Sciatica is one of the most common types of back pain, affecting approximately 40% of people in their lifetime. Sciatica causes lower back pain due to an issue with the sciatic nerve. This nerve is the longest one in your body, spanning from the lower lumbar spine, to down the back of each leg. Injury, or pressure on this nerve can cause pain in the lower back that can spread through your legs, hips, and buttocks.
Symptoms of Sciatica
The hallmark indicator of sciatica is a pain that emanates from the lumbar (lower) region of your spine and down the back of your legs. Pain can occur nearly anywhere along the nerve; However, It’s more common for the pain to flow from your lower back to the buttocks than back of the thigh and calf.
Sciatica can affect both sides of your body, but usually it only affects one. This condition can be chronic, or acute. An episode can last from one to three weeks and usually goes away on its own after a few weeks. Most people feel pain at the beginning, and then numbness or tingling during the tail-end of the episode.
Signs & symptoms of sciatica may include:
- Weakness or numbness
- Difficulty walking, or moving legs/feet
- Hip pain
- A shooting pain that makes it difficult to stand
- Lower back pain
- Chronic pain on one side of the body
- Worsens after coughing or snee zing
- Pain in certain parts of the leg, and numbness in other parts.
- Muscle weakness
- Feeling of pain may vary
- Burning or tingling
- Mild to sharp aching
- Excruciating pain
- Jolting or electric shock
Common Causes of Sciatica?
Several spinal conditions can affect the nerves running down your back. There are many possible causes for Sciatica, ranging from high falls, and trauma from physical sports, to spinal and nerve tumours. You can find the many common causes of sciatica described down below.
A lumbar herniated disc (LHD) is one of the most common causes for sciatica. This is because your lumbar (lower) spine carries a relatively large amount of weight, making your spinal discs vulnerable to injury. Your spinal bones, also known as vertebrae, are separated by clear flexible material called cartilage. This material allows you to be flexible, while cushioning your vertebrae at the same time.
LHD occurs when a layer of cartilage tears in your lumbar region. This same substance can spill out and compress your sciatic nerve, leading to pain and numbness in your legs. Study from the Institute for Quality and Efficiency in Health Care estimates that up to 5 percent of all people will have back pain because of a herniated disk.
Spinal stenosis narrows the foramina, which is a passageway through the bones for your nerves to exit the spine. This narrowing is caused by a condition called osteoarthritis. This condition is not always problematic.
When spinal stenosis occurs in the lumbar region, the narrowing pressures your sciatic nerve roots. Spinal stenosis can be diagnosed with an X-ray. Sciatica resulting from spinal stenosis can be diagnosed using simple physical tests, such as the straight leg raise or slump test. For example, for a physical exam, a medical professional raising one leg while lying down will usually cause pain on the side of your body affected by sciatica.
Spondylolisthesis disease causes one of your lower vertebrae to slide forward on the bone beneath it. When a vertebra extends over another, the extended bones can pinch the sciatic nerves. This can be a fairly painful condition, yet highly treatable. The disease is treated with physical therapy or surgical procedures. Patients may be given exercise techniques to help prevent the condition as well.
Piriformis muscles connect the lower part of your spine to your thighbones. These muscles are essential for hip rotation, and turning your legs and feet outward. Piriformis syndrome causes these muscles to frequently contract involuntarily. Sometimes these muscles can apply pressure on your sciatic nerve, causing sciatica.
Who Is At Risk For Developing Sciatica?
There are many factors that can raise your risk of developing sciatica.
The most common factors for developing sciatica include:
- Old age. As you age, your spine is more vulnerable to bone spurs and herniated disks, common causes for sciatica.
- Occupations that place strain on your back. Certain occupations such as general labour include many back straining tasks: heavy lifting, sitting for extended periods of time, and constant rotation of the spine.
- Obesity increases strain on your spine. Excess body weight can lead to spinal conditions that may possibly jumpstart your sciatica.
- Diabetes. High blood sugar weakens blood vessels that supply your nerves with oxygen and essential nutrients.
- Smoking. Cigarette consumption causes premature aging, and can break down the outer layer of your spinal disks.
- Middle aged men. Males experience sciatica at about three times the rate of women, this is partially due to men being taller on average.
How Is Sciatica Diagnosed?
Sciatica can be diagnosed through basic physical movement tests by your doctor. In some cases an imaging test may be done, such as an X-Ray.
Physical Movement Tests
A doctor may check for these signs during your physical examination:
- Pain when moving the lower back, buttocks thigh, and leg.
- Pain response to stretching the nerve — extending your leg.
- Response to physical touch (i.e. lightly pressing calves or thighs).
