Sciatica

What is sciatica?

Sciatica refers to nerve pain caused by irritation or injury to the sciatic nerve. In addition to pain, one may also experience numbness or tingling in the buttock or back, sometimes radiating down the leg. Severe symptoms may also occur.

The sciatic nerve is the body’s longest and thickest nerve, measuring up to 2 centimetres in width (roughly the size of a U.S. penny or a U.K. 1 pence coin). Despite its name, the sciatic nerve is not a single nerve; it is actually a group of nerves originating from five nerve roots that branch from the spinal cord.

There are two sciatic nerves in the body, one on each side. On one side, the nerve travels through the hip and buttock, running down the corresponding side of the body and ending just below the knee. From there, it branches into smaller nerves that extend to regions such as the lower leg, toes, and foot.

If you have sciatica, you may experience pain ranging from mild to severe in any area connected to the sciatic nerve. Symptoms can significantly affect the lower back, buttocks, hips, and legs, and in some cases, the pain may extend as far as the feet and toes, depending on which nerve(s) are affected.

Types of sciatica

Sciatica is classified into two primary types. Although the effects are similar, they include:

• True Sciatica: This refers to any disorder or injury that directly affects the sciatic nerve.
• Sciatica-like conditions: These are symptoms similar to sciatica but caused by other issues involving the sciatic nerve or the bundle of nerves forming it.

Medical practitioners often use the term 'sciatica' to refer to both types. The distinction generally matters only when determining the appropriate treatment.

How common is sciatica?

Sciatica is a widespread condition, with approximately 40% of the U.S. population experiencing some form of sciatica at some point in their lives. It is uncommon before the age of 20 unless related to an injury.

Symptoms

Sciatica-related pain can occur anywhere along the nerve’s pathway. It most commonly radiates from the lower back towards the buttock, down the back of the thigh and calf.

The intensity of the pain can range from mild discomfort to sharp, burning sensations, or may feel like an electric shock or jolt. It might worsen with coughing, sneezing, or prolonged sitting. Typically, sciatica affects just one side of the body.

Additionally, some individuals experience tingling, numbness, or weakness in the leg or foot muscles. It is possible to feel pain in one part of the leg and numbness in another.

Causes

Sciatica is caused by the pinching of the sciatic nerve roots. Herniated discs in the spine or bone overgrowth (bone spurs) on the spinal bones are the most common causes. In rare cases, a tumour may press on the nerve.

Risk factors

Several factors increase the risk of sciatica, including:

• Age: People between 20 and 50 have a higher risk of herniated discs. Similarly, bone spurs tend to develop with age.
• Obesity: Excess body weight places additional stress on the spine.
• Occupation: Jobs involving frequent back twisting, heavy lifting, or long periods of driving may contribute to herniated discs.
• Prolonged sitting: People who sit for extended periods or are physically inactive are more likely to develop herniated discs compared to those who are active.
• Diabetes: Diabetes affects how the body handles blood sugar, increasing the risk of nerve damage.

Complications

Most individuals with sciatica caused by herniated discs recover fully without treatment. However, sciatica can sometimes lead to nerve damage, so it is important to seek medical attention if you experience:

• Loss of sensation in the affected leg.
• Loss of bladder or bowel control.
• Weakness in the affected leg.

Prevention

Sciatica cannot always be prevented and may sometimes recur. However, you can take steps to protect your back:

• Exercise regularly: Strengthen your back by doing exercises that focus on the core muscles, which include the muscles in your lower back and abdomen that are crucial for good posture and alignment. Your healthcare provider can suggest suitable exercises.
• Maintain good posture when sitting: Sit in a chair with proper lower back support, stable armrests, and a good swivel base. To provide extra support, place a cushion or folded towel behind the lower back to maintain its natural curve. Keep your hips and knees level.
• Use proper body mechanics: When standing for long periods, rest one foot on a box or stool. When lifting heavy objects, use your legs to do the work and hold the object close to your body. Avoid lifting and twisting simultaneously, and ask for assistance with heavy or awkward items.

Diagnosis

To diagnose sciatica, your healthcare provider will perform a physical examination to assess muscle strength and reflexes. For example, they may ask you to walk on your heels or toes, stand up from a squatting position, and raise your legs one at a time while lying on your back.

