What Is Sciatica?
Our spine consists of the vertebral column through which spinal cord runs. From the spinal cord various nerves comes out and supply sensations to the peripheral parts of the body. Sciatic nerve is large nerve that runs from the lower back down the back of each leg. When something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the hip, buttocks, and leg. Up to 90% of people recover from sciatica without surgery. In brief, Sciatica refers to back pain caused by a problem with the sciatic nerve.
Symptoms of Sciatica
- Lower back pain
- Many a times pain extends through the hip and buttock and down one leg
- Usually on one side
- Usually worse when you sit, cough, or sneeze
- The leg may also feel numb, weak, or tingly at times.
- The symptoms may remain for few days to weeks, but the good news is that pain subsides in 95% of cases with conservative treatments and pain management procedures.
How to differentiate sciatica from other causes of back pain?
Not all back pain are sciatica. Every individual in their life time suffers from back pain. As per literature up to 85% of Americans experience some type of back pain during their lives. But this doesn't always involve the sciatic nerve. Muscle and ligament sprain and strain are common reason of back pain. One of the easiest character to differentiate these pain from sciatica pain is – In Sciatica, pain radiates to leg and / or foot (Shooting, shock like, cramp like or aching) in one particular band.
Who Gets Sciatica?
- Age 30-50
- Females during pregnancy (pressure on sciatic nerve) from full size uterus
- Commonest cause is a herniated or slipped disc and degenerative arthritis of the spine
Causes of sciatica
- Herniated Disc – The most common cause of sciatica is a herniated disc. Discs act like cushions between the vertebrae of your spine. Aging makes these discs weaker. They are easy to get damaged by minor injuries. Herniated disc means the central gel leaks out and compress the sciatic nerve. About 1 in 50 people will get a herniated disc at some point in life.
- Spinal Stenosis – Aging, minor injuries over time causes natural wear and tear of the vertebrae can lead to a narrowing of the spinal canal. This narrowing, called spinal stenosis may put pressure on the roots of the sciatic nerve. Spinal stenosis is more common in adults over age 60.
- Spinal Tumors - In rare cases, sciatica may result from tumors growing inside or along the spinal cord or sciatic nerve. As a tumor grows, it may put pressure on the nerves that branch off from the spinal cord.
- Piriformis Syndrome - The piriformis is a muscle found deep inside the buttocks Sciatic nerve runs between 2 heads of the muscle belly. If this muscle goes into spasm, it can put pressure on the sciatic nerve, triggering symptoms of sciatica. Usually women suffer more from this syndrome. Keeping a fat wallet in the back pocket may also cause piriformis syndrome (FAT WALLET SYNDROME)
- Sacroiliitis - Sacroiliitis is an inflammation of one or both of the sacroiliac joints. Sacroiliac joint is a joint between sacrum and hip bone ilium. It causes pain in the buttocks, lower back, and may even extend down one or both legs. The pain is more on prolonged standing or climbing stairs. Sacroiliitis can be caused by arthritis, injury, pregnancy, or infection.
- Injury or Infection - Other causes of sciatica include muscle inflammation, infection, or injury, such as a fracture. In general, any condition that irritates or compresses the sciatic nerve can trigger symptoms. In some cases, no specific cause of sciatica can be found.
Diagnosis of sciatica
- Examination – history, specific examination by the doctor will guide him to the cause of sciatica.
- Imaging – X-ray, MRI, CT Scan
- Complications Related to Sciatica –
- If you develop a loss of bladder or bowel control, contact your doctor right away. This can be a sign of a medical emergency that requires surgery to avoid permanent damage.
- Fortunately, this complication is rare.
Sciatica Treatment :
- Ice and Heat – These are home remedies to relieve pain caused by sciatica. Heating pad or ice pack may be especially helpful. Apply the heat or ice for about 10 – 15 minutes every 4 hours. You can choose any one, once you see which is more effective. Never keep the heating pad on body and sleep as it can cause accidental burns.
- Medication – Commonly used medications (Over-the-counter pain relievers ) can provide short-term relief from sciatica. Acetaminolihen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as asliirin, ibulirofen, and naliroxen are options. Muscle relaxants and other adjuvant medications are also useful.
- Physiotherapy – Physiotherapists at pain clinic of India use different methods like manual therapy, electomodalities, Kinesiology (Taliing), McKenzie treatments for sciatica along with various exercises to strengthen, stretch, and developing core muscles of the back.
- Pain Management injection - At pain clinic Of India various pain management injections are performed to relieve sciatica pain. Image guided Lumbar epidural injection is very very popular and effective in treating sciatica pain. It can resolve symptoms in few hours to days and many times 2-3 injections can cure the condition. It is very effective slip disc treatment option to avoid surgery in most cases. We do recommend taking 1-2 epidurals before taking surgical decision very strongly.
- Surgery - If your sciatica is due to a herniated disc, and it's still causing severe pain after four to six weeks, if pain management injection is not helping, surgery may be an option. The surgeon will remove a portion of the herniated disc to relieve the pressure on the sciatic nerve. About 90% of patients get relief from this type of surgery. At pain clinic of India we do offer various minimally invasive discectomy procedures for sciatica pain. We also offer endoscopic discectomy (stitch less) under local anaesthesia. Other surgical procedures can relieve sciatica caused by spinal stenosis.
- Rehabilitation therapy - After back surgery, you will generally need to avoid driving, lifting, or bending forward for about a month. Your doctor may recommend physical therapy to help you strengthen the muscles in the back. Once recovery is complete, there's an excellent chance you'll be able to get back to all your usual activities.
Prevention is better than cure -
If you've had sciatica once, there's a chance it will return. But there are steps you can take to reduce the odds:
- Exercise regularly.
- Maintain good posture.
- Bend at the knees to lift heavy objects.
These steps can help you avoid back injuries that may lead to sciatica.