SCIATICA-Symptoms & Treatment FAQs

Sciatica causes discomfort and pain during walking

Sciatica is a condition characterized by the presence of sharp, shooting,, or burning pain that radiates along the path of the sciatic nerve, often accompanied by numbness, tingling, or weakness in the affected leg. It can simply be defined as the pain going down the leg which typically originates from the lower back. It is primarily a symptom, not a disease or complication. Usually occurs due to compression or irritation of the sciatic nerve.

The sciatic nerve is the largest in the human body which extends through the buttocks and down the lower limb and provides sensory and motor functions to the legs and foot. It originates from the lumbosacral plexus ( L4 to S3 are the involved nerve roots, respectively).

CAUSES OF SCIATICA

Sciatica can be caused by any condition that irritates or compresses the sciatic nerve or any of the five spinal nerve roots that combine to form the sciatic nerve ( i.e. L4-S3). The main causes of sciatica include the following:

• Trauma or Injuries
• Spinal stenosis
• Herniated Disc
• Piriformis syndrome
• Pregnancy
• Tumors or cysts
• Osteoarthritis
• Cauda equina syndrome
• Spondylolisthesis
• Infections affecting the spine
• Obesity
• Muscle spasms
• Diabetes
• Conus medullas syndrome
• Foraminal stenosis
• Degenerative Disc Disease

WHAT ARE THE RISK FACTORS OF SCIATICA?

As sciatica can be caused by multiple conditions, it has many potential risk factors that include the following:

• Age: The primary risk factor for sciatica is age. As individuals grow older, the discs in the spine become more prone to degeneration and herniation. Also, the prevalence of spinal stenosis increases with age and all of these conditions can lead to sciatica.
• Excess weight or Obesity: The additional weight places unnecessary and greater strain on the spine, causing an increased risk of developing disc problems and nerve compressions that eventually may lead to sciatica. 
•  Type of Job: If your job requires a lot of bending, heavy lifting, prolonged sitting, or working in certain awkward positions then, it may increase the risk of developing spinal or lower back problems.
• Lack of physical activity: Having a sedentary lifestyle i.e. not performing enough physical activity increases the chances of developing many health conditions including sciatica which can result from weight gain due to physical inactivity and having insufficient core strength.
• Diabetes: Diabetes most commonly causes a peripheral neuropathy that damages the nerves including, any of the five spinal nerves that combine to form the sciatic nerve as a result, sciatica occurs.
• Any Unknown Cause: Sciatica may occur due to any unknown cause which can only be found through physical examination by a health care provider or a physiotherapist. 

SIGNS AND SYMPTOMS OF SCIATICA

The signs and symptoms of sciatica include:

• Pain: sharp, shooting, or burning pain that radiates along the path of the sciatic nerve i.e. from the lower back down the leg.
• Numbness and tingling: Pins or needles felt in the affected leg or foot.
• Weakness: muscle weakness may be felt or experienced in the affected leg or foot.
• Difficulty in movement: The symptoms i.e. pain, numbness, and tingling worsen with certain types of movements such as sitting down, standing up, walking,, etc.

In severe cases, there may be loss of bladder or bowel function control (medical emergency).

Symptoms vary depending on the underlying cause and the severity of nerve compression.

WHAT COMPLICATIONS CAN RESULT FROM SCIATICA?

Sciatica can lead to several complications if not properly treated. Such as chronic (long-term) pain, permanent nerve damage, loss of sensation, permanent numbness, muscle weakness, bladder or bowel dysfunction, and mobility issues i.e. impaired movement/mobility. 

To avoid such complications, prompt diagnosis and treatment are essential. 

DIAGNOSIS OF SCIATICA

The diagnosis of sciatica typically includes a combination of a medical history review, a physical examination of the patient, and multiple imaging test options. The health care provider will physically examine the patient, assessing posture, gait,, and alignment, palpating the spine and other muscles to identify tender or painful areas,, and performing ROM tests to evaluate the flexibility and movement in the lower back and legs.

