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Sciatica

Sciatica

Sciatica (pronounced sigh-AT-ih-ka) is low back pain combined with a pain through the buttock and down one leg. The leg pain usually goes past the knee and may go farther to the foot. Sometimes, weakness in the leg muscles occurs with sciatica.

 

  • The sciatic nerves are the largest nerves in the body and are about the size of your little finger. They come out of the spinal column low in the back and then go behind the hip joint, down the buttock, and down the back of the leg to the foot.
  • Sciatica is different from other forms of low back pain because while the pain most often begins in the back, it usually travels down one lower extremity.
  • The pain is usually a shooting pain, like electricity. It can also burn like fire or tingle much like the feeling when your leg "goes to sleep". The pain can range from slightly annoying to totally unbearable. Some people have pain in one part of the leg and numbness in another part of the same leg.

Symptoms

The most common symptom from sciatica is pain. Most people describe a deep, severe pain that starts low on one side of the back and then shoots down the buttock and the leg with certain movements. Sciatica can also causehip pain.

 

  • The pain is usually worse with both prolonged sitting and standing. Frequently, the pain is made worse by standing from a low sitting position, such as standing up after sitting on a toilet seat.
  • In most people, the pain is made worse by sneezing, coughing, laughing, or a hard bowel movement. Bending backward can also make the pain worse.
  • You may also notice a weakness in your leg or foot, along with the pain. The weakness may become so bad you can't move your foot.

Causes

Sciatica is caused by irritation of the sciatic nerve. Usually, there is no specific injury that is related to the onset of sciatica. Occasionally, the pain will suddenly begin after lifting something heavy or moving quickly.

 

The following are causes of sciatica:

 

  • A herniated disc (sometimes called aslipped disc): This is the most common cause of sciatica.
  1. Discs are the cushions between the bones in the back. They act like "shock absorbers" when we move, bend, and lift. They are the size and shape of checkers.
  2. There is a tough ring around the outside and a thick jellylike center inside (called a nucleus pulposus). If the outer edge of the disc ruptures, the center can push through and put pressure on the sciatic nerve, leading to the pain of sciatica (referred to as a herniated nucleus pulposus as the syndrome).
  • Spinal stenosis, a narrowing of the canal that contains the spinal cord: As we age, the bone can overgrow and put pressure on the sciatic nerve. Many people with spinal stenosis have sciatica on both sides of the back.
  • Spondylolisthesis, a condition in which one backbone has slipped forward over another backbone, resulting in pressure on the sciatic nerve.
  • A pinched or stretched sciatic nerve.
  • Piriformis syndrome, which causes the sciatic nerve to become trapped deep in the buttock by the piriformis muscle: The symptoms are the same as those of sciatica.
  • Sciatica can also be caused by other effects of aging, such as osteoarthritisand fractures due to osteoporosis.
  • Many women experience sciatica during pregnancy.
  • Rarely, sciatica is a symptom of a far more serious problem, such as tumor, blood clot, or abscess (boil).

Treatment

Those with lower back pain have historically been prescribed bed rest in order to offer relief for aching bones and joints. Research in recent years has suggested that bed rest alone will not offer relief for those suffering from nerve pain such as sciatica.

 

Staying active may be more beneficial for those who suffer from back pain. Not to say that you should be running marathons! Activity means being up and mobile for periods of time that are not enough to cause further pain and aggravation to your back. Some physicians may prescribe specific exercises, or some may simply suggest walking.

 

A Dutch study, published in The New England Journal of Medicine in 1999, followed 183 patients with sciatica. Half of these were counseled to follow a regimen of bed rest with breaks only for bathing and using the toilet. The other half were instructed to remain active as usual. The patients symptoms were evaluated after two weeks and again after twelve weeks.

 

Whether they had rested or not, the patients symptoms in the two groups were consistent. Two-thirds reported improvement, and both groups recorded similar numbers of days off work and subsequent surgeries.

 

Sciatica Pain Relief

 

Pain is best treated with a non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen or codeine (in acute cases).

 

In some cases a cortisone-like drug may be injected into the epidural space surrounding the spinal column. This procedure is similar to the epidural used during childbirth, and it's called an epidural steroid injection. A course of this type of treatment may offer temporary relief, but does not address the root of the problem.

 

Surgery

 

Some patients with sciatica may find significant relief from surgery. In cases of herniated discs, a surgical procedure called a laminectomy may be performed. In this procedure, a portion of the posterior arch is removed to relieve pressure on pinched nerve tissues.

 

In cases of spinal stenosis, the portion of bone that is putting pressure on the sciatic nerve system can be removed.

 

Surgery is not for everyone. However, for those who have shown no sign of improvement in four to six weeks and who have had CT scans (computed tomography) or MRI that show a herniated disc or spinal stenosis, surgery may offer significant relief.

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