Sciatica

Symptoms Of Sciatica

The sciatic nerve is the largest nerve that branches from the lower back through your hips, buttocks, and down each leg. Sciatica presents itself with pain along the pathway of the nerve, including the lower back, buttock, and the back of the thigh and calf. The symptoms include:

• Unilateral leg pain

• Pain in the lower back

• Radiating pain to foot or toes

• Numbness and burning in the distribution of the nerve

• Increased pain in keeping the lag straight

• Decreased range of motion of the hip joint.

Causes Of Sciatica

Sciatica symptoms occur when there is pathology anywhere along the course of the nerves. Sciatica develops in many ways; among them, the most common are the following:

• Herniated discs: This condition occurs when the soft center of a spinal disc pushes through a crack in the more rigid exterior casing of the spine.

• Degenerative disc disease: It is a natural aging process that acts as a precursor to disc herniation.

• Lumbar (lower back) spinal stenosis: It is the narrowing of the sciatic nerve

• Isthmic spondylolisthesis: This condition results from the vertebra slipping forward on the sacral, pinching the nerve root as it leaves the spine.

• Piriformis syndrome: This occurs when your piriformis muscle (muscle in the gluteal region of the lower limbs) compresses the sciatic nerve and results in swelling and redness.

• Malignancy (cancer): Metastatic (spreading) bone or soft tissue cancer, sciatic nerve cancer, hemangioblastoma (type of brain tumor)

• Infection: That can lead to abscess formation and inflammation of the disc.

• Vascular compression: Compression of the blood vessels can lead to the formation of a pseudoaneurysm (occurs when blood walls of the blood vessels are injured).

• Bony compression: Overgrowth of bones in the sciatic nerve distribution can put pressure on it.

• Gynecological cause: Studies have shown that uterine fibroid and endometriosis (overgrowth of the inner lining of the uterus) can also cause sciatica.

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Sciatica in COVID-19 patients is not uncommon.

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Risk Factors For Sciatica

Sciatica may be caused due to reasons related to the disc or non-discogenic causes. However, your chances of getting sciatica increase with the following factors:

Age

As you age, the changes in your spine can lead to bony overgrowths and herniated discs, the most common causes of sciatica.

Genetic predisposition

Studies suggest that lumbar disc disorders, characterized by disc herniation, have a vital genetic component that can lead to sciatica.

Occupation

Particularly if associated with physical activity, especially flexion/torsion of the trunk, arms frequently raised above shoulder height, and driving motor vehicles.

Incorrect walking posture

While walking, your shoulders should be back, down, and relaxed, as improper posture can compress your lumbar discs and cause sciatic nerve irritation.

Jogging

It can predispose you to pain if you have a history of back or lumbar problems. Research shows that joggers have a lower risk for incidental sciatic pain but a higher risk for persistent symptoms.

Smoking

Studies demonstrate that smoking is a modest risk factor for lumbar pain and clinically verified sciatica. 

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Obesity

Studies show that being overweight and obese increases the risk of lumbar pain and sciatica in both men and women.

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Tall height 

This risk factor is relevant for old age groups only. If you are tall, you may be at a higher risk of developing sciatica.

Mental stress

Sciatica is linked to feeling overwhelmed or under pressure, and stress can exacerbate musculoskeletal conditions, including nerve pain.

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Diagnosis Of Sciatica

Sciatic pain can mimic any other nerve pain, and it is essential to diagnose it correctly for the proper treatment. Sciatica is mainly diagnosed by the following:

Medical History 

A complete history is required to determine the localization, severity, loss of strength, sensibility disorders, duration, course, influence of coughing, rest, or movement, and consequences for daily activities.

Patients generally mention radiating pain in the leg with sensory symptoms like numbness, burning, or tingling. They may be asked to show the distribution of the pain and whether it radiates below the knee. 

Physical examination

It largely depends on neurological testing. The most applied investigation is the straight leg raising test or Lasègue’s sign. Lasègue’s sign is positive if the angle to which the leg can be raised (upon straight leg raising) before complaining of pain is <45°. 

Note: Patients with sciatica may also have lower back pain, which is usually less severe than leg pain. 

