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Sciatica

Sciatica

Lower back pain resulting in pain that shoots down the leg is usually referred to as sciatica.

Sciatica

Sciatica is the lower back pain that results in pain down the leg. The pain is triggered due to the pressure on the sciatic nerve. The sciatic pain radiates from the lower back to the buttocks and then deep down the leg. 

Sciatica Symptoms

  • Pain in the lower back
  • Pain in the back of the leg elevate on sitting
  • Pain in Hip
  • Numbness or altered sensation down the leg
  • Weakness in the leg
  • Difficulty walking

Common Causes of sciatica

Around 90% of the sciatic pain is a result of the herniated disc. Herniated disc causes the compression  of the spinal nerve root that produces the sciatic nerve pain. Sciatic nerve pain originates from a herniated disc in the below mentioned ways:

  • Direct compression of the nerve.
  • Leakage of chemical irritant from the herniated disc that results in inflammation in the area that surrounds the sciatic nerves.
  • Constriction of a single side in nerves produces symptoms in one leg, however, constriction in both the sides affects both legs.

Risk Factors

Risk factors associated with sciatica include:

  • Injury
  • Heavy physical jobs
  • Smoking
  • Obesity
  • Underlying degenerative conditions

Complications

Large disc bulges can result in numbness or weakness of the muscles. In rare cases, a large disc bulge can cause compression onto several nerves in the low back. This devastating condition called cauda equina syndrome results in numbness, weakness and pain in both legs. It can also affect the nerves that control the bowel and bladder. If these nerves are permanently damaged, it results in a complete loss of control of these organs. 

Sciatica Diagnosis

A detailed medical history of the patient is required for a primary diagnosis. A physical examination is conducted by the doctor to check the muscle strength, reflexes and sensations. During the examination, the doctor will make the patient perform certain activities such as lying on their back or walking on their heels. If the patient is suffering from sciatica, the pain would worsen while performing the activity.

Diagnostic test for the sciatica include:

Imaging tests – The imaging tests are suggested by the doctors when the pain is severe and not improving in a week. 

X-ray – Discloses the bone spur, which is constricting the sciatic nerve.  

MRI – Provides a detailed image of the back including herniated disks. 

Electromyography (EMG) – This test certifies if the herniated discs or spinal stenosis are behind the nerve compression. EMG calculates the electrical impulses by nerves and muscle response. 

Sciatica Treatment

There can be various treatment options for this condition. The treatments depend on the extent of the symptoms and the size or degree of the disc prolapse.

Less invasive treatment options include:

  • Pain relief medications along with anti-inflammatory drugs
  • Exercise
  • Physiotherapy
  • Hydrotherapy

More invasive techniques of treatment include:

  • CT guided injections
  • Performing a lumbar microdiscectomy operation

In the majority of cases, pain relief medication and lifestyle modifications will resolve the symptoms. If symptoms persist despite conservative treatment, surgery is an option. Only a very small proportion of patients will need surgical intervention.

A lumbar microscopic discectomy is performed if there is a concern of impending nerve damage due to the extent of disc prolapse. In case there are signs of early nerve damage even at the first presentation, surgical treatment is recommended. The lumbar microscopic discectomy is a minimally invasive procedure. The surgeon makes a corridor of entry into the lumbar spine using small tubes.  He or she will remove the offending disc fragments to free the nerve. Removing the compression upon the nerve results in an improvement of pain symptoms. This minimally invasive surgery helps the patient return back to normal activities early.

Sciatica Prevention

Sciatica cannot be prevented, however the health of back can be preserved in the following ways: 

Daily exercise

Core muscles, including the lower back and abdomen muscles, should be the main focus of exercises to keep the back strong and healthy. They are responsible for the body posture and its alignment.

Maintain the posture while sitting

It is recommended to maintain a good posture. Always keep the level of knees and hips the same. To maintain the curve of the body, add a pillow or rolled towel. Select the seat with armrests, swivel base and better lower back support.

Body mechanics

Avoid standing for a long period. Use stool or some box to make the foot relax while carrying a heavy load. Keep the back straight, however, you can bend the knees. Allow the lower extremities to do the maximum work. Do not simultaneously lift or twist the heavy load.

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