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sciatica- things you need to know

what is sciatica ?

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.

Sciatica is often characterized by one or more of the following symptoms:

  • Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
  • Pain that is worse when sitting
  • Burning or tingling down the leg (vs. a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • A sharp pain that may make it difficult to stand up or to walk

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Specific sciatica symptoms also vary widely in type, location and severity, depending upon the condition causing the sciatica

What are the cause of sciatica?

6 Most Common Causes of Sciatica

There are 6 lower back problems that are the most common causes of sciatica:

Lumbar herniated disc
A herniated disc occurs when the soft inner core of the disc leaks out, or herniates, through the fibrous outer core and irritates the nerve root.

A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.

Degenerative disc disease
While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.

Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the area (including the nerve roots).

Isthmic spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another (e.g. the L5 vertebra slips over the S1 vertebra).

With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.

Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60.

The condition typically results from a combination of one or more of the following: enlarged joints of the spine, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

Piriformis syndrome
The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.

This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.

Sacroiliac joint dysfunction
Irritation of the sacroiliac joint - located at the bottom of the spine - can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.

The leg pain can feel the same as sciatica caused by a nerve irritation.

More Causes of Sciatica

In addition to the most common causes, a number of other conditions can cause sciatica, including:

  • Pregnancy. The changes that the body goes through during pregnancy, including weight gain, a shift on one's center of gravity, and hormonal changes, can cause sciatica during pregnancy.
  • Scar tissue. If scar tissue compresses the nerve root, it can cause sciatica.
  • Muscle strain. In some cases, inflammation related to a muscle strain can put pressure on a nerve root and cause sciatica.
  • Spinal tumor. In rare cases, a spinal tumor can impinge on a nerve root in the lower back and cause sciatica symptoms.
  • Infection. While rare, an infection that occurs in the low back can affect the nerve root and cause sciatica.

Treatment of Sciatica

Treatment can be surgical or non surgical. Surgical treatment is reserved for cases that do not respond to non surgical management or cases where the pain is very severe and not responding to conservative management or in patients who demonstrate symptoms of neurological deficits like muscle weakness

Non surgical Management

Non-surgical sciatica treatments encompass a broad range of options, with the goal of relieving pain caused by compressed nerve roots. One or some combination of the treatments below are usually recommended in conjunction with specific sciatica exercises.

Heat/Ice
For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

Pain Medications
Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can reduce the inflammation that is usually a contributing factor in causing sciatica pain.


Heat/Ice
For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

Pain Medications

Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can reduce the inflammation that is usually a contributing factor in causing sciatica pain.

Epidural Steroid Injections for Sciatica
If the pain is severe, an epidural steroid injection can be performed to reduce the inflammation. An epidural injection is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain.

PHYSICAL THERAPY AND EXERCISES

Physical therapy exercises incorporating strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.

When patients engage in a regular program of gentle strengthening, stretching and aerobic exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.

SURGERY FOR SCIATICA

If the sciatica pain is severe and has not gotten better within six to twelve weeks, it is generally reasonable to consider lower back surgery. Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered:

  • A microdiscectomy (or small open surgery)
  • A lumbar laminectomy (an open decompression)

Surgery is the Patient’s Decision

In most cases, sciatica surgery is elective, meaning that it is the patient’s decision whether or not to have surgery. This is true for both microdiscectomy and laminectomy surgery.

The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. The patient’s overall health is a consideration as well.

As a general rule, surgery for sciatica may be considered in the following situations:

  • Severe leg pain that has persisted for 4 to 6 weeks or more
  • Pain relief that is not achieved after a concerted effort at non-surgical sciatica treatments, such as one or a combination of oral steroids, non-steroidal anti-inflammatory medication, manual manipulation, injections, and/or physical therapy
  • The condition is limiting the patient’s ability to participate in everyday activities

Urgent surgery is typically only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control.

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