Your sciatic nerve begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg. This nerve is your body's longest nerve and one of the most important ones. It has a direct effect on your ability to control and feel your legs. When this nerve is irritated, you'll experience sciatica.
Sciatica is a sensation that can manifest itself as a moderate to severe pain in your back, buttocks, and legs. You may also feel weakness or numbness in these areas. Sciatica is a symptom caused by an underlying injury to your sciatic nerve or an area that impacts the nerve, such as your vertebrae, which are the bones in your neck and back.
Sciatica is most likely to occur to people between the ages of 30 and 50 years old.
Symptoms of Sciatica
Sciatica is a very distinct type of symptom. If you're experiencing pain that flows from your lower back through your buttock area and into your lower limbs, it's typically sciatica.
Sciatica is the result of damage or injury to your sciatic nerve, so other symptoms of nerve damage are usually present with the pain. Other symptoms may include the following:
- You may have pain that gets worse with movement.
- You may have numbness or weakness in your legs or feet, which is usually felt along your sciatic nerve pathway. In severe cases, you may experience a loss of feeling or movement.
- You may feel the sensation of pins and needles, which involves a painful tingling in your toes or feet.
- You may experience incontinence, which is the inability to control your bladder or bowels. This is a rare symptom of cauda equina syndrome, which is described below, and it calls for immediate emergency attention.
What Causes Sciatica?
Sciatica can be caused by a number of conditions that involve your spine and can affect the nerves running along your back. It can also be caused by an injury, for example from falling, or spinal or sciatic nerve tumors.
Common conditions that can cause sciatica are described below.
Your vertebrae, or spinal bones, are separated by pieces of cartilage. Cartilage is filled with a thick, clear material to ensure flexibility and cushioning while you move around. Herniated disks occur when the first layer of the cartilage rips. The substance inside can compress your sciatic nerve, resulting in lower limb pain and numbness.
Spinal stenosis is also called lumbar spinal stenosis. It's characterized by the abnormal narrowing of your lower spinal canal. This narrowing puts pressure on your spinal cord and your sciatic nerve roots.
Spondylolisthesis is one of the associated conditions of degenerative disk disorder. When one spinal bone, or vertebra, extends forward over another, the extended spinal bone can pinch your sciatic nerve.
Piriformis syndrome is a rare neuromuscular disorder, in which your piriformis muscle involuntarily contracts or tightens, causing sciatica. Your piriformis muscle is the muscle that connects the lower portion of your spine to your thighbones. When it tightens, it can put pressure on your sciatic nerve, leading to sciatica. Piriformis syndrome can worsen if you sit for long periods, fall, or experience a car crash.
Risk Factors for Developing Sciatica
Certain behaviors or factors can raise your risk of developing sciatica. The most common factors for developing sciatica include the following
- As your body ages, it becomes more likely that parts will wear out or break down.
- Certain careers place a lot of strain on your back, especially those that involve lifting heavy objects, sitting for extended periods, or twisting movements.
- Having diabetes can increase your risk of nerve damage.
- Smoking can cause the outer layer of your spinal disks to break down.
When to Seek Medical Attention
Seek immediate medical attention if you experience the following symptoms:
- Your pain comes after a severe injury or accident.
- You have sudden, excruciating pain in your lower back or leg that's coupled with numbness or muscle weakness in that same leg.
- You're unable to control your bladder or bowels, which are the symptoms of cauda equina syndrome.
Cauda Equina Syndrome
In rare cases, a herniated disk can press on nerves that cause you to lose control of your bowel or bladder. This condition is known as cauda equina syndrome. It can also cause numbness or tingling in your groin area, decreased sexual sensation, and paralysis if left untreated.
This disorder often develops slowly. It's important to go to your doctor or an emergency room immediately if the symptoms appear.
The symptoms of this disorder can include:
- an inability to control your bladder or bowels, which can result in incontinence or retention of waste
- pain in one or both of your legs
- numbness in one or both of your legs
- weakness in one or both of your legs, making it hard to get up after sitting
- stumbling when you try to get up
- a noticeable progression or sudden severe loss of feeling in your lower body, which includes the area between your legs, buttocks, inner thighs, heels, and entire foot
Sciatica is a symptom that varies from one person to another and depends on the condition that's causing it. To diagnose sciatica, your doctor will first want to get your full medical history. This includes whether or not you have had any recent injuries, where you feel the pain, and how the pain feels. They will want to know what makes it better and what makes it worse and how and when it started.
