What is sciatica: Symptoms, causes, diagnosis, and treatment

Sciatica is a word for lower back pain, numbness, tingling, or weakness that radiates down the body’s biggest nerve, the sciatic nerve, from the lower back.

The sciatic nerve originates in the lower back and travels down the buttocks, down the back of each leg, and into the foot.

Sciatica is a symptom of a medical problem that affects the sciatic nerve rather than a standalone medical illness. Numerous people experience sciatica throughout their lives. It is a relatively common condition.

According to estimates, 40% of people will eventually get sciatica. Adults, especially those between the ages of 30 and 50, are more likely than children to get sciatica [1].

Common symptoms of sciatica

Sciatica is characterized by lower back discomfort that radiates down the sciatic nerve, which passes through the buttocks and down the back of each leg, causing pain, numbness, tingling, or paralysis.

The symptoms of this condition range in severity and could include:

  1. Pain: Sciatica often causes back or buttock discomfort that spreads down the back of the thigh, calf, and occasionally into the foot. When you sit, stand, or move in certain positions, the pain, which may be piercing, burning, or stabbing, may get worse.
  2. Numbness or tingling: In the foot or leg that is being affected by sciatica, numbness, tingling, or a “pins and needles” feeling may be felt.
  3. Weakness: Muscle weakness brought on by sciatica might make it difficult to move or elevate the affected leg or foot [2].
  4. Limited movement: Moving can be difficult while suffering from sciatica because of the pain and discomfort it causes, which can make it difficult to walk or do other everyday tasks.
  5. Uncontrolled bowel or bladder function: In a small percentage of instances, acute sciatica brought on by severe nerve compression can result in loss of control over bowel or bladder function. This is a medical emergency that has to be attended to right away [3].
Sciatica causes you must know
Photograph: wirestock/Envato

Sciatica causes you must know

Sciatica is a symptom brought on by irritation or compression of the sciatic nerve rather than being a disease in and of itself.

The following are some typical sciatica causes that you should be aware of:

1. Herniated or slipped disc

When the tough outer layer of the disc tears or becomes weak, the soft inner core of the disc pushes through, resulting in a herniated or slipped disc.

Age, normal wear and tear, or a spine injury can all cause this. The sciatic nerve and other surrounding nerve roots may get compressed when a disc herniates, resulting in inflammation, irritation, and discomfort that travels from the lower back through the buttocks and down the back of the leg.

2. Lumbar spinal stenosis

In lumbar spinal stenosis, the spinal canal in the lower back (lumbar region) narrows, causing the sciatic nerve and other nearby nerves to be compressed or irritated.

Age, degenerative changes, or the development of bone spurs, which can lessen the room available for the nerves to move through the spinal canal, can all contribute to this narrowing.

3. Spondylolisthesis

A spinal disorder known as spondylolisthesis occurs when one vertebra slides forward over the vertebra below it [4]. This misalignment can be caused by a number of conditions, including acute injuries, stress fractures, degenerative alterations, and congenital anomalies.

Spondylolisthesis frequently affects the lumbar spine (lower back) and can result in sciatic nerve compression.

4. Piriformis syndrome

The piriformis muscle, which is deep in the buttocks, can irritate or compress the sciatic nerve, a condition known as piriformis syndrome. The piriformis muscle supports the hip joint and aids in hip rotation.

The sciatic nerve may experience pressure when it passes through or under a tight, irritated, or spasming muscle in various circumstances.

5. Lumbar degenerative disc disease

The intervertebral discs in the lumbar spine (lower back) progressively deteriorate and lose their capacity to properly serve as shock absorbers between the vertebrae in lumbar degenerative disc disease (DDD).

This deterioration is a normal aspect of aging, but it can also be brought on by trauma or other circumstances. The discs may thin down, lose flexibility, and become more prone to ripping or herniation as they age, which can result in nerve compression.

6. Spinal tumors

Tumors that grow abnormally within or near the spinal column are known as spinal tumors. They may be malignant (cancer) or benign (non-cancerous). Although they are relatively uncommon, spinal tumors can irritate or compress nerves, including the sciatic nerve, resulting in symptoms that resemble sciatica [5].

7. Infection or inflammation

Sciatica may occasionally be caused by lumbar spine infections or inflammation. The spinal structures, such as the vertebrae, discs, or surrounding soft tissues, can be affected by various disorders, which, although less frequent than other reasons, can irritate, compress, or inflame the nerves, including the sciatic nerve.

8. Injury or trauma

Sciatica may occasionally be brought on by lower back or buttock injuries or trauma. Accidents, falls, or other kinds of traumas may have a direct effect on the lumbar spine or the tissues nearby, harming the sciatic nerve or inflaming or compressing it.

