Get relief from sciatica pain with comprehensive information on its causes, symptoms, treatment options, and exercises.

Sciatica

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Syed Intisar Hussain

Overview

Sciatica is defined as pain that radiates along the sciatic nerve, extending from the back and down the back of the thigh. 
Sciatica is not a disorder. It&#39;s a term describing nerve pain. However, it&#39;s often confused with low back pain or radicular leg pain. 
&nbsp;

Also called lumbar radiculopathy, sciatica commonly results from compression of the sciatic nerve.&nbsp;It has a lifetime incidence of 10-40%<a href="#accordion">[6]</a>. While there is no gender predominance, there is a difference in incidence between different age groups, with people in their 40s showing the highest rates<a href="#accordion">[6]</a>. 
&nbsp;

A herniated disc is the major cause of sciatica, while older adults typically experience pain due to lumbar spinal stenosis. Other than pain, people may also experience numbness and inflammation in the affected leg.&nbsp; 
&nbsp;

Sciatica can be classified into different types based on the symptoms and their duration<a href="#accordion">[7]</a>. 
&nbsp;

<ul>
	<li>Acute Sciatica - This type of sciatica has a sudden onset and a 4-8 week duration. The pain does not typically require medical treatment and is often self-managed.</li>
	<li>Chronic Sciatica - The pain lasts more than 8 weeks and may require medical or surgical treatment.</li>
	<li>Alternating Sciatica - Both legs are affected alternately. It most commonly results from degeneration of the sacroiliac joint.</li>
	<li>Bilateral Sciatica - As the name implies, both legs are affected. Degenerative changes in the disc and/or vertebrae or conditions such as cauda equina syndrome can cause bilateral sciatica. 
	&nbsp;</li>
</ul>

Signs and Symptoms

Sciatica is characterized by pain that radiates from the lower back or buttock down the back of the leg, foot, or toes. The pain can be sharp, burning, or shooting, and may be accompanied by other symptoms.

Some of the common signs and symptoms of sciatica include<a href="#accordion">[5]</a>:

<ol>
	<li>Pain In The Lower Back, Buttock, Or Leg: This is the hallmark symptom of sciatica. The pain may be constant or intermittent and may be severe or mild. It may worsen with sudden body movement, like a sneeze or a cough. Moreover, the pain is usually more severe in the leg than in the lower back. Sitting or standing for long periods, standing up, and twisting the upper body can also aggravate the pain. 
	&nbsp;</li>
	<li>Numbness Or Tingling: Sciatica may cause numbness or tingling in the affected leg, foot, or toes. 
	&nbsp;</li>
	<li>Weakness: Sciatica can cause weakness in the affected leg, making it difficult to move or bear weight. 
	&nbsp;</li>
	<li>Shooting Pain: The pain associated with sciatica may be described as shooting or electric, and may be aggravated by movement or prolonged sitting. 
	&nbsp;</li>
	<li>Loss Of Bladder Or Bowel Control: In rare cases, sciatica may cause loss of bladder or bowel control, which is a medical emergency. 
	&nbsp;</li>
</ol>

Note: If you experience any sudden, severe pain in the lower back or leg, along with numbness or muscle weakness in the leg, contact a healthcare professional immediately. Especially if you have trouble controlling your bladder or bowels. 
&nbsp;

Causes

Sciatica is caused by compression or irritation of the sciatic nerve, which is the largest nerve in the body. It travels from the lower back down to the hips, buttocks, and each leg. A variety of underlying conditions can lead to compression or inflammation of the sciatic nerve. Some of the common causes of sciatica include 
&nbsp;