There are specific clinical examinations that the doctor may use to check the severity of your sciatic nerve pain.
Examples of clinical tests for sciatic nerve pain include:
- Slump test: For this test you will be seated upright with both hands clasped behind your back. You will then slouch forward at the hips. Your neck will be bent down with your chin tucked, while one knee is extended as far out as possible. Pain in this position may be a possible sign of sciatica.
- Straight leg raise(SLR) test: The SLR test begins with you lying on your back, one leg bent, while lifting the other leg — alternating between legs. Experiencing pain while lifting the affected leg(s) may be a possible indication of sciatica.
Physical movement tests are performed to check if your sciatic nerve is mechanically compressed(i.e. Herniated disc). Non-mechanical causes such as a chemical irritant or inflammation will most likely not draw a positive conclusion from the physical tests.
A medical history check from your doctor may include:
- Onset of pain
- Muscle spasms
- Decrease in leg or lower back strength
- The type, feeling, and duration of the pain
- Previous trauma or injury in the lower back, buttocks, thigh and calf area
If your doctor suspects that you may have sciatica, there are a variety of ways they could go about treating it. Some doctors may run a diagnostic nerve block, or medical imaging (e.g. MRI) test. These tests are helpful for determining the cause of your sciatica, and planning surgical treatments.
Imaging (Radiology) Tests
If you have a herniated disk or bone spur, it may show up on imaging tests, without showing any specific physical symptoms. Many doctors refrain from doing these tests unless your sciatica condition shows no signs of improvement after a few weeks, or if the pain is severe.
- Computerized tomography (CT): You may have a CT myelogram procedure performed to image the spine. A contrasting dye would be injected into the spinal canal before an X-ray is taken. Then, the dye circulates around your nerves and spinal cord, making them show up as white on the scanned image.
- Electromyography (EMG): This tests electrical impulses produced by your nerves and muscle responses. The EMG tests can confirm if your nerves are compressed due to herniated disks or a narrowing spinal canal (spinal stenosis).
- Magnetic resonance imaging (MRI): This procedure produces radio waves using a strong magnetic field to produce images of your organs, bones, and tissues in your back.
- X-ray: An X-ray machine can point out the possible overgrowth of any bones (bone spurs) in your spine that could be pressing on your sciatic nerve.
How Do I Prevent Sciatica?
You can’t fully prevent sciatica from developing, and the condition can be recurring as well. However, there are physical precautions that can improve and maintain the health of your back.
- Keep a proper seating posture. An ergonomic workspace can help keep your back strong. An optimal seat will have solid lumbar support, be on a swivel, and have armrests. Also, try to keep your knees in line with your hips when seated.
- Use healthy body mechanics. Avoid standing for long periods of time. If that’s not possible, occasionally rest a foot on a stool or box to ease pressure on your spinal cord. When lifting a heavy object, lift with your legs, and life vertically. Hold the object close to your center of gravity. Avoid awkward postures and movements, such as lifting and rotating at the same time. If an object is heavy, or difficult to carry, use proper equipment or find a partner to help.
- Keep your back strong. Exercising to strengthen your lower back and abdomen are beneficial for maintaining a proper posture, and spine alignment. Ask your healthcare provider for specific exercises that can benefit you.
Stretches and Exercises To Help Prevent Sciatica
Daily exercises can strengthen your core muscles and help reduce your chances of recurring sciatica episodes. Here are some exercises you can do if given approval by your healthcare provider.
- Lay down on your back, with both knees bent at a 90° angle. Pull your right knee towards your chest, then hold the position for 10 seconds, then repeat the exercise. Do this for 5 repetitions on each knee.
- This exercise is called a back extension. Lie on your front while proning. Rest your forearms on your side with your elbows bent. While keeping your neck straight, arch your back by pushing down on your hands.You should feel a tightening in your core muscles. While arching your back, inhale then hold the position for 5-10 seconds before resetting. Do this for 8 repetitions.
- Lay down with your hands clasped behind your head, with your arms stretched out by your side. Push your lower back towards the floor, and hold for 5-10 seconds. Do this for up to 10 repetitions.
1.) Standing Hamstring Stretch
Targeted area: The hamstrings are targeted during this stretch; Furthermore, these muscles sit at the back of your leg.
Beginning position: Stand upright, with one leg resting on a stable platform, for instance, a step. Straighten your legs and keep pointing your toes towards the ceiling.
Movement: Lean forward with a straight back. Hold this position for up to 30 seconds, while breathing deeply. Do this for up to 3 repetitions for each leg.
2.) Cobra or Modified Cobra
Targeted area: This stretch targets your abdominal and hip flexor muscles.
