The term sciatica describes the symptoms of leg pain—and possibly tingling, numbness, or weakness—that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of each leg.Sciatica is not a medical diagnosis in and of itself—it is a symptom of an underlying medical condition. Common lower back problems that can cause sciatica symptoms include a lumbar herniated disc, degenerative disc disease, spondylolisthesis, or spinal stenosis.
Sciatica Nerve Pain
Sciatica is often characterized by one or more of the following symptoms:
- Constant pain in only one side of the buttock or leg (rarely in both legs)
- Pain that is worse when sitting
- Leg pain that is often described as burning, tingling, or searing (versus a dull ache)
- Weakness, numbness, or difficulty moving the leg, foot, and/or toes
- A sharp pain that may make it difficult to stand up or walk
- Pain that radiates down the leg and possibly into the foot and toes (it rarely occurs only in the foot)
- Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.
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- While symptoms can be painful and potentially debilitating, it is rare that permanent sciatic nerve damage (tissue damage) will result, and spinal cord involvement is possible but rare.
The sciatic nerve is the largest single nerve in the body and is made up of individual nerve roots that start by branching out from the spine in the lower back and then combine to form the “sciatic nerve.” Sciatica symptoms occur when the large sciatic nerve is irritated or compressed at or near its point of origin.
- The sciatic nerve starts in the lower back, typically at lumbar segment 3 (L3).
- At each level of the lower spine a nerve root exits from the inside of the spinal canal, and each of these respective nerve roots then come together to form the large sciatic nerve.
- The sciatic nerve runs from the lower back, through the buttock, and down the back of each leg.
- Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg—the thigh, calf, foot, and toes.
THE COURSE OF SCIATICA PAIN
Sciatica rarely occurs before age 20, and becomes more commonplace in middle age. It is most likely to develop around age 40 or 50.
Perhaps because the term sciatica is often used loosely to describe leg pain, estimates of its prevalence vary widely. Some researchers have estimated it will affect up to 43% of the population at some point.1, 2
Often, a particular event or injury does not cause sciatica—rather it tends to develop over time.
The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with nonsurgical sciatica treatment.1 For others,
Seeing a doctor for sciatica pain is advised, both for learning how to reduce the pain and to check for the possibility of a serious medical issue.
WHEN SCIATICA IS SERIOUS
Certain sciatica symptoms, while rare, require immediate medical, and possibly surgical, intervention. These include, but are not limited to, progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction (cauda equina syndrome). Infection or spinal tumors can also cause sciatica.
Because sciatica is caused by an underlying medical condition, treatment is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually self-care and/or nonsurgical, but for severe or intractable pain and dysfunction it may be advisable to consider surgery.
6 MOST COMMON CAUSES OF SCIATICA
The following six lower back problems are the most common causes of sciatica:
- Lumbar herniated disc: a herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root.Other terms used to refer to a herniated disc are 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 some level of 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
- Bone spurs, which may develop with spinal degeneration, also may press against a nerve, resulting in sciatica.
- Istmica spondylolisthesis: this condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward 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 older than age 60.The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.
- Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.
- Piriformi 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 lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.
- 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.Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.
MORE CAUSES OF SCIATICA AND SCIATICA-TYPE SYMPTOMS
In addition to the most common causes, a number of other conditions can cause sciatica, including:
- Pregnancy. The changes the body goes through during pregnancy, including weight gain, a shift of one’s center of gravity, and hormonal changes, can cause sciatica during pregnancy.
- Scar tissue. If scar tissue—also called epidural fibrosis—compresses to a lumbar nerve root, it can cause sciatica.
- Muscle strain. In some cases, inflammation related to a lower muscle strain and/or muscle spasm can put pressure on a nerve root and cause sciatica pain.
- Spinal tumor. In rare cases, a spinal tumor can impinge on a nerve root in the lower back and cause sciatica symptoms. It is possible for tumors to originate in the spine, but more commonly spinal tumors develop as cancer from a different part of the body metastasizes and spreads to the spine.
- Infection. While rare, an infection that occurs in the low back can affect the nerve root and cause sciatica.
- Fracture. If a fracture occurs in a lumbar vertebra, it is possible for symptoms to include sciatica. Most fractures occur because of a serious trauma (such as a car accident or a fall) or because the bone has become weak due to osteoporosis or another underlying condition or medication.
- Ankylosing spondylitis. This condition is characterized by chronic inflammation in and around the spine. Often symptoms first show up in the sacroiliac joints, causing sacroiliitis, and symptoms may include sciatica.
- The above is not a complete list. It is important to know the underlying clinical diagnosis of the cause of sciatica, as treatments will often differ depending on the cause. For example, specific sciatica exercises, which are almost always a part of a treatment program, will be different depending on the underlying cause of the symptoms.
NONSURGICAL TREATMENT FOR SCIATICA
- Corset: Corset is a good methods for soothe the pain. A lumbosacral corset is suitable for support the abdomen and prevent the vertebra flatten.
- 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 find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.
GENERAL EXERCISES FOR SCIATICA
Sciatica exercises usually focus on three key areas: strengthening, stretching, and aerobic conditioning.
Many exercises can help strengthen the spinal column and the supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttock) and hip muscles.
Strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.
Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.
Hamstring stretching is almost always an important part of a sciatica exercise program. Most people do not stretch these muscles, which extend from the pelvis to the knee in the back of the thigh, in their daily activities.
Another stretch that is often helpful in easing sciatica is the Bird Dog move: After getting on their hands and knees, individuals extend one arm and the opposite leg. The arm and leg extensions are then alternated. A more advanced version of this exercise is the Plank Bird Dog move, in which the extensions are done once the person is in the plank position on their hands and toes.
Low-impact aerobic exercise
Some form of low-impact cardiovascular exercise, such as walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.
Aerobic conditioning also has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.
These types of exercise may be done separately or in combination. Examples of types of exercise that may include both strengthening and stretching include yoga, tai chi, and Pilates.
For anyone in chronic pain or with a relatively high level of sciatica pain, one option for gentle exercise is water therapy, which is a controlled, progressive exercise program done in a warm pool.