Sciatica is a nerve related condition which is characterised by radiating pain typically felt from the lower back to behind the thigh that radiates below your knee (sometime even in your toes). This results from irritation, inflammation, pinching or compression on the sciatic nerve. While it can cause discomfort and inconvenience, it’s important to understand that it’s often treatable.
What is Sciatica?
Sciatic nerve is considered to be the longest and thickest nerve in our body. As per some research it is almost 2 cm wide. It is actually a bundle of nerves and not just one nerve coming out from the spinal cord on both sides of your body. Sciatica can occur suddenly or even develop gradually.
Types of Sciatica-
There are two types of sciatica, but the symptoms remain the same in both the types. Doctors mention both these types as sciatica, but treatment varies according to its type. Here are the two kinds of sciatica:
- True Sciatica- This occurs when the condition or injury is directly linked to the sciatic nerve.
- Sciatica-like condition- This happens when the condition or injury is not directly linked to sciatic nerve or to the bundle of nerves that bundle together to form sciatic nerve, in spite of this these conditions still feel like sciatica.
What are the Symptoms of Sciatica?
Common symptoms of Sciatica are-
- Radiating pain
- Numbness and tingling sensation in leg or foot.
- Difficulty in walking or sitting/standing.
- Weakness in the leg or foot.
- Worsening pain due to long periods of sitting or standing.
What are the main Causes of Sciatica?
Sciatica can occur because of various reasons. Let’s divide these issues into two parts-
Spinal
- Herniated Disc: This occurs when the soft, jelly-like material present in the centre of the spinal disc comes out from the outer layer. This can cause compression of the sciatic nerve.
- Spinal Stenosis: This occurs when the spinal canal narrows, putting the pressure on the sciatic nerve.
- Spondylosis: Over time, the discs in the spine can degenerate and become less effective at absorbing stress, which can pressure the sciatic nerve.
- Spinal Tumour: In some rare cases sciatica can occur because of this.
Muscular-
- Piriformis Syndrome: This occurs when the piriformis muscle located in our buttock becomes tight or inflamed and thus can compress the sciatic nerve as it goes through the piriformis muscles.
- Deep Gluteal Syndrome: A recent study found that piriformis is not the only cause of sciatica. The obturator internus, levator ani, Gemelli, and coccygeus muscles can also entrap the sciatic nerve and thus cause sciatica.
What are the Risk Factors of Sciatica?
There are many risk factors of sciatica. Some of the risk factors associated with sciatica are mentioned below:
- Ageing: Ageing can lead to gradual wear and tear on your spine and can cause pinched nerves. Age related conditions like osteoarthritis can also lead to sciatica.
- Being obese: This can also stress the spine.
- Pregnancy: Loose ligament (because of relaxin hormone released in the body when you’re pregnant) and shift in the centre of gravity because of the growing uterus can pinch the sciatic nerve.
- Diabetes: Type 2 diabetes can cause peripheral neuropathy and this can damage your nerve endings, leading to sciatica.
- Desk jobs: Prolonged sitting jobs without back support can cause lower back problems and sciatica.
- Insufficient core strength: Having weak core muscles can also cause lower back pain and can lead to sciatica.
- Bad posture is another cause of back pain, as it puts extra pressure on the back muscles, which can lead to sciatica.
- Using tobacco products: As nicotine can affect blood circulation in our body, it can lead to the risk of chronic pain including sciatica.
- Selective Activities: Jobs which require heavy weight lifting, twisting movements of the back, and driving for a long period of time.
What are the complications of Sciatica?
Complications due to sciatica are rare. In severe cases, it can lead to-.
- Permanent nerve damage leading to “foot drop”
- Loss of sensation in the affected leg
- Weakness in the affected leg
- Loss of bowel or bladder function.
How to Diagnose Sciatica?
A healthcare professional goes through a series of tests to evaluate sciatica.
- Medical history: The healthcare provider will ask you some basic questions about your lifestyle and current job, such as when you are facing this issue.
- Walking style- If someone is suffering sciatica then it is quite common that their gait pattern is going to be disrupted. Your healthcare provider will evaluate those changes.
- Straight leg raise test (SLR)- Here, your healthcare provider will ask you to lie down straight and then raise your leg straight towards the ceiling between 30 to 70 degrees (one at a time). Then, he will ask you if you are facing any pain or any other discomfort. This can help him to diagnose the root cause of sciatica.
- Slump test- In this the healthcare provider will ask you to sit upright with hands behind the back. Now bend forward with your chin touching your chest and one knee is extended till the degree possible. Any discomfort and pain will result in a positive slump test.
- Other flexibility and strength checks exercises.
- Clinical evaluation: Tests like Spine X-ray, CT scans and MRI scans, Nerve conduction velocity studies, or Electromyography.
What is the Treatment of Sciatica?
Treatment of sciatica depends on the cause and the severity of the symptoms.
Conservative treatment-
Many cases of sciatica can be cured with the help of conservative treatment. This may include:
- Resting: Avoid the activities that aggravate the pain. This can help the sciatic nerve to heal.
- Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) Like ibuprofen can help in reduction of pain and inflammation.
- Hot or cold therapy: Applying heat or cold to the affected area can help reduce pain.
- Physical Therapy: Physiotherapy is often prescribed for sciatica. Physiotherapist will teach you exercises according to your root cause and severity. This will include some stretching exercises for lower lumbar area and hamstrings, core strengthening exercises, and other regular exercises like walking or swimming.
- Massage: Massage therapy is included to relax the muscles and reduce tension.
Invasive Method-
If conservative methods fail to provide relief, then invasive techniques may be considered. Some of them are:
- Corticosteroid injections: To reduce inflammation and pain, corticosteroids are injected into the areas around the sciatic nerve.
- Epidural steroid injections: These injections are similar to corticosteroid injections but they are injected into the epidural space.
- Surgery: In severe cases surgery is the best option. Surgical procedures like Discectomy, Laminectomy are usually opted for.
How to Prevent Sciatica?
While it may not always be possible to prevent sciatica, certain lifestyle changes can reduce the risk. Some of them are:
- Maintain a healthy weight
- Stay active and do regular exercises
- Maintain a good posture
- Quit or don’t use tobacco products
- Ergonomic workspace.
Conclusion
Sciatica is a painful condition. It can disrupt daily life, but it can be managed. With the right care, there’s a chance for healing. Early diagnosis & treatment matter. They help prevent long-lasting issues. Many patients find relief from sciatica. This often happens with conservative methods. By being proactive, you can lower the chances of sciatica affecting your life. It's important to maintain a healthy weight. Exercise often & practise good posture. These simple actions help protect your back.
In summary, sciatica is manageable. With the right approach, you can regain comfort & mobility. This attention to care can lead to an improved quality of life.
Frequently Asked Questions (FAQs)
Q1- How long does it take to treat sciatica?
Answer: It usually depends on the root cause and the severity of the symptoms. In some cases it takes 5-6 weeks to treat it properly. In other cases, it can take several months or even more time.
Q2- What are the basic exercises to treat sciatica?
Answer: Basic exercises to treat sciatica are-
- Hamstring Stretches: Like lying hamstring stretch and seated hamstring stretch.
- Hip Flexor Stretches: Like lunge stretch and quadriceps stretch.
- Piriformis Stretch
- Back Stretches: Like Bridges and bird-dog stretches.
Core Strengthening Exercises: Like planks, crutches, etc.
