Sciatica – Do you have sciatica? Learn more about the symptoms, signs, causes, risk factors and treatment

Most of us have experienced back pain at least once. Our spine supports the weight of the rest of the body, and any improper movement, strain or trauma can potentially lead to back pain, which is usually localized in the lower back. But there are several types of back pain, and one of them stems from nerve tissue.

The most common type of neurogenic back pain is sciatica, which is not only felt in the back but can go down to the legs and cause severe disability. Have you ever experienced this type of pain? This article discusses sciatica pain and everything you need to know about this variant of low back pain.

Overview of Sciatica

These days, there is a lot of confusion surrounding sciatica. About what it is, what it means to have it and how to treat it. Many people think they have it when in fact they don’t, while others suffer in silence without knowing why. Sciatica is often misdiagnosed, so it is essential to educate people about this debilitating condition. In this way, we can avoid confusion, misdiagnosis and fear-mongering.

But what is sciatica pain?

Sciatica is a generic term used to encompass symptoms associated with unnatural compression of the sciatic nerve. This somewhat unclear definition is the source of patient confusion.

Sciatica is characterized by a shooting pain that affects the lower back and travels along the path of the sciatic nerve. Sciatica pain is also felt in the back of the hip and lower legs. A burning sensation is known to alternate with tingling and numbness. Sciatica is potentially debilitating as it can make moving and even standing difficult. Therefore, it is imperative to find practical ways to relieve this debilitating pain.

What causes sciatica pain?

As mentioned above, the main cause of sciatica is abnormal compression of the sciatic nerve. Most commonly, sciatica is caused by a herniation of the spinal discs. Other possible causes are displacement of a vertebra, pelvic tumors and pregnancy.

As you can see, sciatica pain cannot be understood without studying the spine and spinal problems. In most cases, patients with sciatica have also experienced back pain for three months or more. The diagnosis of their back pain may be nonspecific, but they could have a hidden degenerative or herniated disc.

When a degenerative change occurs in the intervertebral discs, this sponge-like structure loses its ability to cushion the vertebrae. The spaces between the vertebrae shrink, and the spaces where the nerves exit the spinal cord are smaller. This creates compression of the spinal cord, and if the sciatic nerve is involved, we will experience sciatica pain.

However, this is just theory, and the real world is a bit more complex. Sometimes we can see patients with significant degenerative changes in the spine but no pain. Other patients have no degenerative changes or only a mild problem, and they have severe sciatica pain. Thus, mechanical causes of sciatica are sometimes not enough, and other factors must be considered. These are known as inflammatory or biochemical pathways.

Inflammation is a natural response to defend the body against invaders, but sometimes it backfires. Cytokines released by white blood cells alter the function of blood vessels and cause edema. This creates mechanical pressure on surrounding structures and can trigger pain. But cytokines can also activate nerve endings and cause pain without any intermediary. This is why anti-inflammatory drugs are very useful to relieve a headache or pain after a trauma.

Risk factors

Low back pain and sciatica are common health problems in industrialized countries. We may have a higher risk of sciatica if we meet the following conditions:

  • Genetics: Sciatica may have a specific genetic predisposition, mainly due to its degenerative causes. Some people are more susceptible than others to degeneration of the spine, which could run in our veins as a family legacy.
  • Age: Advanced age is a risk factor. Sciatica can develop at any age, but it is more common as we age. At age 40-50, the incidence is highest, especially in women. Some researchers say that sciatica pain is as common in men as in women, but that women are more likely to report the problem and seek solutions.
  • Overweight and obesity: Being overweight increases the load on the spine and increases the likelihood of several spinal problems, including disc degeneration. Obesity leads to chronic joint loading, and is associated with increased systemic inflammation that promotes the development of sciatic pain.
  • Extreme height: In some studies, being very tall has been detected as a risk factor for sciatic pain. Other studies find no relationship, but it is a possibility to keep in mind.
  • Smoking: Tobacco smoke contains hundreds of inflammatory substances and can accelerate the development of sciatica pain via biochemical/inflammatory pathways.
  • Core Instability: Fitness level is sometimes linked to the onset of sciatica pain, and some people experience significant relief after strengthening their core muscles. Weakness and instability in the core can contribute to joint wear and tear and the development of sciatica pain.
  • Occupational factors: Depending on your job, you may or may not be exposed to significant spinal stress. Carrying heavy weights, standing for long periods of time, sitting all day, being exposed to vibration for long periods of time, and constant bending and twisting can increase the risk of sciatic nerve compression.
  • Job dissatisfaction: Not feeling satisfied with one’s job is often observed in patients with sciatica. This can become a source of stress and tension that facilitates the development of spinal pain and sciatica.
  • Emotional Problems: Other emotional problems, such as financial stressors and social anxiety, can also trigger sciatica pain or lead to more severe pain episodes.

