Sciatica

Sciatica pain is caused by an irritation, inflammation, pinching or compression of a nerve in the lower back. The most common cause is a herniated or slipped disk that causes pressure on the nerve root. Most people with sciatica get better on their own with time and self-care treatments.

Causes #

Sciatica can be caused by several different medical conditions including:

• A herniated or slipped disk that causes pressure on a nerve root. This is the most common cause of sciatica. Disks are the cushioning pads between each vertebrae of the spine. Pressure from vertebrae can cause the gel-like center of a disk to bulge (herniate) through a weakness in its outer wall. When a herniated disk happens to a vertebrae in your lower back, it can press on the sciatic nerve.

• Spondylolisthesis is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits. The extended spinal bone can pinch the sciatic nerve.

• Osteoarthritis - Bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves.

• Trauma injury to the lumbar spine or sciatic nerve.

• Tumors in the lumbar spinal canal that compress the sciatic nerve.

• Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.

• Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.

Symptoms #

The symptoms of sciatica include:

• Moderate to severe pain in lower back, buttock and down your leg.

• Numbness or weakness in your lower back, buttock, leg or feet.

• Pain that worsens with movement; loss of movement.

• Pins and needles feeling in your legs, toes or feet.

• Loss of bowel and bladder control (due to cauda equina).

Diagnosis #

• Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.

• Magnetic resonance imaging (MRI) or computed tomography (CT) scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.

• Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.

• Myelogram to determine if a vertebrae or disk is causing the pain.

Treatment #

Physical therapy #

• The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve.

• An exercise program should include stretching exercises to improve muscle flexibility and aerobic exercises (such as walking, swimming, water aerobics).

• Your healthcare provider can refer you to a physical therapist who’ll work with you to customize your own stretching and aerobic exercise program and recommend other exercises to strengthen the muscles of your back, abdomen and legs.

Spinal injections #

• An injection of a corticosteroid, an anti-inflammatory medicine, into the lower back might help reduce the pain and swelling around the affected nerve roots.

• Injections provide short-time (typically up to three months) pain relief and is given under local anesthesia as an outpatient treatment.

• You may feel some pressure and burning or stinging sensation as the injection is being given.

• Ask your healthcare provider about how many injections you might be able to receive and the risks of injections.

Alternative therapies #

• Alternative therapies are increasingly popular and are used to treat and manage all kinds of pain.

• Alternative methods to improve sciatic pain include spine manipulation by a licensed chiropractor, yoga or acupuncture.

• Massage might help muscle spasms that often occur along with sciatica.

• Biofeedback is an option to help manage pain and relieve stress.

Microdiscectomy #

This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.

Laminectomy #

In this procedure, the lamina (part of the vertebral bone; the roof of the spinal canal) that is causing pressure on the sciatic nerve is removed.

Prevention #

Maintain good posture #

Following good posture techniques while you’re sitting, standing, lifting objects and sleeping helps relieve pressure on your lower back. Pain can be an early warning sign that you are not properly aligned. If you start to feel sore or stiff, adjust your posture.

Don’t smoke #

Nicotine reduces the blood supply to bones. It weakens the spine and the vertebral disks, which puts more stress on the spine and disks and causes back and spine problems.

Maintain a healthy weight #

Extra weight and a poor diet are associated with inflammation and pain throughout your body. To lose weight or learn healthier eating habits, look into the Mediterranean diet. The closer you are to your ideal body weight the less strain you put on your spine.

Exercise regularly #

Exercise includes stretching to keep your joints flexible and exercises to strengthen your core the muscles of your lower back and abdomen. These muscles work to support your spine. Also, do not sit for long periods of time. Choose physical activities least likely to hurt your back: Consider low-impact activities such as swimming, walking, yoga or tai chi.

Keep yourself safe from falls #

Wear shoes that fit and keep stairs and walkways free of clutter to reduce your chance of a fall. Make sure rooms are well-lighted and there are grab bars in bathrooms and rails on stairways.