Sciatica is the name given to pain caused by irritation of the sciatic nerve that irritates this nerve can cause pain, the cause of ranging from mild to severe sciatica is a compressed nerve in the lower spine.
Sciatica Causes
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disc in your spine or an overgrowth of bone(bone spur) on your vertebrate.
More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.
Risk Factors for Sciatica
Risk factors for sciatica include:
- Age
age-related changes in the spine like herniated discs and bone spurs are the most common causes of sciatica. - Obesity
By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica. - Occupation
A job that requires you to carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica but, there is no conclusive evidence of this link. - Prolonged sitting
People who sit for prolonged periods are more likely to develop sciatica than active people are. - Diabetes
This condition, which affects how your body uses blood sugar, increases your risk of nerve damage.
Symptoms of Sciatica
The main symptom is a shooting pain anywhere along the sciatic nerve from the lower back, through the buttock, and down the back of either leg.
Other common symptoms of sciatica include:
. Numbness in the leg along the nerve
. Tingling sensation (pins and needles) in the feet and toes
This pain can range in severity and may be aggravated by sitting for long periods.
Diagnosis of Sciatica
When in the physical exam, your doctor may check your muscle strength and reflexes. For example, you may need to walk on your toes or heels rise from a squatting position. And, while lying on
your back lifts your legs one at a time.
Pain that results from sciatica will usually worsen during these activities.
Imaging Tests
Many people have herniated discs or bone spurs that will show up on X-rays and other imaging tests but have no symptoms.
So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.X-ray
An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
MRI
This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI proceeds a detailed picture of the bone and soft tissues such as herniated discs. During the test, you lie on a table that moves into the MRI machine.
CT-Scan
When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the x-rays are taken. A procedure is called a CT myelogram. The dye then circulates your spinal cord and spinal nerves. Which appear white on the scan.
Electromyography (EMG)
this test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated discs or narrowing of your spinal canal also called spinal stenosis.
Sciatica Treatment
If your pain doesn’t improve with self-care measures, your doctor
might suggest some of the following treatments.
- Medications
The types of drugs that might be prescribed for sciatica pain include:
. Anti-inflammatories
. Muscle relaxants
. Narcotics
. Tricyclic antidepressants
. Anti-seizure medications - Physiotherapy
Once your acute pain improves, your doctor or a physiotherapist can design a rehabilitation program to help you prevent future injuries. - Steroid Injections
In some cases, your doctor might recommend an injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. - Surgery
This option is usually reserved for when the compressed nerve causes significant weakness. Loss of bowel or bladder control or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.
Signs of Sciatica
Sciatica is – we often think of sciatica more as a syndrome rather than as a pure diagnosis in itself. But sciatica is commonly where the disc itself compresses on the nerve in the lumbar spine and that affects the functioning of the nerve. In which case you either have pain or changes in sensory or motor ability down the leg. Now the interesting part about sciatica and why it can often be described as a syndrome is, it is not always a disc that causes those changes to the nerve. You can have restrictions and movement, specifically within the foraminal space where the nerve exits the spine. Tethering or adhesions along the pathway or the tract of that nerve can again restrict the ability or affect the ability of the nerve, which again can produce sciatic-like symptoms. Compression from soft tissue, such as muscles that are tight or sitting in an awkward position, or on your wallet, or several other aspects can again compress on that nerve and produce sciatica-like symptoms for some people. We can often have what’s referred to as a double compression syndrome which is where two points along that channel that the nerve runs are restricted and the combination of the dual restriction causes sciatic-like symptoms. The last one which is also a possibility is that the nerve itself is irritated or inflamed such as in neuritis which would cause pain up and down that leg or along with the distribution of the nerve, again producing sciatic-like symptoms.
Common presentation, as we’ve touched on, is a pain in the spine that radiates down the back of the leg. Typically it does only affect one side. If it’s affecting both sides, then it does raise the concern level that a therapist would have, and we would be looking to ascertain what other things are potentially going on. Pain areas. Buttocks, hip, and lower extremity. The pain can be mild, can be severe, can be sharp, can be Lansing. So many descriptors are often used to describe sciatic-like symptoms. Numbness, pins and needles can be present. Often people talk about them within their foot, specifically toes, ball of the foot, again depending specifically on the nerve and the pathways which are being affected.
Burning sensations, leg weakness and limping are also other common findings for this condition.
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