Some of the most commonly used and effective methods for the diagnosis of sciatica are mentioned below.

 

WHAT ARE THE SPECIAL TESTS USED TO DIAGNOSE SCIATICA?

• Straight Leg Raises (SLR)
• Slump test
• Femoral Nerve Stretch Test
• Prone Knee Bend Test

WHAT TESTS ARE DONE TO DIAGNOSE THIS CONDITION?

The diagnostic tests used for sciatica typically include the following but, are not limited to:

• X-rays
• MRI scans (Magnetic Resonance Imaging)
• CT scan (Computed Tomography)
• EMG ( Electromyography)
• Nerve Conduction studies
• Bone Scan
• Ultrasound

MANAGEMENT AND TREATMENT:

The treatment of sciatica usually includes self-care measures, and some medical treatments, and in severe cases,, it may require surgery. The treatment options depend upon the underlying cause and the severity of the condition. Here are some of the effective treatment options for sciatica:

SELF-CARE MEASURES

The self-care measures or the home-based treatment for sciatica include:

• Rest: Short periods of rest can help and are advisable but, prolonged physical inactivity is generally discouraged as it may worsen the pain and other symptoms.
• Cold/Ice therapy: Applying ice packs/cold packs or ice massage for the first 48 hours can help reduce the inflammation leading to pain relief and reduced swelling.
• Heat therapy: Heat packs can be used to relax the muscles.
• Exercise: Gentle ROM exercises and stretching can help relieve the pressure on the sciatic nerve thus, leading to a reduction in symptoms. Activities such as swimming, walking, and yoga are beneficial and advisable.
• Posture Correction: Practicing and maintaining a good posture while sitting, standing, walking, and sleeping can significantly alleviate the symptoms. 
• Lifestyle Modifications: Weight management, regular exercise,, and proper body mechanics.

PHYSICAL THERAPY TREATMENT 

The physical therapy treatment for sciatica includes stretching and strengthening exercises, manual therapy, open-chain and closed-chain exercises, and the use of ergonomic devices. Details are given below:

STRETCHING EXERCISES

Hamstring Stretch: Lie on your back then, bend one knee, and extend the other leg straight up. Hold behind your thigh and gently pull towards your chest. OR Lie on your back and lift one leg. While keeping it straight, use a towel to gently pull the leg towards you.

Piriformis Stretch: In a sitting position, Cross one leg over the other. Now, gently pull the knee of the crossed leg towards the opposite shoulder.

Cat-Cow Stretch: On your hands and knees, Arch your back towards the ceiling and then, lower it. Now, lift your head and tailbone.

Figure Four Stretch: In a supine lying position, cross one ankle over the opposite knee and pull the bottom of the knee towards your chest.

STRENGTHENING EXERCISES 

• Planks and Bridges to strengthen the core.
• Quadricep exercises and Calf raises to strengthen the legs.
• Bird Dog and Superman exercises to strengthen the lower back.

MANUAL THERAPY TECHNIQUES

• Soft tissue mobilization
• Joint mobilization 
• Myofascial release
• Trigger point therapy

ERGONOMIC DEVICES FOR THE TREATMENT OF SCIATICA:

• Lumbar support cushions
• Adjustable chairs
• Standing desks
• Footrests
• Proper footwear

OPEN CHAIN EXERCISES ( feet are not fixed)

• Leg extensions 
• Hamstring curls
• Straight leg raises
• Ankle pumps

CLOSED CHAIN EXERCISES (feet are in contact with the ground)

• Squats
• Lunges
• Step-ups

MEDICATIONS USED FOR SCIATICA

Most commonly the over-the-counter pain relievers are used to treat sciatica. These include NSAIDs such as ibuprofen or aspirin to reduce pain and inflammation. The prescription medications include:

• Muscle relaxants for muscle spasms.
• Opioid analgesics in severe cases.
• Anti-inflammatory Drugs to reduce inflammation.
• Antidepressants and Anticonvulsants may also be prescribed for nerve pain in some cases.

