What is sciatica?
Sciatica is the term used to describe pain that occurs along the course of the sciatic nerve. The sciatic nerve is the largest nerve in the body, and it travels from the lower back, through the hips and buttocks, to your legs on either side. Any damage to the sciatic nerve causes pain that originates in the lower back and radiates to the legs.
What causes sciatica?
Sciatica need not always be caused by injury to the sciatic nerve. It can also be due to any pinching or compression of the nerve along its course. Some of the leading causes of sciatica include:
- Herniated or slipped disc – It’s the most common cause. Intervertebral discs are soft, gel-like structures between your vertebrae that act like cushions. Pressure from the vertebrae can sometimes cause the disc to bulge out through a weak spot and into the outer wall. If this occurs in the lower back, it leads to compression of the sciatic nerve, resulting in sciatica
- Degenerative disc disease – Long-standing degenerative changes can lead to a slipped disc
- Spinal stenosis – Narrowing of the spinal canal reduces the space for the spinal cord and nerves
- Spondylolisthesis – The vertebrae are situated one over the other, and slippage of a vertebra out of this alignment can result in compression of nerves
Spasm (tightening) or inflammation of lumbar or pelvic muscles - Piriformis syndrome – Piriformis muscle is a small muscle that is located deep in the buttocks. When this undergoes spasm, it can irritate the sciatic nerve
- Sacroiliac joint dysfunction – Dysfunction of this joint in the hip causes inflammation and pain
What are the risk factors for sciatica?
- Injury or trauma to the spine
- Being overweight
- Pregnancy
- Lifting heavy weights
- Weakness of the core muscles
- Bad posture
- Diabetes
- Osteoarthritis
- Inactive lifestyle
- Smoking
- Older age
- Occupations that require you to carry heavy weight
- Prolonged sitting
What are the symptoms of sciatica?
- Moderate to severe pain that starts in the lower back and radiates along the buttocks and down your leg
- Worsening of pain with movement
- Pins and needles sensation on legs, feet, and toes
- Numbness or weakness along the lower back, buttocks, or legs
- Loss of bowel or bladder control
When should I consult a doctor?
You must consult a doctor immediately in the following scenarios:
- Sudden, severe pain
- Pain occurred after a violent injury
- Pain that is persistent for longer than a week
- Pain along with a loss of bladder and bowel function
How is sciatica diagnosed?
After enquiring about your symptoms, your doctor performs a physical examination. You will be asked to walk normally on your toes and on your heels. You’ll be made to lie on your back and lift your legs as much as possible. You may also be asked to stretch your muscles to look for spasms or weakness.
You’ll be advised to undergo:
- X-ray: Spinal X-rays to look for fractures and wear
- MRI or CT scans to detect the exact location of the compression
- Nerve conduction testing
- Myelogram to assess the relationship between your vertebrae and the disc
What is the treatment for sciatica?
- Self-care
– Hot pack or ice pack – Fill a hot water bag with hot water and apply it to the affected area for about 20 minutes. You can also alternate between a hot pack and an ice pack by applying each for 10 minutes Painkillers (Ibuprofen, naproxen, paracetamol, etc.)
– Mild stretches to strengthen muscles - Medicines (muscle relaxants, opioid painkillers, vitamin supplements to strengthen your nerves, etc.)
- Physiotherapy – for strengthening your back muscles
- Injection of a local anaesthetic or steroid into your lower back
- Surgery – Surgery is considered when all other non-surgical treatments fail and in case of tumours, cauda equina syndrome, or severe infections. The most commonly performed procedures include microdiscectomy (a small part of the intervertebral disc is removed to relieve pressure), laminectomy (a part of the lamina is removed), and foraminotomy (the foramen is enlarged)
- Alternative therapies – Ayurvedic massage, acupuncture, biofeedback, etc
What are the complications of sciatica?
- Numbness of the legs, feet, and, toes
- Weakness of the leg muscles
- Loss of bladder and bowel control
How do I prevent sciatica?
- Maintain a good posture while sitting
- Strengthen core muscles through exercise
- Avoid lifting heavy objects by yourself