<ol>
	<li><a href="https://merisehat.pk/disease/herniated-disc">Herniated Disc</a>: A herniated disc occurs when the soft, jelly-like center of a spinal disc pushes out through a tear in the outer layer of the disc, putting pressure on the sciatic nerve. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/spinal-stenosis">Spinal Stenosis</a>: Spinal stenosis occurs when the spinal canal narrows, putting pressure on the spinal cord and nerve roots, including the sciatic nerve. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/degenerative-disc-disease">Degenerative Disc Disease</a>: Degenerative disc disease occurs when the spinal discs that cushion the vertebrae in the spine break down and wear away, causing the vertebrae to rub together and irritate the sciatic nerve. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/spondylolisthesis">Spondylolisthesis</a>: Spondylolisthesis is a condition in which a vertebra slips out of place and onto the vertebra below it, putting pressure on the sciatic nerve. 
	&nbsp;</li>
	<li>Piriformis Syndrome: This occurs when the piriformis muscle in the buttocks spasms or becomes tight and compresses the sciatic nerve. Piriformis syndrome can cause pain, numbness, or tingling in the buttocks and down the back of the leg. 
	&nbsp;</li>
	<li>Trauma Or Injury: Trauma or injury to the lower back or buttocks can also cause sciatica. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/osteoarthritis-64627">Osteoarthritis</a>: Due to aging, bone spurs can form in the spine, compressing the lower back nerves. 
	&nbsp;
	<ol>
		<li><a href="https://merisehat.pk/disease/cauda-equina-syndrome">Cauda Equina Syndrome</a>: This rare condition affects the cauda equina, a bundle of nerves present at the end of the spinal cord. It results in pain along the leg, numbness in the anal area, and loss of bladder and bowel control. 
		&nbsp;</li>
	</ol>
	</li>
</ol>

There are no specific screening tests for sciatica. However, symptoms and physical examination can help doctors detect the disease. 
&nbsp;
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Diagnosis

A diagnosis of sciatica is based on the patient&rsquo;s symptoms, history, and physical examination. In some cases, doctors may also order imaging scans. 
&nbsp;

<h5>Physical Exam:</h5>

To evaluate the afflicted leg&#39;s muscular power, reflexes, and range of motion, a physical examination may be conducted. The patient may be asked to walk on their heels or toes or stand from a squatting position. 
&nbsp;

Some clinical tests used to diagnose sciatica include:

<ul>
	<li>Straight Leg Raise (SLR) Test: This is commonly used to test for sciatica. It requires the patient to lie on their back and lift one leg at a time while the other stays bent at the knee. Pain on lifting the affected leg indicates sciatica. 
	&nbsp;</li>
	<li>Slump Test: The patient sits upright with their hands behind the back and bends forward at the hip. They then bend their neck down to make the chin touch the chest, while one knee is extended to a possible degree. If pain occurs in this position, the patient may be suffering from sciatica. 
	&nbsp;</li>
</ul>

It is important to note that these tests are only positive when the pain is due to sciatic nerve compression at any point along its origin. If the sciatica is due to chemical irritation or inflammation, these tests will not cause pain. 
&nbsp;

In severe cases, doctors may order the following tests.

<ol>
	<li>X-Rays: X-rays may be used to evaluate the bones of the spine and detect any abnormalities, such as fractures or arthritis.</li>
	<li>Magnetic Resonance Imaging (MRI): MRI uses a magnetic field and radio waves to create detailed images of the spine and surrounding tissues, allowing doctors to identify herniated discs, tumors, or other conditions that may be causing sciatica.</li>
	<li>Computed Tomography (CT) Scan: CT scans use X-rays to create cross-sectional images of the spine, which can help identify spinal stenosis, fractures, or other conditions that may be causing sciatica.</li>
	<li>Electromyography (EMG): EMG measures the electrical activity in the muscles and nerves of the affected leg, which can help identify nerve damage.</li>
	<li>Myelogram: A myelogram is a type of X-ray that uses a contrast dye to highlight the spinal cord and nerve roots, allowing doctors to identify conditions such as spinal stenosis. 
	&nbsp;</li>
</ol>

Treatment

The treatment of sciatica depends on the underlying cause and severity of the condition. In most cases, conservative treatments such as pain management, physical therapy, and exercise are effective in managing the symptoms of sciatica. However, in severe cases or cases that do not respond to conservative treatments, surgery may be necessary. 
&nbsp;

