Sciatica or radiculopathy is a common painful condition affecting men and women in their 40s and beyond. The disorder affects over 4 percent of Americans at any given time and is considered the most important cause of back pain. While those in their late 50s and early 60s are more susceptible to sciaticait can occur in individuals as young as 20.
What is sciatica?
Sciatica indicates pain and other symptoms associated with injury, irritation, pinching, or compression of the sciatic nerve. A type of neuropathy, sciatica cannot be called a disease. At best, it is an umbrella term used to denote a range of symptoms linked to irritation of the sciatic nerve.
The sciatic nerve is the primary means of sensation to thigh, hip, buttock, leg and foot. When it becomes subject to irritation, inflammation, injury or root compression, it cannot function properly. Pain starts in one or more of “five spinal nerve roots of each sciatic nerve” and radiates to the back, thigh and leg.
How does sciatica set in?
The sciatic nerve is positioned on the back of the thigh and runs from the lower back to the leg. Any bone protrusion, injury, tumor or disc herniation results in the compression of the nerve roots. Similarly, infection, muscle spasm, spasticity and excessive stress may cause inflammation of the nerve. The sciatic nerve becomes irritated and patients experience sciatica symptoms, including pain.
What are symptoms of sciatica?
The sciatic nerve branches into different spinal nerves and provides motor and sensory information to various parts of skin and muscles. Symptoms and patterns of pain vary based on which spinal nerve root is affected. The most common symptoms may include,
- sharp, jolting pain that starts in the lower back, hip and thigh and gradually spreads to buttocks and leg
- leg cramps
- burning pain along the pathway of the sciatic nerve
- numbness, muscle weakness and loss of reflexes
- pain in one or both buttocks
- pain extends from the back of the thigh to the foot and worsens with sitting or squatting
- pain intensity increases with stress/ pressure
What are the causes of sciatica?
Sciatica is caused when the sciatic nerve is squeezed, irritated or inflamed because of
- traumatic injury to the sciatic nerveherniated lumbar spine discs
- stress or pressure on the lumbar spine
- bone or muscle protrusion and pressure
- injury or degeneration affecting spinal discs linked to the sciatic nerve
- arthritis impacting lumbar spine discs
- stenosis in the lower spine
- muscle or tissue damage around the sciatic nerve due to lack of adequate blood supply
Who are at increased risk of sciatica?
Arthritis, obesity, diabetes and neuropathic disorders increase the risk of sciatica. Pregnancy, sedentary lifestyle, heavy manual labor, spinal infection, smoking and recurrent stress on the sciatic nerve also add to the risk.
When to see a doctor?
Consult a doctor if you have persistent pain in the buttocks and thigh. Frequent cramps in the leg and pain while sitting are other indications of early sciatic nerve injury.
How is sciatica or lumbar radiculopathy diagnosed?
- Comprehensive physical examination
- X-ray to rule out other conditions
- EMG and nerve conduction studies to determine if nerve damage is present, and if so, to what extentMRI or CT scans
What are complications?
Prolonged sciatica may lead to worsening pain and disability impacting thighs and legs. Muscles become weak and reflexes may be diminished.. In severe cases patients with sciatica may develop paraplegia. What are the treatment methods available for sciatica or lumbar radiculopathy?
- Conservative Treatment: Adequate rest, ice therapy, back massage, lifestyle changes and avoiding stressful activities may relieve early sciatica pain. Most patients require a specific type of Physical Therapy known as McKenzie Therapy (www.mckenziemdt.org).
- Medication: Patients are prescribed NSAIDs or analgesic drugs to relieve pain, treat swelling and control inflammation.
- Pain Management Injections
- Epidural steroid injection: Injecting steroid into the epidural space results in 80 to 90 percent sciatica pain relief.
- Spinal cord stimulator: It emits electrical impulses that stun irritated nerves and obstructs transmission of pain signals to the spine.
- Surgery: Laminotomy and discectomy help decompress the squeezed sciatic nerve roots by removing a layer of the bulging disc.
References
Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. 2007;334:1313-7.
Tarulli AW & Raynor EM (2007). Lumbosacral radiculopathy. Neurol Clin, 25(2):387-405.
Bronfort G, Evans RL, et al. Spinal manipulation, epidural injections, and self-care for sciatica: a pilot study for a randomized clinical trial. J Manipulative Physiol Ther. 2004 Oct;27(8):503-8.
Valat JP, Genevay S, et al. Sciatica. Best Pract Res Clin Rheumatol. 2010 Apr;24(2):241-52.