INJECTIONS

• Corticosteroid injections are used to reduce pain and inflammation.
• Anesthetic injections to block the pain signals from the affected nerve are also used.

ALTERNATIVE TREATMENT METHODS

• Acupuncture
• Chiropractic care
• Massage therapy
• TENS (Transcutaneous Electrical Nerve Stimulation)

SURGICAL INTERVENTION FOR SCIATICA

Surgery may be performed in severe cases. Some surgical procedures that are used in the treatment of the underlying cause of sciatica are as follows:

• Microdiscectomy to remove the herniated disc material which might be causing compression of the nerve. 
• Laminectomy is performed to remove a part of the vertebrae i.e. lamina to create more space for the nerve.
• Spinal Fusion involves the joining of two or more vertebrae to improve the stability of the spine. 
• Foraminotomy is performed to enlarge the foramina (i.e. an opening from where the nerve roots exit the spine) to relieve pressure on the nerve.

HOW TO PREVENT SCIATICA?

Prevention of sciatica involves some lifestyle modifications along with maintaining a good posture and avoiding activities that might lead to injury to the back or spine. Some effective preventive measures are listed below:

• Regular exercise such as walking, swimming, yoga, and stretching.
• Proper lifting techniques when lifting heavy objects.
• Maintaining a healthy weight.
• Practicing and maintaining good sitting, standing, and sleeping posture.
• Prevent exercise-induced injuries by performing warm-up exercises before workouts and avoiding high-impact activities.
• Follow workplace ergonomics and take breaks in case of a job that involves prolonged sitting or standing.
• Manage your stress by practicing relaxation techniques such as deep breathing, meditation,, or yoga. Stress can also contribute to muscle tension resulting in back pain or sciatica.
• Wear comfortable shoes.
• Quit smoking or tobacco use.

 

FAQs

HOW SCIATICA OCCURS?

Sciatica occurs when the sciatic nerve becomes compressed or irritated leading to pain in the lower back which radiates down the leg. Sciatica is characterized by pain, numbness, and tingling in the affected leg.

WHAT SCIATICA PAIN FEELS LIKE?

Pain caused by sciatica feels like sharp, shooting, and burning pain that radiates from the lower back, through the buttocks, and down the leg. 

WHEN SCIATICA NEEDS SURGERY?

Sciatica may require surgery in case of severe underlying conditions which cause sciatica to occur. Surgical procedures used in this case include microdiscectomy, laminectomy, foraminotomy, etc.

HOW TO REDUCE SCIATIC NERVE PAIN?

Self-care measures that can help relieve sciatic nerve pain include rest, ice therapy for the first 48 hours using ice packs, heat therapy to relieve muscle spasms, stretching exercises, and medications such as NSAIDS or over-the-counter pain relievers.

IS SCIATICA SERIOUS?

Sciatica itself is not a pathology but, it can be a symptom of an underlying condition. If sciatica is caused by a herniated disc can go away with treatment after a few weeks or months.

IS SCIATICA CURABLE?

Yes, in most cases people fully recover from sciatica and it is possible to cure sciatica permanently. As sciatica is a symptom of an underlying condition the recovery depends upon the severity of the condition that causes sciatica. If the nerve is severely damaged, then it may lead to further complications such as 'foot drop'. But, it can be treated via proper treatment.

WHAT IS THE FASTEST WAY TO TREAT SCIATICA?

The most effective methods used to treat sciatica include cold and heat therapy along with some exercises. Such as hamstring stretch, piriformis stretch, straight leg raises, walking, planks and bridges, cat-cow pose, swimming, and yoga.

ARE SCIATICA AND SHINGLES RELATED?

No, sciatica and shingles are not directly related. However, they may share some similar symptoms such as nerve pain and weakness. Sciatica is a condition caused by nerve compression or irritation of the sciatic nerve. On the other hand, Shingles is caused by the varicella-zoster virus which is the same virus that causes chickenpox.