Imaging tests

Imaging may be indicated at this stage only if indications or “red flags” like infections, cysts, tumors, or fractures, rather than disc herniation. These tests include:

1. X-ray: Radiographs of the spine may reveal any overgrowth of bone that can be pressing on a nerve.

2. CT scan: A non-contrast computed tomography (CT) scan may be performed to evaluate fracture if plain radiographs are negative. CT is also done to assess any soft tissue anomalies.

3. MRI: Magnetic resonance imaging (MRI) is indicated if the pain is persistent for more than 6-8 weeks to rule out any neurologic deficit is present or a mass effect is suspected.

4. Electromyography (EMG): It is a minimally invasive diagnostic test that evaluates how well the electrical signals between nerves and muscles are working. It is done to determine the severity of nerve damage.

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Prevention Of Sciatica

Prevention is always the best course of action for any disorder. The best strategies for preventing sciatica include:

Avoid prolonged rest

Too much rest can aggravate sciatica pain. Stay active as much as possible. Here are a few tips that can help you with it:

• Use the stairs instead of an elevator

• Make sure to get up and move every 30 minutes

• Switch to a standing desk with an adjustable height

• Add simple stretches that you can do while sitting on your office chair

• Go for regular, short walks

• See a physical therapist and make exercise a part of your daily routine

Exercise regularly

Beneficial exercises to prevent sciatica include walking, swimming, pilates, and yoga. It strengthens the abdomen and back muscles that support the spine.

Sleep in the correct posture

One strategy is to lie flat on the back and bend the knees slightly while keeping the buttocks and heels flat against the bed. You can also practice stretching before sleeping and using a firm mattress to support your back.

Burn that extra fat

Obesity is one of the critical risk factors in the development of sciatica. Losing weight can help relieve sciatica and prevent it in the long run.

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Be mindful of your postures

When sitting or standing, keep your back straight and shoulders back to relieve the pressure on the back. Sitting in the same position or habitual slouching while working at the desk for a long time can also harm your back. 

Lift weights with the proper technique

A sudden lifting injury can herniate your disc, impinging or irritating a sciatic nerve root. We often tend to lift objects improperly, keeping the back straight while rising with the hips and legs. 

Say no to smoking

We all know the terrible effect that smoking has on our bodies. Studies show that abstaining from smoking can reduce, but not eliminate, the excess risk of developing sciatica.

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Specialist To Visit

Sciatica is a disorder of the nerve. The doctors who can diagnose and treat sciatica include:

• Neurologists

• Neurosurgeons

• Orthopedic surgeons 

A neurologist and neurosurgeon are specialists who treat diseases of the brain and spinal cord, peripheral nerves, and muscles. An orthopedic surgeon is a doctor with special training in diagnosing and treating injuries and conditions of the musculoskeletal system.

When to see a doctor?

See a doctor immediately if: 

• The pain persists for more than a week or worsens

• Numbness or weakness in the leg

• Loss of bowel or bladder control.

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Treatment Of Sciatica

While sciatica may not be a life-threatening disease, it can severely affect the quality of life, taking a toll on the mind and body. Various treatment options of sciatica include:

Conservative management

This consists of explaining the cause of the symptoms and reassuring the patients that symptoms usually diminish over time, even without specific measures. Advise them to stay active and continue daily activities with yoga or stretches to relieve the pain. 

Pharmacological management

If there is a lot of pain, certain medications are prescribed to provide relief. These include:

1. Anticonvulsant medications: Research supports the use of anticonvulsants that can relieve pain caused by damaged nerves. These include:

1. Gabapentin

2. Pregabalin

2. Tricyclic antidepressants (TCAs): TCAs are the most studied antidepressants for the treatment of pain related to the nerves. Amitriptyline is most commonly used for management of sciatica.

3. SNRIs: Serotonin and norepinephrine reuptake inhibitors (SNRI) are antidepressants that help relieve depression symptoms and are also used for anxiety disorders and nerve pain. The drugs used in sciatica include:

1. Duloxetine

2. Venlafaxine

4. Opioid analgesics: These are used for pain relief and include:

1. Oxycodone

2. Tramadol

3. Morphine sulfate (MST)

5. Epidural steroid injections: These can temporarily relieve sciatica and help a patient progress with rehab and exercise. 

