What is Sciatica?
Sciatica is a term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to a disc bulge in the low back. This is most commonly seen in middle-aged adults and men are more susceptible. The term sciatica originated from the sciatic nerve, which is the single largest nerve in our body. This nerve is responsible for a significant proportion of leg sensation and movement. Sciatica represents pain in the area supplied by the sciatic nerve.
What Causes Sciatica?
Sciatica occurs when the sciatic nerve is pinched. The possible cause of nerve pinch causing sciatica are discussed as:
- Herniated Disc
- Degenerative Disc Disease
- Osteoarthritis
- Sudden Injury
- Bone tumor
What are the symptoms of sciatica?
The severity and symptoms may vary considerably. In severe cases the affected individual may find it difficult to walk or even stand up straight.
Some of the commonly observed symptoms include
- Sharp, burning, stinging, shooting, electric shock, or cramps like pain in one or both legs often as far down as the foot. Movement, coughing, and sneezing can intensify the pain
- Tingling, pins and needles, and/or numbness in the leg or foot
- Muscle weakness with difficulty in weight bearing or walking.
- Buttock/low back pain and stiffness.
Diagnosis of Sciatica
Your doctor may request for investigations such as magnetic resonance imaging (MRI) scan and blood tests. Sometimes computerized tomography (CT) scans may also be required. X-rays are not as helpful and they can provide only limited information.
Bulging discs on an MRI scan are not an uncommon finding. It is important not to get fixated on the MRI findings. A bulging disc is not permanent and can reverse. The investigation results should be interpreted in combination with patient history, and examination findings to assess their significance. A number of patients with severe MRI findings may be asymptomatic and vice versa.
Treatment Options
A range of different options- non surgical (such as injections- nerve root blocks, epidurals, piriformis injection, etc) or surgical may be considered.
Pain relief:
Pain reduction achieved by medicines helps to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms, and individual factors such as comorbidities and allergies. Some of the commonly prescribed painkillers include
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Neuropathic pain killers
- Opioids
- Muscle relaxants
- Spinal Injections
Physiotherapy:
Physiotherapy is an essential component of sciatica treatment. Your physiotherapist can help with posture advice, do’s and don’ts relevant to your condition, understanding the concept of the pacing of activities, setting practical goals, teaching strengthening exercises for core, and leg muscles, and manual handling techniques.
Surgery:
If the above options fail to provide adequate relief then surgical options such as discectomy (operation to remove bulging part of the disc or separated disc fragments) and microdiscectomy can be considered for sciatica resulting from disc bulge. Surgical options will vary depending on the cause of sciatica and sometimes may be the first choice, depending on the actual pathology and its severity.
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