Conservative treatments for sciatica may include:

<ol>
	<li>Pain Management: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage the pain associated with sciatica. However, care should be taken when taking aspirin as it can cause bleeding and ulcers. Moreover, depending on the level of pain, prescription medications, such as muscle relaxants may also be used to relieve pain. 
	&nbsp;</li>
	<li>Physical Therapy: Physical therapy may be used to improve mobility, strengthen the muscles, and reduce pain associated with sciatica. 
	&nbsp;</li>
	<li>Exercise: Exercises that focus on stretching and strengthening the muscles of the lower back and legs may help relieve the symptoms of sciatica. 
	&nbsp;</li>
	<li>Heat And Cold Therapy: Heat or cold therapy may be used to reduce inflammation and relieve pain associated with sciatica. Ice packs can be applied for 20 minutes at a time, several times a day. After a few days, one can switch to a hot pack or heating pad. 
	&nbsp;</li>
	<li>Injections: In some cases, injections of corticosteroids or other medications into the lower back may be used to reduce inflammation and relieve pain associated with sciatica. 
	&nbsp;</li>
</ol>

Whereas, surgical treatments for sciatica may include:

<ol>
	<li>Discectomy: In cases where a herniated disc is causing sciatica, a discectomy may be performed to remove the damaged portion of the disc.</li>
	<li>Laminectomy: A laminectomy may be performed to remove the lamina, or bony arches of the vertebrae, to relieve pressure on the nerves in the affected area. 
	&nbsp;</li>
</ol>

Alternative therapies such as acupuncture, yoga, or biofeedback are also gaining popularity for treating and managing pain. 
&nbsp;

Sciatica can cause several complications, particularly if left untreated. Some of the potential complications of sciatica include: 
&nbsp;

<ol>
	<li>Permanent Nerve Damage: If the underlying cause of sciatica is not treated promptly, it can cause permanent damage to the nerves in the affected area. This can lead to a loss of feeling and weakness in the affected leg. 
	&nbsp;</li>
	<li>Loss Of Mobility: Sciatica can cause significant pain and discomfort, which can limit mobility and make it difficult to perform everyday activities. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression </a>And <a href="https://merisehat.pk/disease/anxiety">Anxiety</a>: Chronic pain associated with sciatica can lead to depression and anxiety, particularly if the condition persists over an extended period. 
	&nbsp;</li>
	<li>Reduced Quality Of Life: Chronic pain associated with sciatica can have a significant impact on a person&#39;s quality of life, leading to difficulty sleeping, reduced productivity, and a lower overall sense of well-being. 
	&nbsp;</li>
	<li>Bowel Or Bladder Dysfunction: In severe cases of sciatica, pressure on the nerves in the affected area can lead to bowel or bladder dysfunction. 
	&nbsp;</li>
</ol>

Several factors can increase the risk of developing sciatica. Some of the common risk factors for sciatica include: 
&nbsp;

<ol>
	<li>Age: The likelihood of acquiring sciatica rises with age. This is due to increased strain on the sciatic nerve as the spinal discs start to lose their suppleness and ability to cushion the vertebrae.</li>
	<li>Obesity: Excess weight puts extra pressure on the lower back and can contribute to the development of sciatica.</li>
	<li>Occupations That Require Heavy Lifting: Jobs that involve heavy lifting, twisting, or bending can increase the risk of developing sciatica.</li>
	<li>Sedentary Lifestyle: A sedentary lifestyle, which includes prolonged sitting, can contribute to the development of sciatica.</li>
	<li>Diabetes: Diabetes can increase the risk of developing nerve damage, including damage to the sciatic nerve.</li>
	<li>Previous Back Injury: Previous injury to the back, including a herniated disc, can increase the risk of developing sciatica. 
	&nbsp;</li>
</ol>

While some risk factors for sciatica cannot be avoided, several preventive measures can help reduce the risk of developing sciatica. Some of the common preventive factors for sciatica include<a href="#accordion">[5]</a>: 
&nbsp;