Surgery

Surgical intervention for sciatica focuses on removing herniated discs and, eventually, part of the disc to eliminate the suspected cause of sciatica. Treatment is aimed at easing the leg pain and corresponding symptoms, not reducing the back pain.

Studies suggest that cauda equina syndrome (compression of a collection of nerve roots) is an absolute indication for immediate surgery. Elective surgery is the choice for unilateral sciatica. Surgeries include:

• Microdiscectomy: This is a minimally invasive surgical procedure performed on individuals with a herniated lumbar disc.

• Laminectomy: It is a surgery that creates space by removing bone spurs and tissues associated with arthritis of the spine.

Epidurioscopy with adhesiolysis

Epidural endoscopic adhesiolysis is a minimally invasive technique for accurately placing the drug injection (generally a local anesthetic) into the epidural space. Studies demonstrate that this technique alleviates pain and reduces sensory nerve dysfunction in patients suffering from sciatica.

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Home care For sciatica

Management of sciatica needs care and maintaining the posture right. Some of the home remedies that can prove beneficial in alleviating the pain include:

Use hot and cold packs

Applying ice packs lessens the pain, numbs the area, and decreases inflammation. It is suggested in acute cases when sciatica flares up. A handy tip while using an ice pack is to alternate it with a heat pack once the acute pain subsides. 

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Support your back

Wear a lumbar or hip brace for short durations, as it can help stabilize and support the lumbar tissues. Lumbar braces limit excessive spinal movement and can help relieve pain from nerve root endings.

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Take out time for stretching

The pain from sciatica generally benefits from a stretching routine that targets the hips and hamstrings that relieves overused or inflamed muscles.

Apply topical pain relieving creams

Topical gels, creams, or patches that contain painkillers or even numbing gels can provide fast and effective pain relief. These medications penetrate your tissues and act locally. Some of the drugs include:

• Methyl salicylate

• Menthol

Complications Of Sciatica

Sciatica results from pressure on the sciatic nerve, and potential complications of unresolved sciatic nerve compression include:

• Increased pain in the nerve distribution over time

• Weakness in the affected leg

• Burning or prickling sensation in the affected leg

• Decreased or loss of bowel or bladder function

• Permanent nerve damage.

Alternative Therapies For Sciatica

Complementary or alternative therapies are quite helpful in managing pain related to sciatica. However, always consult your doctor before starting anything new. Some of the beneficial treatments include:

Physiotherapy

An essential component of conservative treatment is physiotherapy, which aims to promote physical and psychological health for the patient, mainly due to disc problems. Physical therapy generally includes mild stretching and pain relief modalities, conditioning exercise, and an ergonomic program.

Acupuncture

Acupuncture is a form of alternative medicine in which thin needles are inserted into the body at specific points to provide pain relief. Studies suggest that acupuncture therapy is an effective non-drug therapy for sciatica as it allows physicians to facilitate individualized treatment decisions regarding managing sciatica.

Is acupuncture effective in managing chronic pain?

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Chiropractic therapy

It is a form of alternative medicine used to diagnose, treat, and prevent mechanical disorders, especially of the spine. A chiropractor is a trained person who treats physical problems by pressing and moving the bones in a person’s back, which might be able to help relieve sciatica pain. 

Living With Sciatica

Sciatica is a common condition that is a significant cause of work absenteeism and a major financial burden to industry and health service providers. Remember, time heals everything, and you can learn to manage pain with time. Some of the things to keep in mind if you are suffering from sciatica include:

• Do not sit or stand in the same position for more than 20 minutes

• Avoid exercises that stretch your hamstrings (muscles from at the back of the thighs from hips to the knee)

• Always warm up before lifting heavy weights

• Avoid rowing machines in the gym as they can strain the lower back

• Do not stress your back by bending over too often

• Stay away from complete bed rest

• Make sure your office chair is comfortable

• Avoid twisting the motion of your spine

• Try not to lift heavy objects

• Avoid long car trips

• Learn to manage stress efficiently