What Is Sciatica

Introduction

Sciatica is a term used to describe the pain and discomfort resulting from the irritation, inflammation or compression of the sciatic nerve. The sciatic nerve originates in the lower back and extends through the buttocks and into the legs, making it a critical component of our body's nervous system. It is the longest nerve in the human body. 

Sciatica commonly arises from the compression or irritation of the sciatic nerve, which can be triggered by a variety of factors. These factors include herniated disc, spondylolisthesis, muscular spasm or inflammation.¹ The severity and duration of pain can vary, making it crucial to diagnose the cause accurately. Treatment options can include physical therapy, pain management, and surgical procedures in more severe cases.²

Understanding sciatica is crucial for those experiencing its symptoms and seeking relief. 

This article intends to delve further into the underlying causes and symptoms and available treatments for sciatica, providing a comprehensive overview of this condition and its management.

Understanding the sciatic nerve

The sciatic nerve is a critical component of the human body's nervous system, providing motor and sensory functions.

Sciatic nerve structure

• It's the body's longest and thickest nerve.
• Starts in the lower back, continues through the buttocks and into the feet
• Stems from 5 nerve roots in the spine³ 

Sciatic nerve function

• Allows you to feel and move your thigh, leg and foot
• Sends signals for leg motion and sensation³

Sciatic nerve role in the nervous system

• Part of the outer nervous system
• Connects your central nervous system (the brain and spinal cord) to your legs
• Lets you control leg muscles and feel things with your legs
• If something presses on or harms the sciatic nerve, it can lead to lower back and leg discomfort, numbness, or weakness³

Symptoms of sciatica

The symptoms of sciatica can include:

Pain

A prevalent symptom of sciatica is an intense, shooting pain that spreads from the lower back or buttocks down through one leg. The pain can vary in intensity from mild to intense. Your symptoms may worsen when moving, sneezing or coughing.

Numbness and tingling

You may experience numbness, tingling, or a pins and needles sensation in the leg or foot affected by sciatica.

Muscle weakness

Weakness in the leg or foot on the affected side can occur, making it difficult to move or lift the leg.¹

Burning sensation

Some people with sciatica describe a burning sensation deep in the buttocks.¹

Urinary or faecal incontinence

The sciatic nerve also controls the bladder and bowel function; if you notice any incontinence symptoms with your leg pain, it is important to consult a doctor immediately. 

It's important to note that the severity and combination of symptoms can vary from person to person, and the location of the pain may differ as well; seeking guidance from a healthcare professional is crucial for obtaining an accurate diagnosis and receiving suitable treatment.

Causes of sciatica

The most common causes of sciatica include:

Herniated disc

The most common cause of sciatica is a herniated or bulging disc in the spine. When the soft inner core of a spinal disc leaks out and presses on the sciatic nerve, it can lead to pain and other symptoms. 

Spinal stenosis

Spinal stenosis occurs when the spinal canal narrows, compressing the nerves within the lower back. It can lead to sciatica-like symptoms when the sciatic nerve is affected.

Spondylolisthesis

This condition occurs when a bone in the spine shifts forward, exerting pressure on the sciatic nerve.

Piriformis syndrome

The sciatic nerve can run beneath or through the piriformis muscle in the buttocks. When the piriformis muscle is inflamed or spasms, it can compress the nerve, leading to symptoms similar to sciatica.¹

Degenerative disc disease

With age, the spinal discs can degenerate, causing pain and irritation in the area, which may result in sciatic nerve compression.

Spinal tumours or infections

Tumours or infections affecting the spine can occasionally exert pressure on the sciatic nerve, albeit in rare instances.

Pregnancy

The weight of the growing uterus can sometimes compress the sciatic nerve in pregnant women, causing sciatic pain.

Risk factors of sciatica

The risk factors of sciatica include:

• Age
• Obesity
• Diabetes
• Sedentary lifestyle
• Back injury
• Smoking²

Diagnosis of sciatica

Diagnosis of sciatica typically involves a combination of medical history, physical examination, and diagnostic tests. 

