Sciatica

Sciatica is nerve pain that radiates along the course of the sciatic nerve i.e. from the lower back to buttocks, legs, and feet. It is a common neurogenic disorder affecting 50% of people, especially women during pregnancy - due to pressure on the sciatic nerve from the developing uterus. 

What is Sciatica?

Sciatica is a condition in which the sciatic nerve or any of its roots or branches are compressed resulting in sharp shooting pain in the leg, lower back, and buttock. It usually affects one side.

Sciatic Nerve:

The sciatic nerve is the longest and the thickest nerve in the body. It is a branch of the sacral plexus which arises from L4, L5, S1, S2, and S3 nerve roots. At the popliteal fossa, this nerve bifurcates into; Common peroneal nerve and tibial nerve.

Each sciatic nerve supplies each leg. 

Causes and Symptoms:

The main cause of Sciatica is the pinched nerve (nerve compression) due to injury, herniated disc, piriformis syndrome, spondylolisthesis, arthritis of the vertebral column, bony spur on the spine, or spinal stenosis - the narrowing of the spinal canal. This is also known as "True Sciatica" - the radiating pain due to injury.
Sometimes sciatica is confused with every low back pain or buttock pain that does not radiate down the legs. 

Causes

Some of the symptoms are;

• Pain that radiates down the course of the sciatic nerve i.e. from the lower back to hips, legs, and toes. 
• Burning or sharp and shooting pain.
• Numbness 
• Tingling
• Muscle weakness in legs 
• Pain during long sitting or long-standing.
• Pain while sudden body movements for example cough and sneezing.

Symptoms may vary from mild to severe.

Diagnosis:

Most of the time, Sciatica is confused with every other low back pain and hence the actual cause is never treated due to misdiagnosis. For diagnosis of true sciatica, all of the steps below must be followed.

1. Start by taking a medical history. 
2. Inquire about recent injuries.
3. Ask the patient about the intensity, duration, and location of the pain.
4. Check if it radiates down the entire course of the sciatic nerve.
5. Ask about the character of pain i.e. if it is sharp or shooting and what makes the pain feel better and what aggravates it.
6. Do a thorough physical exam. Ask the patient to walk on their heels and toes and check how their spine carries their weight. 
7. SLR - Perform Straight Leg Raises and check the pinpoint location of the pain. 

Furthermore, go for imaging tests. These tests include;

1. X-ray - If your spine has anything abnormal like bony spurs causing compression it will detect it.
2. MRI - As MRI can produce a detailed image of soft tissues as well, it will detect the herniated disc pinching the nerve.

Treatment:

The goal of treatment for sciatica is usually to control pain. The first line of treatment is Self-care and if self-care does not help then the treatment moves forward to a Physiotherapy consult or pharmacological management. 

Self-care:

It includes stretches, avoiding strenuous workouts, doing moderate levels of exercise regularly, avoiding long sitting or long-standing, stretching your legs and back after every 1 hour of sitting, and avoiding smoking. 

Pharmacological Management:

These are the OTC (over-the-counter) medications that reduce pain and inflammation. Others are;

• Muscle relaxants (Cyclobenzaprine)
• Acetaminophen
• NSAIDs (Ibuprofen, aspirin & naproxen etc.)
• Tricyclic antidepressants
• Anti-seizure medications

Physical Therapy:

The physical therapy approach can be reached after the acute pain is relieved. It includes;

SLR
 

• Stretching exercises to enhance flexibility.

1. Knee to opposite shoulder stretch.
2. Side-lying hip stretch
3. Straight leg raise - SLR
4. Back lying hip stretches

• Exercises to improve mobility.
• Exercises to counter the nerve compression.        
  
• Hamstring stretches 
• Gluteal Stretch
  
  

  

  Knees to opposite shoulder

Epidural Spinal Injections:

The next approach is injections. These include corticosteroid injection which is a steroid and help relives pain and inflammation. This injection is given under anesthesia and the effects are usually short-term.

Surgery:

There are some surgical options as well. Surgery is the last approach to relieving sciatica. Surgery is considered when a person loses his bowel or bladder control or is unable to walk due to severe muscular weakness. Surgical procedures include;

• Microdiscectomy (removing the fragments of a herniated disc that are causing compression)
• discectomy (removal of the whole disc)
• Laminectomy (removal of lamina that is causing this compression)

Risk Factors:

Some of the risk factors include;

• Age
• Pregnancy (as a growing uterus or additional weight puts an immense amount of pressure on the spinal cord)
• Tobacco Smoking (Nicotine in tobacco smoke is directly responsible for IVD degeneration as it causes cell damage in both annulus fibrosis and nucleus pulposus)
• Lifting heavy objects (this causes strain on back muscles)
• Long sitting
• Long-standing
• Obesity
• Diabetes (as high blood glucose levels cause nerve damage)

Preventive Measures:

By avoiding avoidable risk factors you can prevent sciatica.

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