What is Sciatica and what are the symptoms?
Sciatica refers to radiating pain in the back, hips and legs, and is caused by the compression or irritation of the spinal nerve root in the lower back. The pain distribution follows the sciatic nerve from the lumbar spine to the hips, buttocks, legs and feet. An injury to to the lumbar spine can cause a number of symptoms in the lower body, and can develop suddenly or over time.
• Leg pain that resembles a severe cramp, or shooting pain in the legs while standing or sitting
• Tingling sensation (“pins and needles”, can be intensely uncomfortable)
• Limited motion in knee, foot and/or toes
Sciatica pain can be worse when sitting, coughing or sneezing.
Sciatica is treatable, and full relief and mobility can be recovered. Left untreated, sciatica can cause lumbar disk degeneration.
What causes Sciatica?
There are two primary causes of sciatica are:
• A herniated disc — a rupture in the outer wall of a vertebral disc, which allows the soft middle of the disc to bulge outward and possibly press against a nerve root
• Degenerative disc disease — the weakening of the spinal disc, which allows the surrounding vertebrae to shift out of position, and possibly press against nerve roots
Other conditions which can pinch the spinal nerve and cause sciatica:
• Bone spurs and/or the narrowing of the spinal canal
• Spasms or tightness in the piriformis muscle in the buttocks
• Disease, such as diabetes
• Injury or trauma
How is Sciatica diagnosed?
Sciatica is best diagnosed by a comprehensive medical history review and physical exam. Licensed clinicians can often pinpoint the cause and location of sciatica pain by simple manipulations of the lower body.
In some cases, further testing can be necessary. Examples include:
• X-ray for bone structure analysis
• Magnetic resonance imagining (MRI) or computed tomography (CT) scans for soft tissue analysis
• Electromyography and nerve conduction velocity (EMG/NV) tests for nerve damage analysis
• Myelogram for vertebra and disc analysis
How is Sciatica treated?
Sciatica is primarily treated with rest, physical therapy and pharmaceutical pain and inflammation management.
Limiting physical activity and resting on a hard surface like a firm mattress or the floor can limit the movement of the spine, reducing pressure on the sciatic nerve and allowing time for swelling to go down.
Physical therapy will consist of stretching and strengthening exercises that reduce pressure on the nerve, limit pain and increase mobility.
In some cases, non-steroidal anti-inflammatories, pain management medicine and muscle relaxants can treat severe pain, swelling and spasms. In more serious cases, epidural steroid injections and/or nerve root blocks are necessary.
Surgery, such as microscopic lumbar discectomy (MLD) may be necessary for patients that do not respond to other treatment, or are experiencing severe and unmanageable pain.