The next step is a physical exam that will include testing your muscle strength and reflexes. Your doctor might also ask you to do some stretching and moving exercises to determine which activities cause more pain.
The next round of diagnosis is for people who have dealt with sciatica for longer than a month or have a major illness, such as cancer. Nerve tests will allow your doctor to examine how nerve impulses are being conducted by your sciatic nerve and learn if there are any abnormalities. Imaging tests will allow your doctor to get a look at your spine, which will help them determine the cause of your sciatica.
The most common imaging tests used to diagnose sciatica and find its cause are spinal X-rays, MRI, and CT scans. Normal X-rays will not be able to provide a view of sciatic nerve damage. An MRI uses magnets and radio waves to create detailed images of your back. A CT scan uses radiation to create detailed images of your body. Your doctor will more than likely conduct a CT myelogram in which they inject a special dye into your spine to help produce clearer pictures of your spinal cord and nerves.
Treatment Options for Sciatica
Upon first diagnosis of sciatica, your doctor will likely give you tips for treating your sciatica pain. You should continue your daily activities as much as possible. Lying in bed or avoiding activity can worsen your condition.
Some commonly suggested at-home treatments are described below.
You can purchase ice packs or even use a package of frozen vegetables. Wrap the ice pack or frozen vegetables in a towel and apply it to the affected area for 20 minutes per day, several times per day, during the first few days of pain. This will help to reduce swelling and ease pain.
You can also purchase hot packs or a heating pad. It's recommended that you use ice during the first couple of days to reduce swelling. After two or three days, switch to heat. If you continue to have pain, try alternating between ice and heat therapy.
Gently stretching your lower back can also be helpful. To learn how to stretch properly, get personal, one-on-one physical therapy or even yoga instruction from a physical therapist or instructor trained to deal with your injury.
Over-the-counter medications, such as aspirin and ibuprofen, can also help with pain, inflammation, and swelling. Be careful about using aspirin excessively, since it can cause complications, such as stomach bleeding and ulcers.
The more you stay active, the more endorphins your body releases. Endorphins are painkillers made by your body. Stick to low-impact activities at first, such as swimming and stationary bicycling. As your pain decreases and your endurance improves, create an exercise regimen that includes aerobics, core stability, and strength training. A regimen with these components can decrease your risk of future back problems.
If at-home treatments fail to treat your pain effectively, your doctor might suggest that you take further measures.
Exercises in physical therapy can help to improve your posture and strengthen your back muscles.
Your doctor might prescribe muscle relaxers, narcotic pain relief, or antidepressants. Antidepressants can increase your body's endorphin production.
Epidural Steroid Medication
Corticosteroid medications are injected into an area called the epidural space, which is the canal that surrounds your spinal cord. Because of side effects, these injections are given on a limited basis.
Surgery may be needed for severe pain or situations in which you have lost control of your bowel and bladder or have developed weakness in certain muscle groups of the lower extremity. The two most common types of surgery are discectomy, in which part of the disk that's pressing on your sciatic nerve is removed, and microdiscectomy, in which the disk removal is done through a small cut while your doctor uses a microscope.
Alternative medicine is growing in popularity. There are a number of alternative remedies for sciatica. These include the following:
- An acupuncturist can insert sterilized needles at key points to affect the flow of energy in your body. This procedure is virtually painless.
- A chiropractor can manipulate your spine to achieve maximum spinal mobility.
- A trained professional can induce hypnosis, which is intended to put you in a very relaxed, focused state of mind, allowing you to best receive healthy suggestions and instructions. In the case of sciatic pain, the messages might involve pain relief.
- A massage therapist can apply motion, pressure, tension, or vibration to your body to relieve pressure and pain.
How to Prevent Sciatica
The following steps can help you prevent sciatica or keep it from occurring again:
- Exercise often. Strengthening your back muscles and your stomach or core muscles is the key to maintaining a healthy back.
- Mind your posture. Make sure your chairs offer proper support for your back, place your feet on the floor while sitting, and use your armrests.
- Mind how you move. Lift heavy objects in the proper way, by bending at your knees and keeping your back straight.