9. Pregnancy

Several factors, including pregnancy, can sometimes result in sciatica or symptoms very similar to sciatica. The lower back and pelvic area may experience greater pressure as the uterus grows to support the developing fetus.

This can cause posture abnormalities, muscular imbalances, and stress on the spinal structures. These modifications may compress or irritate the sciatic nerve, resulting in symptoms resembling sciatica.

10. Obesity

Because being overweight puts additional strain on the lower back and the spine’s supporting structures, obesity may be a cause of sciatica. The sciatic nerve may be compressed or irritated as a result of this additional strain on the spine.

Basic diagnosis for sciatica

A detailed medical history, physical examination, and, occasionally, imaging tests are often used to diagnose sciatica.

A medical expert will assess your symptoms, identify the underlying reason, and rule out any other disorders that might be manifesting as a similar set of symptoms.

The fundamental stages in diagnosing sciatica are as follows:

  1. Medical history: The doctor will inquire about your symptoms, their onset and length, any activities that make the pain worse or better, and any prior back or leg pain you may have experienced. They will also ask whether there have been any recent accidents, injuries, or pertinent medical concerns.
  2. Physical examination: To determine your range of motion, muscular strength, reflexes, and sensitivity to touch, the healthcare provider will do a physical examination. They could carry out certain tests, such as the straight leg raise test, which has you lying on your back as the medical practitioner elevates your leg while maintaining a straight knee. This examination identifies inflammation or compression of the nerve roots.
  3. Imaging tests: Your doctor may request imaging tests to get a better understanding of the structures in your lower back if they suspect a specific underlying reason or if your symptoms are severe, chronic, or becoming worse. This may use radiographic techniques like X-rays, MRIs, or CT scans.
  4. Additional tests: To assess the function of the nerves and muscles involved in your symptoms, your doctor may occasionally prescribe further tests such as nerve conduction studies or electromyography (EMG).

Effective treatments for sciatica

The underlying reason and the severity of the symptoms will determine the best course of action for treating sciatica.

The majority of sciatica patients may be treated conservatively and without surgery. Surgical intervention, however, can be required in more severe situations or when conservative therapy falls short of meeting the patient’s needs.

The following are some efficient sciatica treatments:

1. Self-care and lifestyle modifications

Self-care and lifestyle changes can help you manage your sciatica symptoms and stop further occurrences. You may ease pressure on the sciatic nerve and lessen stress on your lower back by taking care of your body and making healthy decisions [6].

Symptoms can be reduced by rest, avoiding activities that make the discomfort worse, and adopting excellent posture. Recurring cases of sciatica can also be avoided by eating healthfully and staying active.

physical therapy

2. Physical therapy

To increase flexibility, strengthen the muscles that support the spine, and maintain good posture, a physical therapist might create a tailored exercise program. By doing so, you can lessen the strain on your sciatic nerve and stop further bouts.

3. Medication

Over-the-counter painkillers and anti-inflammatory drugs (such as ibuprofen or naproxen) can help control pain and decrease inflammation. For pain relief, prescription drugs such as muscle relaxants, antidepressants, or anticonvulsants may occasionally be advised [7].

4. Heat and ice therapy

This treatment helps reduce pain and swelling by applying heat or ice to the afflicted region. Heat may be good once the acute phase has subsided, whereas ice may be especially helpful in the first 48 to 72 hours.

5. Alternative treatments

Acupuncture, chiropractic care, and massage therapy are a few examples of alternative treatments that some people use to treat their sciatica problems. These therapies can be beneficial when used in conjunction with other therapies even if they may not be effective for everyone.

6. Epidural steroid injections

A medical expert may advise epidural steroid injections when inflammation is a factor in sciatica. Direct corticosteroid medicine delivery via these injections helps to decrease inflammation and temporarily relieve pain in the afflicted region.

7. Surgery

Surgery may be required if non-surgical options are unsuccessful or if there is considerable nerve compression resulting in excruciating pain or neurological impairments.

Microdiscectomy (removal of a herniated disc fragment) and lumbar laminectomy (removal of a part of the vertebra to make more space for the nerves) are two surgical treatments that may be available.

[1] https://www.ncbi.nlm.nih.gov/books/NBK507908/
[2] https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/sciatica
[3] https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
[4] https://www.health.harvard.edu/pain/5-causes-of-sciatica
[5] https://www.pinnaclehealthchiro.com/blog/can-tumors-cause-sciatica
[6] https://www.mayoclinic.org/diseases-conditions/sciatica/diagnosis-treatment/drc-20377441
[7] https://www.medicalnewstoday.com/articles/7619

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