Sciatica (Pinched Nerve)

Sciatica (Pinched Nerve)

Susan has been experiencing throbbing pain radiating down her buttocks, through the thigh, and reaching her lower leg and ankle. She visited the doctor, and during her physical examination, she said that she had never experienced such pain in her life. Based on her complaints, the doctor suspects sciatica.

What is Sciatica?

The term "sciatica" describes pain that spreads along your sciatic nerve's course. The sciatic nerve is the biggest nerve in the human body. It originates in your lower back, extends through your hips and buttocks, and travels down the back of your legs.

Sciatica is not a disease; it is usually a symptom of an underlying problem. It occurs due to the compression of a part of the sciatic nerve, causing pain, inflammation, and numbness in the affected leg. Typically, sciatica affects only one leg, and the symptoms may appear suddenly or develop gradually. It usually heals over time without any treatment.

What are the symptoms of Sciatica?

The common symptom of sciatica is pain that radiates from your lower back through the back of your thigh down to your leg. It can be mild or severe, making it difficult to perform regular activities. The damaged side of the body is typically only one side.

Other signs may include:

• Pain in your lower back or hip
• Pain while you move, sneeze, or cough
• Ongoing discomfort on one buttock's side
• Pain in your buttocks that may worsen when you sit for longer periods
• Numbness and tingling sensation in your legs
• Weakness and difficulty in moving your leg
• Cramping or burning sensation in your leg
• Sharp pain in your leg that makes it difficult to stand

What are the causes and risk factors for Sciatica?

Several conditions that may lead to compression of the sciatic nerve include:

• Herniated disk: Slipped disc in the spine
• Bone spur: Overgrowth of the bone on the vertebrae
• Spinal stenosis: Narrowing of the spinal canal
• Piriformis syndrome: Irritation of the sciatic nerve due to piriformis muscle (a small muscle in the buttocks) spasms
• Spondylolisthesis: Slippage of the bony vertebra beneath the spinal bones
• Other causes: Sometimes tumors, certain infections, or nerve disorders may also lead to sciatica.

Additionally, the risk of sciatica increases with the following factors:

How is sciatica diagnosed?

The diagnosis of sciatica includes a detailed medical history and a physical examination. The physician may obtain your medical history, which includes your past injuries, symptoms, and situations during which pain gets worse. The pain developed during sciatica aggravates while performing certain activities, indicating the presence of the condition. Such activities may include raising one leg at a time while lying on your back, rising from a squatting position, or walking on your toes or heels.

If sciatica is suspected, then you may need to undergo certain imaging tests to confirm the diagnosis. They may include:

• X-ray: X-rays helps to identify bone spurs (overgrowth) or fractures in the spine that may pinch the nerve.
• Magnetic resonance imaging (MRI): The detailed images of the bones and soft tissues obtained by MRI help in identifying conditions like herniated disks, spinal stenosis, or bone spurs.
• Computed tomography (CT): CT is also useful for creating detailed images of the spinal structures that help in identifying conditions like herniated disks, bone spurs, etc.
• Myelogram: A special contrast dye injected into your spine circulates around the spinal cord and spinal nerves. Further imaging with CT helps in the identification of the cause.
• Electromyography (EMG): EMG helps to measure the electrical impulse produced by the sciatic nerve and to confirm the compression or damage that happened to the nerve.

How is sciatica treated?

Treatment of sciatica depends on the cause and severity of the symptoms. The symptoms are usually relieved with simple self-care measures, such as light exercises, stretching, and changing your posture from time to time to relieve the pressure on the sciatic nerve. However, if the pain persists even after self-care measures or if the condition is severe, then the physician may recommend the following treatments:

• Medications: The following are the type of medicines prescribed for relieving sciatica pain:
  • NSAIDs: Non-steroidal anti-inflammatory drugs (for the treatment of pain and inflammation)
  • Muscle relaxants: To relieve muscle spasm
  • Anti-depressants and Narcotics: To relieve severe pain
• Injections: If the pain is severe, corticosteroid injection is administered into the area surrounding the nerve. They help in relieving inflammation and swelling around the irritated nerve.
• Hot or cold packs: Using hot or cold packs alternatively may help in providing relief from severe pain.
• Physical therapy: After finding that there is a considerable improvement in your condition, the physician may recommend you to a physical therapist. A physical therapist helps in designing a personalized rehabilitation program, which helps in relieving pressure on the sciatic nerve and preventing future injuries. Physical therapy involves strengthening the muscles and improving flexibility.
• Surgery: Surgery is an option when conservative methods fail to relieve symptoms or when the compressed nerve leads to weakness or bowel or bladder incontinence. Surgical procedures are done to remove the bone spurs or herniated disks that are compressing the nerve.

How can sciatica be prevented?

Not all the causes of sciatica are preventable, but following these simple steps can reduce its risk. They may include:

• Regular exercise
• Proper lifting technique
• Maintain good posture (while sitting or standing)
• Avoid sitting for longer periods
• Avoid smoking