Medical history

Your healthcare provider will initiate the assessment by inquiring about your symptoms, including the location, duration, and intensity of any pain experienced. They'll also inquire about your medical history to identify any pre-existing conditions that might contribute to sciatica.⁴

Physical examination

A physical examination is usually performed to check for physical signs of sciatica. They may ask you to perform certain movements to determine where the pain is coming from, such as lifting your leg or bending your back.⁴

Imaging tests

Imaging techniques like X-rays, MRI, and CT scans may be employed to visualize the spine and identify the source of irritation to the sciatic nerve. These examinations can aid in pinpointing structural abnormalities in the spine, such as herniated discs or bone spurs.⁴

Electromyography (EMG)

Occasionally, electromyography (EMG) may be conducted to evaluate the electrical signals of muscles and nerves, aiding in the assessment of potential nerve damage.

Once a diagnosis is made, treatment options may vary depending on the underlying cause of your sciatica. 

Treatment options for sciatica

The objectives of treating sciatica include alleviating pain, decreasing inflammation, and targeting the root cause of the condition. The common treatment options for sciatica include–

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can assist in alleviating pain and reducing inflammation⁵
• Muscle relaxants: If muscle spasms are exacerbating your symptoms, your physician might recommend muscle relaxants like cyclobenzaprine and tizanidine⁵
• Neuropathic pain medications: In some cases, your doctor may recommend stronger pain relievers, such as gabapentin, pregabalin or duloxetine, but these are generally used only for severe pain and on a short-term basis⁵

Physical therapy

A physical or manual therapist can help you with exercises to improve your strength, flexibility, and posture. Low-impact exercises such as pool exercise and deep tissue release massage therapy can be used to relieve pressure on the sciatic nerve.⁵

Hot and cold therapy

Applying heat and ice packs can help reduce pain and inflammation. Alternating between the two can be effective for some people.

Epidural injections

For severe pain, your doctor may recommend epidural steroid injections. These injections can offer temporary relief by diminishing inflammation surrounding the nerve.²

Surgery

In cases of severe or persistent sciatica that doesn't respond to other treatments, surgery may be necessary. Common surgical options include discectomy (removal of part of a herniated disc), laminectomy (removal of bone spurs or part of a vertebra),² or spinal fusion (joining two or more vertebrae together).⁵

Lifestyle modifications

Making changes to your daily activities, such as maintaining a good posture, light stretching and avoiding prolonged sitting, can help prevent sciatica or reduce its recurrence.¹

It's important to consult a healthcare professional to determine the most appropriate treatment, as the cause and severity of the condition can vary. They can devise a customized treatment strategy tailored to your symptoms and medical background. 

Summary

Sciatica is a painful condition that affects the sciatic nerve, the longest nerve in the human body. It typically results from compression or irritation of the nerve roots in the lower spine. Common causes of sciatica include herniated discs, spinal stenosis, or muscle imbalances. The condition is characterized by a sharp, shooting pain that radiates from the lower back down one leg, often accompanied by numbness and tingling.

Treatment for sciatica usually begins with conservative approaches, including rest, physical therapy, and pain medication. In severe cases, epidural injections or surgery may be necessary to alleviate the pressure on the nerve.

Prevention of sciatica involves maintaining a healthy lifestyle, including regular exercise to strengthen the back and core muscles, proper lifting techniques, and maintaining good posture. Managing weight and avoiding prolonged sitting can also help reduce the risk of developing sciatica.

FAQs

1. How do I get sciatica to go away?

To alleviate sciatica, try gentle exercises, such as stretching and walking, which help to relieve pressure on the sciatic nerve. Apply warm and cold packs, and consider pain-relieving medications. If symptoms persist or worsen, consult a healthcare professional for tailored treatment options like physical therapy, injections, or surgery.

2. What triggers sciatica?

Sciatica is often triggered by conditions like herniated discs, spinal stenosis, or bone spurs that compress the sciatic nerve in the lower back. Additionally, muscle strains, injuries, or prolonged sitting may exacerbate symptoms. Lifestyle factors, like obesity or poor posture, can contribute to its onset as well.

3. What not to do with sciatica?

With sciatica, avoid activities that worsen symptoms, such as heavy lifting, sudden movements, or prolonged sitting. Refrain from high-impact exercises like running and strenuous bending. Consult a healthcare provider for a comprehensive approach to manage and treat the condition.