What is it?

Sciatica is constant pain and tenderness of the back, hip and leg, sensations of numbness and weakness originating from the lower back and radiating downwards towards the feet following the sciatic nerve. 

The term sciatica has been used loosely and often mistakenly used to describe any back and leg pain. Sciatic is most commonly caused by pressure/impingement of the sciatic nerve.

Signs, Symptoms, and health issues?

Sciatica is most commonly caused by the impingement of the Sciatic nerve which is the longest nerve in the body; the nerve is situated on both sides of the lower spine and then extends down the back of the leg to the toes. The sciatic nerve is made up of five different nerves (4th and 5th lumbar nerves and first three of the sacral nerves); any problems in the lower lumbar area can affect these nerves which then feed down into the sciatic nerve causing the radiating feeling of pain associated with sciatica. The sciatic nerve connects from the spinal cord to the outer thigh area, the hamstrings, down to the lower leg and then the feet.

The six most common causes of sciatica are following.

  • Lumbar herniated disc
  • Degenerative disc disease
  • Isthmic spondylolisthesis
  • Lumbar spinal stenosis
  • Piriformis syndrome
  • Sacroiliac joint dysfunction

 

All these conditions in one way or the other affect the sciatic nerve and therefore causes sciatic pain.

Sciatic pain begins in the lower back and spreads downwards, past your glutes, back of thigh, lower leg and occasionally the foot. The pain has been described as aching or burning sensations but also sharp pain that radiates broadly down the lower half of the body. 

Depending on where the sciatic nerve is being pinched will determine what type of pain that the person will feel. Sciatica is more often than not going one way, commonly dorsolateral (back and sides) configuration (disk rupture, foraminal stenosis) or possibly bilateral (two sides) pain (central disk herniation, lumbar stenosis, spondylolisthesis)

 

Hsu, (n.d.) states that; “It is important to understand that most Sciatica will resolve itself within a few weeks or months and rarely causes permanent nerve damage.” Acute sciatica (short term) can last a few weeks or chronic sciatica (long term) is pain persisting for more than 3 months. Acute sciatica typically does not require professional medical treatment and symptoms can be treated at home. Chronic sciatica may be an indication of further serious spinal problems and may require further investigation.

Risk Factors?

Sciatic pain can affect anyone but as with all things certain factors can increase the risk of getting sciatica.

  • Age– Due to the nature of our bones, the deterioration of the spinal disc in elder people has a higher risk than those relatively young.  
  • Diet/Lifestyle– The lack of exercise and or poor diet can lead to weight problems causing stress and pressure to the spinal column, also those who sit/inactive for extended periods of time are also at risk.
  • Pregnancy– Changes during pregnancy such as weight gain, hormones, and central shift of gravity to the expecting mother causes stress to the spine.
  • Occupation Risk– Those who have a job that involves heavy lifting and/or twisting the torso for an extended period of time, especially those that use incorrect technique to lift heavy objects. 
  • Medical Factors– Diabetes or cancer (depending on the cancer) can be a cause.
  • Smoking– While smoking does not directly cause sciatica it does decrease the circulation around the body and can starve the spinal discs of nutrients.

Due to pressure or pinching to the sciatic nerve, these changes to the spine are recognized as the causing factor. People who are more at risk than others are those that either have a spinal condition due to aging (the elderly and aging) or physical strain. (occupation/sport/weight)

Treatments?

Treatment for sciatica is slightly vague as it can resolve itself without treatment. Treatments can range from common and simple to complex procedures such as surgery. Over the counter medication non-steroidal anti-inflammatory drugs (NSAIDS) to treat the pain symptoms, prescribed medication from your doctor for severe pain, exercises and light stretches to strengthen trunk muscles, ice or heat packs applies to affected areas.

Epidural steroid injections to the spine that deliver anti-inflammatory medication to the muscles around the affected nerve, massage therapy to decrease and soothe muscle spasms, Physical therapy for exercises and further (future) prevention, spinal adjustments to help the spine return to its natural position. 

Surgery is often considered the last option (Persistent chronic pain, no reaction to other non-surgical treatments, condition interferes with the patient’s ability to participate in normal day activities) Depending where and what the problem is the patient may need a Lumbar laminectomy, Discectomy. In any case the doctor will go over possible treatments and options and will assist in deciding what best works for the patient.

Massage?

Those who have sciatica will have muscle spasms and it will be painful to the client as the therapist applies pressure. “The pain is caused by ischemic muscle tissue. Ischemia means the muscle is lacking proper blood flow, usually due to the muscle spasm” (Mueller, 2002) 

Muscle spasm should respond when pressure is applied to the affected muscles; if the muscle does not respond and relax then it could be an indication of inflammation.