Signs and symptoms of sciatica

The main symptom of sciatica is pain, but it is not just any pain. In most cases, patients experience both lower back pain and leg pain. In the case of sciatica, the leg pain is located in the nerve distribution from L4 to S2. In other words, the nerve roots affected by the disease are those that leave the intervertebral space from the fourth lumbar vertebra to the second sacral vertebra. These nerve roots receive impulses from their own areas of the skin and underneath, and that’s where it hurts the most. This is called the dermatomal distribution, and it creates a useful pattern for identifying sciatica pain.

In some cases, the dermatomic distribution of the pain is not clear, but there are other things that help detect the problem. For example, sciatica pain often occurs after prolonged strain on the spine, such as standing for a long period of time or carrying a heavy weight. It can also be triggered by sitting too long, as the sciatic nerve runs down the legs to the buttocks. Bending forward, vacuuming and other activities can make the pain worse, while changing position or lying down to unload the spine reduces the sensation of pain.

In addition to pain, other symptoms of sciatica include:

  • Tingling in the back of the leg: Tingling is an abnormal sensory impulse usually seen when a nerve is compressed against another structure. In this case, it is the sciatic nerve, and the effects can be felt in the back of the leg, on the buttocks and sometimes on the foot.
  • Numbness of the buttocks or legs: Numbness is also the result of abnormal sensory impulses. In this case, it reduces the sensitivity of the affected area and is sometimes accompanied by vascular changes.
  • Lower extremity weakness: The sciatic nerve can also contribute to motor function, and some patients experience weakness in the affected limb.

If you have these symptoms, your healthcare provider will perform a physical examination to determine the cause of the pain and rule out sciatica. Your doctor may ask you to walk normally or to walk on your heels. He or she may also lay you down and lift your legs straight up with his or her hands. This is a handy sign when he or she triggers pain and can help you understand where the injury is.

Your doctor may also find useful signs of the disease in diagnostic tests such as:

  • X-rays, especially to find disc problems, tumors, fractures and other physical or mechanical causes of pain.
  • Magnetic resonance imaging or CT scans, when assessing soft tissue or the nervous system.
  • Electromyography and nerve conduction velocity tests to assess how well the nerves conduct electrical impulses, as obstruction reduces the timing of nerve impulses.

Treatment of Sciatica Pain

Sciatica is a complex health problem, and there are different treatments that can relieve the pain. Not all of them work for every patient, and doctors often try different methods until they find the one that provides the longest pain relief and improves the patient’s quality of life.

The following variations can be tried:

Medications

There are several medications available to improve the pain of sciatica. Some of them are available over the counter, such as non-steroidal anti-inflammatory drugs. Naproxen and ibuprofen are two examples. They improve pain by reducing inflammation and its effects on the sciatic nerve.

Other medications are prescription drugs, such as tricyclic antidepressants, anticonvulsants and steroids. In this case, antidepressants and anticonvulsants are not prescribed because you have depression or seizures. What they do for sciatica pain is reduce the intensity of nerve impulses and inhibit certain impulses in the brain. Oral steroids are very powerful anti-inflammatory drugs that work best when over-the-counter anti-inflammatory drugs are not enough.

Activity modification and rest

Identifying the trigger for sciatic pain is an essential part of treatment. It could be your posture, lifting technique or a particular activity at work or at home. Your doctor can help you identify the trigger, which is the first step in recommending activity modifications.

Rest is essential, but do not prolong periods of bed rest. Physical inactivity does not support the structures of the spine and can increase your susceptibility to suffer a new episode of sciatica pain.

Physical Therapy

This is an alternative treatment that also helps relieve pain. It combines stretching exercises, aerobic body conditioning and muscle strengthening. Physical therapy is often guided by a therapeutic program and performed with a physical therapist. But if your problem is not severe, you can perform physical therapy on your own by following the instructions.

In this treatment modality, the main goal is to strengthen the spine to protect the spinal structures. It strengthens the core muscles and increases the flexibility of the hamstrings and other muscles. It can be done at home, in a medical facility or in a pool for low-impact exercises.

Stretching and physical activity

One of the best ways to relieve sciatica pain is to engage in stretching exercises. Yoga or Pilates are excellent disciplines that have a series of movements to help you feel good again. Stretching your lower back muscles and hip flexors will go a long way in reducing the pressure on your sciatic nerve.

However, for this method to be effective, you must make stretching a regular practice. Start a daily routine that includes the following stretches:

  • Runner’s Lunge: Begin this stretch in a plank position while your hands are positioned directly under your shoulders. Bring your left foot forward toward your hands and lower your arms to the floor. Relax your hips and lower back. This stretch will deeply depress the hip and groin muscles.
  • Pelvic tilt: While lying on your back, bend your knees, tilt your pelvis and lift your tailbone off the floor. Exhale as you flatten your spine against the floor and inhale as your tailbone descends.

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