The term Sciatica is used to describe a certain kind of nerve pain. It is not a medical condition itself but a symptom of different underlying conditions leading to impingement of the Sciatic nerve. This causes pain in the region supplied by the aforementioned nerve. Sciatica pain often starts from lower back, radiating to the buttock, down to the leg and foot. Mostly it affects unilateral lower half of the body.
According to a research done by Dr. M.A.Standford, Dr. P.Peng, Dr. D.A.Hill published in British Journal of Anesthesia (BJA), “Sciatica is a relatively common condition with a lifetime incidence varying from 13% to 40%. The corresponding annual incidence of an episode of sciatica ranges from 1% to 5%.”
Overview of Sciatic Nerve
Sciatic nerve is the largest nerve of the body starting at lower back (L3). The nerve runs down from lower back, to the ipsilateral buttock, leg and foot. During it course it gives out branches that innervate areas of thigh, calf, foot and toes. Hence any pathology of sciatic nerve leads to pain and numbness of its areas of innervation.
Causes of Pain
Some common reasons of Sciatica are:
1. Disc Herniation:
Vertebral Disc herniation leads to sciatic nerve impingement and thus Sciatica. Any sort of over growth in the disc or spine can also lead to sciatic pain. Nearly 85% of the sciatica cases are associated to disc disorder.
2. Degenerative Disc Disease:
Degeneration of the vertebral discs is a natural process and may lead to nerve compression and sciatica.
3. Lumber Spinal Stenosis:
It is a condition in which there is a natural narrowing of the spinal canal as a part of aging. This is a common cause of sciatic pain in old age especially people above 60years.
The physiological changes during pregnancy like weight gain, hormonal changes, and shift of gravity may lead to Sciatica. More over prolonged and obstructed labor may cause damage to lower back nerve roots causing this condition.
5. Muscle strain:
Sometimes constant strain to lower abdominal muscles may put pressure on the lower back nerve roots e.g. in case of chronic cough, constipation, heavy sneezing etc.
Other causes include fracture of the vertebrae, spinal tumor or mass, arthritis, infection etc. Risk factors of sciatica include obesity, Diabetes, Prolonged sitting, etc.
Common symptoms of Sciatica include:
Constant lower back pain radiating to buttock, leg and foot.
Pain worsens on standing or sitting for long hours.
Pain is described as sharp, shooting pain.
Weakness of the affected limb.
“Pins and Needles” sensation or numbness of the affected limb.
Symptoms intensify while changing position.
In extreme cases loss of bowel or bladder function.
Sciatica and underlying cause of sciatic pain can be diagnosed through a combination of thorough physical examination and imaging studies of the spine. Commonly used methods are;
Treatment depends upon the underlying cause leading to sciatic pain and maneuvers to release the nerve compression. For symptomatic treatment medications can be used like Non-steroidal anti-inflammatory drugs prescribed by the doctor.
Physiotherapy also helps in relaxing the muscles and maintaining posture. It also helps by strengthening the back and increasing flexibility. Corticosteroids injections on the affected area also play a key role in symptomatic relief. Use of hot packing alternatively with cold packing also controls the symptoms to a great extent.nervous
Surgical release of the nerve is the definitive treatment but is not used on large scale because of the risks associated to the surgery. This option is mostly kept for extreme cases where bowel and bladder functions are affected.
For majority of the people, sciatic pain is severe and debilitating. But with a combination of good medication, lifestyle modification and physical therapy, the symptoms can be managed and the patient can do the daily chores without any hindrance.