sciatica is to decrease your pain and improve mobility. Many cases of sciatica go away over time with self-care treatments. These includes cold or hot compresses, over the counter pain killers, gentle stretches, etc.
The doctor may recommend physiotherapy, steroid medications (oral or injected) and postural modifications. If the condition does not improve, surgery may become an option. The type of surgery would depend on the cause and site of the sciatica. Minimally invasive surgeries like endoscopy are preferred these days.
