27 Dec Sciatica: The Notorious Neuropathy
Sciatica: The Notorious Neuropathy
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.
Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.
What is sciatica?
Sciatica: The Notorious Neuropathy, is a condition that can lead to pain in the back and legs. It occurs when pain travels along the path of the sciatic nerve. This nerve starts in the lower spine, and travels through the hip and buttock and down the back of the leg to the foot.
There are a range of different causes of sciatica. In most cases, the condition gets better over time, either on its own or with treatment.
What are the symptoms of sciatica?
Symptoms of sciatica can include pain, tingling and numbness in the leg.
Sciatica is felt as nerve pain radiating from the buttock down the back of the leg, often when sitting, sneezing, coughing or going to the toilet. You may also feel lower back pain, and/or tingling, pins and needles, numbness or weakness in your leg.
Although sciatica pain can be severe, most people find their symptoms improve in time. As sciatica is seen as a more serious low back condition, it’s advisable to see your doctor within the first few days of getting the symptoms. To diagnose sciatica, the doctor will take a medical history and examine your spine and legs.
You should seek medical attention immediately if you have problems controlling your bladder or bowels, or have weakness, numbness or severe pain.
What causes sciatica?
The causes of sciatica include spinal injury or trauma, bone spurs or other growths, narrowing of the spinal canal, or tight or swollen muscles in the buttock. In many cases, people can’t pinpoint a specific injury that caused the condition.
Risk factors for sciatica include:
- age-related changes to the spine
- obesity, which can put extra pressure on the spine
- occupations where you twist the spine or pick up heavy loads
- prolonged sitting
- diabetes, which can increase the risk of nerve damage
How is sciatica treated?
The choice of sciatica therapies depends on the length of symptoms and severity of your condition. These therapies include:
- special back care education
- physical therapies
- medication treatment
- lifestyle changes
Mild sciatic usually goes away in time. When you first experience sciatica, 1 or 2 days’ bed rest may be needed. However, it’s important to return to activity as soon as possible, to help your spine stay strong.
Sciatica treatment includes pain relief medicine such as paracetamol, anti-inflammatory drugs such as ibuprofen and physiotherapy. Most people with sciatica get better with conservative treatments such as physiotherapy.
You should see your doctor again self-care measures fail to improve your pain, if your pain lasts longer than a week, is severe or becomes progressively worse.
If your symptoms persist, an injection of anaesthetic into the spine may be needed or, in rare cases, surgery.
Can sciatica be prevented?
Looking after your back, managing your weight, and improving your general physical condition can all help prevent sciatica. Doing physical therapy at home, such as muscle strengthening exercise, can help to prevent sciatica coming back.
6 Leading Causes of Sciatica and Sciatic Nerve Pain
Several lumbar spine (lower back) disorders can cause sciatica. Sciatica is often described as mild to intense low back pain that travels into the left or right leg. Sciatica is caused by compression of one or more of the 5 sets of nerve roots in the lower back. Other terms used to describe sciatica include sciatic neuralgia or sciatic neuropathy. Sometimes doctors call sciatica a radiculopathy. Radiculopathy is a medical term used to describe pain, numbness, tingling, and weakness in the arms or legs caused by a nerve root problem. If the nerve problem is in the neck, it is called a cervical radiculopathy. However, since sciatica affects the low back, it is called a lumbar radiculopathy.
Pathways to Sciatic Nerve Pain
Five sets of paired nerve roots in the lumbar spine combine to create the sciatic nerve. Starting at the back of the pelvis (sacrum), the sciatic nerve runs from the back, under the buttock, and downward through the hip area into each leg. Nerve roots are not “solitary” structures but are part of the body’s entire nervous system capable of transmitting pain and sensation to other parts of the body. Radiculopathy can occur when a spinal nerve root is compressed (nerve compression) such as from a low back disc rupture (lumbar herniated disc) or bone spur (osteophyte) in the lumbar spine prior to it joining the sciatic nerve.
What Causes Sciatic Nerve Compression?