Tests

If your pain is severe or persistent and does not improve after several weeks, further tests may be required:

• X-ray: A spinal X-ray can show changes that may be affecting the space where the nerve roots exit the spine.
• MRI: This imaging test uses strong magnets and radio waves to produce detailed cross-sectional images of the back. It is particularly useful for visualising soft tissues, such as herniated discs and compressed nerves.
• CT scan: This procedure may involve injecting dye into the spinal canal before taking X-rays (CT myelogram). The dye highlights the spinal cord and nerves, making them more visible on the images.
• Electromyography (EMG): This test measures the electrical impulses generated by nerves and muscles, helping to assess the severity of nerve root injury.

Treatment

If your pain does not improve with self-care, your healthcare provider may recommend the following treatments:

• Medications
  Some medications that may help relieve sciatica pain include:
• Anti-inflammatory drugs
• Antidepressants
• Corticosteroids
• Anti-seizure medications
• Opioids
• Physical therapy
  Once the pain subsides, your doctor can create a tailored exercise programme to prevent future injuries. This usually includes exercises to strengthen the core, improve posture, and enhance your range of motion.
• Steroid injections
  In some cases, a corticosteroid injection near the nerve root causing the pain may provide relief. One injection may be sufficient, although up to three can be administered in a year.
• Surgery
  Surgery may be recommended to remove a bone spur or part of a herniated disc pressing on the nerve. However, surgery is usually reserved for cases where sciatica causes bowel or bladder control issues, severe weakness, or persistent pain that does not respond to other treatments.

Lifestyle and Home Remedies

Many people find that self-care approaches are effective in managing sciatica. While resting for a day or two can be helpful, remaining inactive for too long may worsen symptoms. Other useful self-care strategies include:

• Cold packs: Apply a cold pack to the affected area for at least 20 minutes several times a day. You can use an ice pack or a bag of frozen peas wrapped in a towel.
• Hot packs: After two or three days, apply heat to the painful area using a hot pack, a low-setting heating pad, or a heat lamp. For ongoing pain, alternate between hot and cold packs.
• Stretching: Gentle stretches targeting the lower back may help provide relief. Hold each stretch for about 30 seconds, and avoid bouncing, twisting, or jerking while stretching.
• Medications: Pain relievers like naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB) may help manage sciatica. However, these medications should only be taken as directed.

Alternative treatments

Other therapies commonly used to treat lower back pain include:

• Acupuncture: This involves inserting tiny needles into specific points on the skin. Some research suggests acupuncture may help relieve back pain, though results are mixed. Ensure you seek treatment from a licensed practitioner.
• Chiropractic care: Chiropractors perform spinal manipulations and adjustments to alleviate pain and restore spinal movement. Spinal manipulation is generally considered a safe and effective treatment for lower back pain.
• Massage therapy: This can help relax tight muscles in the hips and back that may have developed spasms.

Preparing for Your Appointment

Not all sciatica cases require medical intervention. However, if symptoms are severe or last for more than a month, you should schedule an appointment with your doctor.

What to do

• Write down all your symptoms, including when they started.
• Make a list of important information, such as any other health conditions you have and any medications, supplements, or vitamins you are taking, along with their dosages.
• Note any recent injuries or accidents that could have caused back damage.
• If possible, bring a family member or friend to help remember important details.
• Prepare a list of questions to ask your doctor.

If you are experiencing radiating lower back pain, consider asking your healthcare provider the following questions:

• What is causing my back pain?
• What are the other possible causes?
• What tests will I need to undergo?
• What treatment options do you recommend?
• Will I need surgery? Why or why not?
• Are there any restrictions I should follow?
• What self-care measures should I take?
• How can I prevent the symptoms from recurring?

Feel free to ask any other questions that come to mind.

What to expect during your visit

Your healthcare provider may ask you the following questions about your condition:

• Do you experience weakness or numbness in your legs?
• Are there specific activities or positions that seem to relieve or worsen the pain?
• How much does the pain interfere with your daily activities?
• Are you engaged in any heavy physical work?
• Do you exercise regularly? If so, what kind of activities do you engage in?
• Have you tried any treatments or self-care techniques? If so, have they been effective?