Definition:

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve that travels from the lower back through the hips, buttocks, and down each leg.

Sciatica most often occurs when a herniated disk or an overgrowth of bone puts pressure on any part of the nerve. This pressure will cause inflammation, pain, and sometimes numbness in the affected leg. Sciatica pain might be severe in some cases, but most cases clear up with a treatment in a few weeks. Although this pain can be easily treated, some cases who suffer from severe pain or numbness might need surgery.

Sciatica nerve anatomy

The Sciatica nerve is the longest and largest nerve in the human body, its diameter is about ¾ of an inch. It originates in the sacral plexus, a network of nerves in the lower back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine and the sacrum combined, way down at the base of the spine and above the tailbone or coccyx.

Actually, it is composed of five nerve roots: three from the sacrum, the last segment of the spine, and two from the lumbar spine, which is located in the lower back.

The right and left sciatic nerves are created when the five nerve roots combine. One sciatic nerve per side of your body travels through the hip, buttock, and leg, ending just below the knee.

Following this, the sciatic nerve splits off into additional nerves that go down your leg and into your foot and toes.

Although true sciatic nerve damage is extremely uncommon, the term “sciatica” is frequently used to refer to any discomfort that starts in the lower back and travels down the leg. An irritation, inflammation, pinching, or compression of a nerve in your lower back is what causes this discomfort, which is what it has in common with another nerve injury.

What does sciatica pain feel like?

Some individuals report the pain as piercing, shooting, or jolting. The pain has also been described as “burning,” “electric,” or “stabbing” by others.

The discomfort might be ongoing or intermittent. Additionally, your leg often experiences greater discomfort than your lower back does. Long durations of sitting or standing, getting up, and twisting your upper body may make the discomfort feel worse. The discomfort might also get greater if you make a rapid, forceful movement like coughing or sneezing.

Can sciatica occur down both legs?

Typically, sciatica only affects one leg at a time. Sciatica can, however, manifest itself in both legs. Where the nerve is being pinched along the spinal column is all that differs.

What are the causes of sciatica?

•  A disk that has slid or herniated and is pressing on a nerve root. The most frequent reason for sciatica is this. A slipped disk will occur at some time in the lives of 1% to 5% of the general population. The cushions between each vertebra of the spine are called disks. A disk’s gel-like core may expand (herniate) due to a weakening in the outer wall brought on by pressure from the vertebrae. The sciatic nerve may be compressed if a herniated disk occurs in a lower back vertebra.
•  Degenerative disk disease is the natural wear down of the disks between vertebrae of the spine. The wearing down of the disks shortens their height and leads to the nerve passageways becoming narrower (spinal stenosis). Spinal stenosis can pinch the sciatic nerve roots as they leave the spine.
• Spinal stenosis: The improper narrowing of the spinal canal is known as spinal stenosis. The spinal cord and nerves’ accessible area is diminished as a result of this constriction.
• Spondylolisthesis: One vertebra sliding out of alignment with the one above it causes spondylolisthesis, which narrows the hole where the nerve leaves the spine. The sciatic nerve may be compressed by the stretched spinal bone.
• Trauma injury to the lumbar spine or sciatic nerve.
• Tumors in the lumbar spinal canal compress the sciatic nerve.
• Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.
• Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus, and loss of bowel and bladder control.

Risk factors that could lead to sciatica:

• Previous injuries of the spine could put you at risk of having sciatica
• Normal aging can put your nerves at risk of being injured or pinched by the changes and shifts in bone, disks, and ligaments
• Overweight: When you are obese, your spine resembles a vertical crane. Your muscles act as a counterbalance. Your spine’s (crane’s) job is to raise the weight you bear at the front of your body. Your back muscles (counterweights) have to work harder the more weight you are carrying. Back sprains, aches, and other back problems may result from this.
•  Weak core muscles: Your back and stomach muscles make up your “core.” Your lower back will have greater support the stronger your core is. Your muscles are the sole thing holding up your lower back, as opposed to your rib cage, which supports the area around your chest.
• Have a physically demanding job: Positions requiring a lot of lifting or requiring lengthy periods of sitting might put you at risk for low back issues and back pain.
• Poor posture
• Diabetes increases your chance of nerve damage, which increases your chance of sciatica.
• Sedentary lifestyle: having no time to exercise and sitting for long periods with no activity can increase the risk of having lower back problems
• Osteoarthritis can cause damage the spine and put pressure on the nerves
• Smoking increases the risk of sciatica cause nicotine can damage spinal tissues, and speed the wearing down of intervertebral disks.

What are the symptoms of sciatica?

Sciatica symptoms include:

• Lower back, buttock, and leg discomfort that ranges from moderate to severe.
• Numbness or weakness in your lower back, buttock, leg, or feet.
•  Pain that worsens with movement; loss of movement.
• “Pins and needles” feeling in your legs, toes or feet.
• Loss of bowel and bladder control.

How is sciatica diagnosed?

Your healthcare practitioner will first go over your medical background. They will then ask about your symptoms.

Straight leg raise test is used to identify if the patient is suffering from a compression on the sciatic nerve. The most popular physical examination for diagnosing sciatica and lumbar disc hernia is the straight leg raise (SLR) test. When the sciatic nerve and below the knee between 30 and 70 degrees of hip flexion experience radiating pain, the SLR is deemed positive.

Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.

Magnetic resonance imaging (MRI) or computed tomography (CT) scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.

Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.

Myelogram to determine if a vertebra or disk is causing the pain.

Management

•  Patient Education: to include information on the nature of low back pain, advice on self-management techniques, and encouragement to continue normal activities
• Promote self-management techniques such as the use of hot or cold packs for comfort and to decrease inflammation; avoidance of inciting activities or prolonged sitting/standing, Regularly changing position i.e. from sitting to standing, practicing good, erect posture, use of proper lifting techniques
• Activity includes strengthening exercises for the core, modest hamstring and lumbar spine stretches, and frequent light exercises such as walking, swimming, or aquatherapy.
• Physiotherapy and manual therapy: spinal manipulation, mobilization or soft tissue techniques such as massage – used alongside exercise and patient education.

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