Sciatica - Causes, Symptoms, Treatments & More InformationDocument Transcript
Sciatica - Causes, Symptoms, Treatments & More InformationSciatica is a term that refers to the symptoms of an underlying problem along the sciatic nerve in thelower back, buttock, or leg. Originating in the spinal cord in the lower back, the sciatic nerve is thelongest nerve in the body stretching all the way to the feet. This nerve controls many of the musclesbehind the knee and lower leg, and provides feeling to the thigh, leg, and foot. If the sciatic nervebecomes become compressed, radiating pain can manifest in the lower body. Although sciatica can bevery uncomfortable, for the vast majority of people, symptoms improve within a few weeks of followingself-care measures.Causes of SciaticaSciatica is typically not associated with one specific injury or event. Instead, the pain tends to developover time due to the constant wear and tear on the lower spine, occurring most often among peoplebetween the ages of 30 and 50.A common cause of sciatic nerve pain is degenerative disc disease. Including bulging, slipped, ruptured,or protruding discs, this condition occurs when one of the body’s intervertebral discs breaks open,allowing the gel-like material at the center of the disc to spill into the spinal canal. This generally occursbecause spinal discs, which act as shock absorbers, wear down over time, or degenerate as part of thenatural aging process. If the soft inner core (nucleus pulposus) of a disc leaks out through its outer core(annulus fibrosus), it may press on the sciatic nerve root causing pain, weakness, and numbness in theaffected extremities.Another cause of sciatica is spinal stenosis, the narrowing of one or more areas in the spine includingthe lower back. This narrowing can put pressure on the spinal cord or its nerve roots and over time weardown cartilage cushioning the spine. Depending on which area is compressed, spinal stenosis can causeradiating pain from the neck, arms, shoulders, back, hips, legs, and feet. It can also cause a tingling orburning sensation in the lower back and leg, as well as numbness or weakness.Other causes of sciatica can include:• Piriformis syndrome• Sacroiliac joint dysfunction• Pelvic fracture• Spinal tumor• Sciatic nerve tumor• Infection in the lower backSciatica SymptomsSciatica symptoms can manifest differently from person to person, depending on the underlying causeand where the pressure on the nerve occurs. However, the most common symptom among those with
sciatica is radiating pain that varies from a mild ache to a sharp sensation. The pain can also sometimesfeel like a jolt or an electric shock. It may worsen upon coughing, sneezing, or even laughing.Typically sciatica affects only one side of the lower body, but it can present on both sides. Othersymptoms can include numbness, burning or tingling, pain in the buttocks or legs that worsens withprolonged sitting or standing, shooting pain which makes it difficult to stand up, and weakness in thelegs and knees. Mild sciatica symptoms can sometimes lessen in severity over a short period of time.Diagnosis Methods In some instances, pain associated with sciatica does not improve within a few weeks of self-care,requiring a consultation with a doctor or spine specialist. Typically a consultation will involve a thoroughmedical history and a physical examination, which may include neuromuscular tests. The doctor mayorder one or more imaging tests to determine the location, cause, and extent of the patient’s sciaticnerve compression, and to rule out certain factors that may be causing the sciatica symptoms. Imagingtest options include X-rays, MRIs, and CT scans. Once the cause of pain is determined, the doctor mayprescribe various treatments to reduce the discomfort of sciatica.Non-Surgical Treatment and Alternative TherapiesFor most people, mild or acute sciatica symptoms generally respond to non-surgical treatments such asheat and/or ice packs, the use of over-the-counter medicine like ibuprofen, aspirin, or acetaminophen,and physical therapy exercises to stretch and strengthen the muscles in the lower back, legs, and feet.The main goal of these treatments is to relieve the existing pain and prevent future occurrences of pain.There are also a number of alternative treatments which can provide sciatica relief, either in addition toor separate from non-surgical therapy. Some of the most popular alternative care methods includemassage therapy, chiropractic manipulation, and acupuncture.Certain forms of massage therapy can be beneficial to patients suffering from back or leg pain because itincreases blood circulation and relaxes tight muscles. Massage therapies for sciatica may include deeptissue and cranial sacral therapy. Deep tissue massage involves applying direct pressure to various partsof the body to release tension in the ligaments, tendons, and muscles, whereas cranial sacral therapyoffers a gentle manipulation of the soft tissue and bones of the head, spine and pelvis.Chiropractic manipulation is similar to massage in that it alleviates pain through touch. It also utilizesgentle manual pressure to adjust and align the spinal column.An ancient practice that originated in China, acupuncture involves inserting thin needles into strategicparts of the body, known as trigger points, which then release natural painkillers called endorphins andopioids.Surgical Options
There may be cases where some patients do not respond to non-surgical and/or alternative therapytreatments and a more targeted treatment like surgery may be recommended. Sciatica surgery istypically used as a last resort for patients who suffer sciatica symptoms for weeks or months with noimprovement or whose leg pain is severe enough to limit daily activities. Patients diagnosed with sciaticaneed to carefully weigh the risks and benefits of sciatica surgery before electing to undergo anoperation.Depending on the cause and duration of a patient’s sciatica, one of two types of surgery may beperformed. The first is microdiscectomy, a procedure performed through a small incision in the lowerback used to treat a degenerated disc that is causing compression of the sciatic nerve. The portion of theruptured disc pinching the sciatic nerve or its roots is removed, along with any bone fragments. Amicrodiscectomy is recommended for those patients who have suffered leg pain for at least six weeksand experience weakness in the legs or feet, or numbness in the extremities.The second type of sciatica surgery is called lumbar laminectomy, or open decompression. The goal ofthis surgical procedure is to alleviate lower back or leg pain associated with spinal stenosis or herniateddiscs. During a lumbar laminectomy, a surgeon removes the lamina, a bony plate on each of the spine’svertebra, to create more space for the nerves. Bone spurs and disc fragments may also be removed,thus relieving pressure on the spinal nerves.Following a lumbar laminectomy or microdiscectomy, patients are prescribed outpatient physicaltherapy. Initial treatments aim to aid in controlling post-operative pain and inflammation. Subsequentphysical activities are then added to tone muscles and strengthen the lower back and legs.In addition to these two surgeries, there are minimally invasive, outpatient endoscopic techniquesavailable to those suffering from sciatica that offer an alternative to invasive open spine surgeryincluding percutaneous endoscopic discectomy and endoscopic foraminotomy. Each procedure involvesthe use of a laser to shrink and remove the affected disc and remove any excess bone material. Consultwith a doctor for more information on all of the options available for the treatment of sciatica.