Sciatica is a pain that radiates from the low back down a lower extremity; it is caused by irritation of the sciatic nerve. The sciatic nerve transmits sensation from the lower extremities and lumbar area of the low back. It is common for people to recover from sciatica without a surgical operation.
Low back pain that radiates to the hip, buttock, and down a lower extremity is the most common symptom of sciatica. Sometimes sciatica pain worsens with bending at the waist, coughing, sitting, or sneezing. Sciatica can also cause tingling, numbness, or weakness of the leg. Sciatica symptoms can occur rapidly and persist for weeks.
Back pain is extremely common. There are many causes of lower back pain that are not sciatica. Frequently, low back pain is caused by back strain of muscles and ligaments. The characteristic feature of sciatica is pain that radiates down the leg from the low back, often reaching the foot.
Sciatica is common as we reach middle age. Pregnancy can lead to sciatica as a result of direct pressure on the sciatic nerve by the enlarging uterus. Other causes of sciatica are degenerative spinal arthritis and lumbar disk herniation.
Disk herniation is a common cause of sciatica. The disk cushions between the spinal vertebrae weaken and are more vulnerable to injury as we age. The weakened disk can herniate its gel-like center to cause direct pressure on the nerves in the spinal canal that form the sciatic nerve.
Degeneration of the vertebrae of the spine can lead to narrowing of the spinal canal; this is called spinal stenosis. This can lead to pressure on the spinal nerve roots that form the sciatic nerve. Sciatica can be a symptom of spinal stenosis.
Tumors are rare causes of sciatica when they put direct pressure on the sciatic nerve or its nerve roots.
The piriformis muscle in the buttock can sometimes lead to irritation of the sciatic nerve. This is referred to as piriformis syndrome.
A wallet or object that is in the back pocket during prolonged sitting can lead to piriformis syndrome and irritation of the sciatic nerve, causing sciatica. Placing the wallet in the front pocket instead can avoid the problem.
Rarely, sciatica can be caused by injury, fracture, infection, or inflammation. Any condition that leads to direct pressure or irritation of the sciatic nerve can cause sciatica. Sometimes, no specific cause of sciatica can be detected.
To detect the cause of sciatica, the doctor will ask about all the symptoms the patient is experiencing as well as their location and aggravating or relieving features. During the examination, the patient may be asked to do various maneuvers with the lower extremities.
Various tests, such as MRI scans, CT scans, and others, may be used to help detect the cause of sciatica. With a precise diagnosis, the treatment program can be optimized.
When sciatica is complicated by uncontrolled loss of bowel or bladder control, it is considered an emergency. These symptoms are evaluated rapidly to consider whether or not an immediate surgical operation is necessary.
Home remedies for new sciatica include heat-pad or ice-pack applications. Each can be applied for approximately 20 minutes every couple of hours. Some benefit from alternating heat and ice applications.
Medications that are over the counter and are used for sciatica include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Cortisone injections into the spinal canal can be helpful for selected patients.
Strict bed rest is recommended less often than in the past. Physical therapists are experts at designing optimal exercise programs for sciatica. Brief walking can be helpful for certain people with sciatica.
Spinal injection of cortisone medication (steroids) can be beneficial for severe sciatica. This medication rapidly reduces the inflammation around the nerves.
For persisting sciatica that does not respond to medical management, surgical operation can sometimes be required. Various operations differ depending on the exact condition causing the sciatica. Sometimes disk material and bone is actually removed to free up the adjacent irritated nerves.
After spinal surgery, there are often activity restrictions, as tissues must heal. Physical therapy is often prescribed to strengthen the back and promote healing by avoiding injury. The goal is eventual return to one's usual activities.
Adjunctive therapies, such as massage, yoga, osteopathic & chiropractic care, and acupuncture, can sometimes be helpful for back pain.
Sciatica can recur. To minimize the chances of recurrence, people should exercise regularly, maintain proper posture, and protect the back by bending at the knees to lift heavier objects.
IMAGES PROVIDED BY:
- Image Source: Primal Pictures, 3D4Medical/Photo Researchers Inc. Sciatica Pictures Slideshow
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- Klippel, J.H.: "The Primer On The Rheumatic Diseases"