Beginning position: Lay face down with a fully extended body, and legs straight. Hands should be slightly wider than shoulder width apart, and raised to chest level.
Movement: Keep your elbows bent while lightly pushing against the floor, in order to raise your head and torso simultaneously. Then, hold this stretch for 10-30 seconds.
3.) Sciatic Mobilising Stretch
Targeted area: This stretch is to help mobilise your sciatic nerve, and improve the flexibility of your lower back.
Beginning position: Lay down with your back on the floor. Place a small flat cushion such as a book under your head. Keep your chin gently tucked, and relax your upper body.
Movement: Pull your knee up to your chest by grabbing your upper legs, then slowly straighten your leg, and point it upwards. This position should be held for 20-30 seconds for each leg.
Treatments for Sciatica
Sciatica usually resolves itself on its own after a few weeks. Self-care measures are usually sufficient enough to manage this condition for many people.
Self-Care Measures for Sciatica
- Heat and ice therapy. Alternating between a heat pad and an ice pack can provide relief and reduce inflammation for Sciatica. The heat speeds up the healing process by increasing blood flow to the affected area; Ice reduces the inflammation. Apply ice for 10-15 minutes every hour, apply the heat pad for the same amount of time, but for every 3 hours.
- Don’t stop moving. It’s okay to relax for a few days after a flare up. However, an extended break can actually make things worse. Moving around helps manage the pain from your sciatica in many ways: strengthens muscles — helps stabilize your spine, improves circulation, speeds up the healing process, which makes the pain more tolerable.
- Anti-inflammatory drugs. You can get these over the counter (OTC) NSAIDS such as ibuprofen and advil. Because NSAIDS relieve pain and reduce inflammation they are more effective than other Acetaminophen and Tylenol pain medications which only relieve pain.
- Wear a hip brace. Braces supporting your lower back can help support the tissues in your lumbar region. They restrict excessive movements of your spine, helping to prevent worsening pain from your sciatic nerve.
- Acupuncture. A form of alternative medicine that uses thin needles to be inserted into specific points on your skin called acupuncture points. Acupuncture is theorized to actually stimulate your nervous system; Therefore, it would cause your body to release feel-good chemicals called endorphins, which block pain pathways in your brain.
- Inversion therapy table. The purpose of inversion therapy is to battle gravity, the force that pulls everything down towards earth’s center. Inversion table therapy is able to decompress the spine, by naturally turning the force of gravity upside down. When standing regularly, gravity pulls your spine downwards, which compresses your discs, vertebrae and nerves. This is particularly why humans seem to ‘shrink’ as we age. Inversion therapy uses gravity to temporarily relieve the compression of your spine, lengthen it, and reduce pressure on your back.
If your pain does not improve after using these self-care treatments, your health care provider may proceed with some of these treatments below.
Medication prescribed to sciatica patients may include:
- Muscle relaxers
- Prescribed pain relievers for severe pain
Once your pain improves, physical therapy is often the first-line treatment for rehabilitating your back and preventing recurring flare ups. Physical therapy includes correcting your posture, improving flexibility, and strengthening core muscles to support your spine.
In certain cases your doctor may recommend a steroid injection near the root of the nerve. Steroids can help reduce your pain by managing inflammation around the nerve. The effects of this treatment usually lasts for a few months. Because Steroid injections pose serious risks when done too frequently, they aren’t prescribed that often.
Surgeons are able to remove the bone spur, or the part of your herniated disk that is pinching the sciatic nerve. Surgery is an uncommon route for people being treated for sciatica. Your doctor may suggest surgery when the nerve damage is causing severe issues: bladder or bowel control issues, pain worses and doesn’t improve with other treatments, significant muscle weakness.
When to See a Doctor
Sciatica with mild pain can usually be controlled through self-care strategies, and the help of a physical therapist. You should seek care from a medical provider if pain lasts more than a few weeks, and you find the pain difficult to manage.
Although, if signs of sciatica are associated with an injury or physical trauma, you should seek care immediately. You should also seek immediate care if the sciatic nerve is inflamed and damaged to the point where parts of your body aren’t working.
Signs it May be Something Other Than Sciatica
Losing control of your bowels, not being able to urinate, and numbness in the perineum area (area between the anus and scrotum/vulva) are signs of cauda equina syndrome. This syndrome causes inflammation of the nerves at the end of your spinal cord, and you should seek emergency care to prevent permanent injuries.
Weakness of muscles, foot drop (inability to lower the front part of your foot), being unable to dorsiflex (point toes upwards), is a call for immediate medical evaluation.