An estimated 90% of people in the U.S. will experience back pain at some point in their lives. One of the most common and debilitating types of back pain is sciatica. Contrary to popular belief, sciatica is less of a diagnosis and more of a collection of symptoms, stemming from injuries that occur along the sciatic nerve. Sciatic pain can be some of the most excruciating pain a person can experience. Let’s learn more about the answer to the question, “What is sciatica?”
What is sciatica? The anatomy
The sciatic nerve is the longest and widest single nerve in the body. This nerve has its roots multiple places on the lumbar spine. It is buried deep within the muscles of the buttocks and travels all the way down the legs to the feet.
Because the sciatic nerve covers so much ground in the body, it is possible to find injury at any part along its length but the most common point is at the lumbar spine.
Sciatica – The symptoms
The symptoms of sciatica are straightforward and fairly universal. Unlike some chronic pain conditions that have sometimes vague symptoms, sciatica has tell-tale signs that include:
- Pain in the low back where the sciatic nerve attaches
- Numbness in the body anywhere along the sciatic nerve, including feet and toes
- Tingling or “pins and needles” in the low back, buttocks, legs, and feet
- Burning sensations anywhere along the nerve path
- Weakness in the leg
Although the symptoms are fairly universal, the severity and incidence may not be. Some people with sciatica may experience fairly mild symptoms that resolve with treatment. Others might find that their symptoms vary between severe and mild. Still others might find that symptoms are uniformly severe.
Much of the variety of intensity of symptoms has to do with the underlying cause of sciatica and sciatic pain.
Sciatica – The causes
As the longest nerve in the body, the sciatic nerve is vulnerable to injury all along its length. For most sciatic nerve pain, injury occurs in the area of the lumbar spine. Some conditions that can lead to sciatica include:
- Herniated disc: A rupture in the intervertebral sac that separates and cushions the vertebrae
- Spinal stenosis: Narrowing of the spinal column
- Degenerative disc disease: Caused by age or by other conditions or medications that weaken discs
- Spondylolisthesis: When a vertebrae slips forward and rubs on the bone beneath it
- Ankylosing spondylitis: An arthritis-related condition that causes inflammation in the spine and eventual fusion of vertebrae
- Osteoporosis and compression fractures: Fractures in the vertebrae caused by bone loss
Injury to the spine is not the only cause of sciatica. The piriformis is a muscle that is seated deep within the buttocks. This muscle can become tense and strained, and that can place pressure on the sciatic nerve, causing pain. This is called piriformis syndrome and may be difficult to diagnose due to the depth of the muscle. Piriformis syndrome commonly occurs after an injury or accident.
Sciatica – The risk factors
Because of the location and size of the sciatic nerve, sciatica can be present in nearly every age and demographic. There are some risk factors that increase the likelihood of developing sciatic nerve pain.
Many causes of sciatica – osteoporosis, spinal stenosis, and degenerative disc disease, to name a few – are often a function of age-related wear-and-tear on the spine. Some research shows that at a certain age, the risk for back pain in general begins to level off, but until that point is reached, age is a risk factor for sciatica.
Those people who are largely sedentary have an increased risk of developing sciatica. Weak abdominal and back muscles are not able to properly support the spine during normal activity. “Weekend warriors” – those who exercise only on weekends – have an increased risk of injury due to a wildly fluctuating level of activity.
Jobs that require lifting, bending, and twisting put workers at risk for sciatica. Other occupations that vibrate the body continuously (as in long-haul trucking) also place a person at risk. The longer someone works in a high-risk occupation, the more their chances of low back pain and sciatica increase.
Pregnancy is a risk for sciatic pain because of the pressure placed on the lumbar spine as the baby grows. Other risk factors like depression and job satisfaction play into how well a person copes with any incidence of back pain, including sciatic nerve pain.
Sciatica – Diagnosis and treatments
Diagnosis of sciatic nerve pain requires a thorough patient history and physical exam. Patients may be asked to:
- Walk, sit, stand, and bend on flat feet and tiptoes
- Lift their leg straight up while lying down
- Allow the physician to move their leg in different positions
The doctor will measure reflexes and sensitivity. They may assess strength using various exercises and resistance.
X-rays may be ordered to help ascertain the cause of sciatic nerve pain. The doctor may order an MRI to look carefully at the soft tissue to see if there is an injury.
Once the cause of the sciatic pain is determined, there are a number of different treatment options available. Many pain management plans include a variety of holistic treatments to improve overall health to prevent further flare-ups of sciatica. These include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): These help control inflammation while other measures are put into place
- Targeted exercise: Stretches for the piriformis can relieve sciatic pain and pressure on the sciatic nerve
- Epidural steroid injections: These help reduce swelling and can offer short-term pain relief
- Antidepressants: Antidepressant medications can help lessen the impact of pain on daily life
- Discectomy: In the case of degenerative disc disease, removing the affected disc can help
- Laminectomy: Helps to open up more space in the spine by removing the lamina, two small bones that make the vertebrae, or the bone spurs in the back
- Spinal fusion: This is done to fuse two vertebrae and can be useful for sciatica caused by spinal stenosis or spondylolisthesis
Other treatments such as physical therapy, acupuncture, chiropractic, and low-impact exercise can help relieve pain and improve overall health and well-being.
Back pain can be debilitating and affect the quality of everyday life. New studies are coming out that show a new target for sciatica medications, but until they are on the market, tell us: how do you manage your sciatic pain? What is sciatica to you and how has it affected your life?