<ol>
	<li>Exercise Regularly: Regular exercise, including low-impact activities like walking, swimming, or yoga, can help strengthen the muscles in the back and reduce the risk of developing sciatica. 
	&nbsp;</li>
	<li>Maintain Good Posture: Maintaining a good posture while sitting, standing, and lifting can help reduce the pressure on the spine and prevent sciatica. 
	&nbsp;</li>
	<li>Lift Properly: When lifting heavy objects, it is important to use proper lifting techniques to avoid straining the back and potentially causing sciatica. 
	&nbsp;</li>
	<li>Maintain A&nbsp;Healthy Weight: Maintaining a healthy weight can reduce the pressure on the lower back and decrease the risk of developing sciatica. 
	&nbsp;</li>
	<li>Avoid Prolonged Sitting: Prolonged sitting, especially in a slouched position, can increase the pressure on the lower back and contribute to the development of sciatica. 
	&nbsp;</li>
	<li>Use Proper Ergonomics: Using proper ergonomics, including sitting in a chair with good back support and positioning computer monitors at eye level, can help reduce the risk of developing sciatica. 
	&nbsp;</li>
</ol>
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Key Points

<ul>
	<li>Sciatica is defined as pain that radiates along the sciatic nerve, extending from the back and down the back of the thigh. It is not a disorder, but rather a symptom.</li>
	<li>A herniated disc is the major cause of sciatica, while older adults typically experience pain due to lumbar spinal stenosis. Other than pain, people may also experience numbness and inflammation in the affected leg.</li>
	<li>Compression of the sciatic nerve results in pain, numbness, and weakness in the affected region.</li>
	<li>Pain in the lower back, buttocks, and thighs is the hallmark symptom of sciatica.</li>
	<li>The pain associated with sciatica may be described as shooting or electric and may be aggravated by movement or prolonged sitting.</li>
	<li>A straight leg test is often used to diagnose sciatica. Doctors may also order imaging scans, such as MRIs, X-rays, and CTs. Nerve conduction studies may also be used.</li>
	<li>The treatment of sciatica depends on the underlying cause and severity of the condition.</li>
	<li>In cases where a herniated disc is causing sciatica, a discectomy may be performed to remove the damaged portion of the disc.</li>
	<li>A laminectomy may be performed to remove the lamina, or bony arches of the vertebrae, to relieve pressure on the nerves in the affected area.</li>
	<li>If the underlying cause of sciatica is not treated promptly, it can cause permanent damage to the nerves in the affected area.</li>
	<li>Chronic pain associated with sciatica can lead to depression and anxiety, particularly if the condition persists over an extended period.</li>
	<li>The likelihood of acquiring sciatica rises with age.</li>
	<li>Jobs that involve heavy lifting, twisting, or bending can increase the risk of developing sciatica.</li>
	<li>Regular exercise, including low-impact activities like walking, swimming, or yoga, can help strengthen the muscles in the back and reduce the risk of developing sciatica.</li>
	<li>Prolonged sitting, especially in a slouched position, can increase the pressure on the lower back and contribute to the development of sciatica. 
	&nbsp;</li>
</ul>

[1] American Academy of Orthopedic Surgeons. Sciatica. Accessed on April 16, 2023.

[2] Oliveira CB, Maher CG, Pinto RZ, et al. Epidemiology of chronic low back pain in lat in america and africa: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2018;43(14):E830-E839. doi:10.1097/BRS.0000000000002584

[3] Lopes-Junior LC, Peixoto-Souza FS, Gomes-Oliveira MH, et al. Prevalence and factors associated with sciatica in older adults: a population-based study. BMC Musculoskelet Disord. 2020;21(1):745. doi:10.1186/s12891-020-03842-1

[4] Vleggeert-Lankamp CL, Arts MP, Jacobs WC, et al. Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons. J Orthop Surg Res. 2016;11(1):30. doi:10.1186/s13018-016-0361-2.