Several spinal disorders can cause spinal nerve compression and sciatica or lumbar radiculopathy. The 6 most common are:
- Bulging or herniated disc
- Lumbar spinal stenosis
- Piriformis syndrome
- Spinal tumor
Common Sciatica Cause #1: Lumbar Bulging Disc or Herniated Disc
A bulging disc is also known as a contained disc disorder. This means the gel-like center (nucleus pulposus) remains “contained” within the tire-like outer wall (annulus fibrosus) of the disc.
A herniated disc occurs when the nucleus breaks through the annulus fibrosus. It is called a “non-contained” disc disorder. Whether a disc bulges or herniates, disc material can press against an adjacent nerve root and compress delicate nerve tissue and cause sciatica.
The consequences of a herniated disc are worse. Not only does the herniated disc cause direct compression of the nerve root against the interior of the bony spinal canal, but the disc material itself also contains an acidic, chemical irritant (hyaluronic acid) that causes nerve inflammation. In both cases, nerve compression and irritation cause inflammation and pain, often leading to extremity numbness, tingling sensations, and/or muscle weakness.
Common Sciatica Cause #2: Lumbar Spinal Stenosis
Spinal stenosis is a nerve compression disorder most often affecting older adults. Leg pain similar to sciatica may occur as a result of lumbar spinal stenosis. The back pain is usually positional, often brought on by activities such as standing or walking and relieved by sitting down.
Spinal nerve roots branch outward from the spinal cord through passageways called neural foramina comprised of bone and ligaments. Between each set of vertebral bodies, located on the left and right sides, is a foramen. Nerve roots pass through these openings and extend outward beyond the spinal column to innervate other parts of the body. When spinal stenosis develops, these passageways become narrow or clogged causing nerve compression; the term foraminal stenosis is used.
Common Sciatica Cause #3: Spondylolisthesis
Spondylolisthesis is a disorder that most often affects the lumbar spine. It is characterized by one vertebra slipping forward over an adjacent vertebra. When a vertebra slips and is displaced, spinal nerve root compression occurs and often causes sciatic leg pain. Spondylolisthesis is categorized as developmental (found at birth, develops during childhood) or acquired from spinal degeneration, trauma or physical stress (eg, weight lifting, gymnastics).
Common Sciatica Cause #4: Trauma
Sciatica can result from direct nerve compression caused by external forces to the lumbar or sacral spinal nerve roots. Examples include motor vehicle accidents, falling down, football and other sports. The impact may injure the nerves or, occasionally, fragments of broken bone may compress the nerves.
Common Sciatica Cause #5: Piriformis Syndrome
Piriformis Syndrome is named for the piriformis muscle and the pain caused when the muscle irritates the sciatic nerve. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. Piriformis syndrome develops when muscle spasms develop in the piriformis muscle thereby compressing the sciatic nerve. It may be difficult to diagnose and treat due to the lack of x-ray or magnetic resonance imaging (MRI) findings.
Common Sciatica Cause #6: Spinal Tumors
Spinal tumors are abnormal growths that are either benign or cancerous (malignant). Fortunately, spinal tumors are rare. However, when a spinal tumor develops in the lumbar region, there is a risk for sciatica to develop as a result of nerve compression.
If you think you have sciatica, contact us. The first step toward relieving pain is a proper diagnosis.
The term sciatica dates back to 1398 AD, appearing to originate from the Latin word meaning “of pain in the hip” and from the Greek term meaning “pain in the hips”. We generally use sciatica to describe pain that radiates along the path of this nerve from back to buttock and leg. The discomfort can be minimal or disabling, and maybe accompanied by tingling, numbness, or obvious muscle weakness. Sciatica is actually a symptom of an underlying problem, some of which were outlined above.
Sciatic pain generally improves within approximately 4 to 6 weeks. Weakness and numbness may take longer to resolve. Symptomatic treatment, such as cold packs, anti-inflammatory medications, physical therapy and stretching may help ease discomfort and promote return to normal activities. Surgery to take pressure off the nerve (called spinal decompression) is generally reserved for cases of severe pain, progressive nerve damage, and failure to respond to conservative care.