Sciatica; we’ve all heard this word before. In common terms, “Sciatica” is a condition that is characterized by pain radiating down the leg along the sensory distribution of the sciatic nerve. One can experience the symptoms of sciatica from compression of the nerve itself, or compression of any of the individual nerve roots that contribute to what we know as the sciatic nerve (but I don’t want to get too technical so soon). This medical condition typically occurs when other injuries along the lower back or buttocks are already present. Because of these injuries, the nerve can get compressed or irritated as it passes down its typical route. As a result, the person with sciatica presents with signs and symptoms of traveling and shooting leg pain.
Usually this condition resolves within a few days or weeks, although this depends on the extent of the injury. Because of this, most of the people who have this condition usually only require conservative treatment strategies like physical therapy. In severe cases, however, more advanced treatment options may be needed to provide pain relief which can range from epidural injections or corrective surgery.
MOST COMMON CAUSES
There are a few areas where the symptoms of Sciatica can arise. The sciatic nerve itself can get compressed underneath a swollen muscle, in the region of the buttocks. In another scenario, structural deformities like bone spurs and herniated lumbar disks in the spine can compress nerve roots that feed into the sciatic nerve causing these same symptoms (this is typically called “lumbar radiculopathy”). In some cases, tumors or infections may press against this nerve and produce the same type sciatica pain although this is rare.
Although it may not be so obvious, obesity may also play a role in the development of sciatica. In the setting of obesity and improper biomechanics, the sciatic nerve has a greater chance of getting compressed, thus producing the tingling sensation and discomfort. Likewise, increased abdominal obesity may also lead to damage and injury to the lower back and lumbar spine, and thus also contributing to nerve root compression.
In some instances, a person’s occupation may also play a role in the development of sciatica. If the person’s work requires them to sit for prolonged periods without interruption or lifting heavy objects repeatedly, they can be susceptible to lumbar disc injury. As a rule, prolonged sitting without breaks is not a healthy position for the discs in your lumbar spine.
SIGNS & SYMPTOMS
The usual symptom of sciatica is pain. This pain radiates from the low back region to the back and along the back of the person’s thighs and legs. In some cases the pain may reach as far as the ankle and foot. The pain is typically described as lightning-like, burning, shooting, and tingling however it can vary from person to person. Occasionally there can be numbness as well. In cases of leg or foot weakness, a doctor should be consulted quickly.
Because most sciatica cases typically resolve by themselves, a conservative treatment approach is first done to restore function and minimize the discomfort brought about by pain. During the healing process, people with sciatica may resort to various management interventions to help control the pain and the discomfort.
Using Ice or Hot Packs: For the acute phase of sciatica, it is best to resort to modalities like ice and heat for the lower back pain component. Ice or hot packs can be used in intervals of 15-20 minutes multiple times a day.
Medications: Analgesics also play a crucial role in managing the pain, However, these should be taken with the correct dosage and frequency to ensure that these are no adverse effects that may take place. In this case, non-steroidal anti-inflammatory drugs (also known as NSAIDs) may be administered. One example of an over-the-counter anti-inflammatory is Ibuprofen. Pain relievers like Acetaminophen (ex. Tylenol) can also be of help. In some cases, your doctor may prescribe oral steroids to help reduce inflammation on the affected regions. In more extreme cases, a short course of opioid medications can be of help but should be used with caution.
Exercise Therapy: Physical Therapy may be helpful to reduce symptoms of sciatica. May therapy techniques can be used to reduce muscle tension, and certain movement therapies can help minimize the radiating leg pain severity.
Advanced Therapies: In some cases, after conservative treatments have been tried, your doctor may recommend a trial of nerve blocks. These are typically done under guidance of Xray or Ultrasound for improved accuracy. Seeking consult from a well-trained Interventional Pain Physician may be of service in this case. If minimally-invasive treatments also do not seem to provide relief, surgical options may have to be discussed.