Sciatica I Do You Have a Sciatica? Learn More About Symptoms, Signs, Causes, Risk Factors, and Treatment - Page 5 of 10

Most of us have experienced back pain at least once. Our spine holds the weight of the rest of the body, and any wrong movements, tension, or trauma may potentially lead to back pain, which is usually located in the lower back. But there are several types of back pain, and one of them originates from nervous tissue.

The most common type of neurogenic back pain is sciatica, which is not only felt in the back but may run down to the legs and cause severe disability. Have you experienced this type of pain? This article deals with sciatica pain and everything you need to know about this variant of low back pain.

Sciatica Overview

Nowadays, there is a whole lot of confusion about sciatica. About what it is, what it means to have it, and ways to treat it. Many think they have it when in reality, they do not, while others yet are silently suffering without knowing why. Sciatica is often misdiagnosed, and thus it is critical that we educate people about this debilitating disease. This way, we can avoid confusion, misdiagnosis, and fear-mongering.

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But what is sciatica pain?

Sciatica is a blanket term used to encompass the symptoms associated with the unnatural compression of the Sciatic Nerve. This somewhat loose definition is what confuses patients.

Sciatica is characterized by shooting pain that affects the lower back and travels all along the path of the sciatic nerve. Sciatica pain is also felt along the back of the hip and lower legs. A burning sensation is known to alternate with tingling and numbness. Sciatica is potentially debilitating because it can make moving about and even standing up difficult. It is therefore imperative to find practical ways in which to alleviate the crippling pain.

What causes sciatica pain?

As noted above, the leading cause of sciatica has to do with an unnatural compression of the sciatic nerve. Most commonly, sciatica is caused by a herniation of the spinal discs. Other possible causes include displacement of a vertebra, pelvic tumors, and pregnancy.

As you can see, we can’t understand sciatica pain without studying the spine and spinal problems. In most cases, patients with sciatica pain also experienced low back pain for three months or more. Their back pain diagnosis can be nonspecific, but they could have a hidden disk degeneration or herniation.

When a degenerative change occurs in the intervertebral discs, this sponge-like structure loses its capacity to cushion the vertebrae. The spaces between vertebrae narrow down, and the spaces where nerves come out of the spinal cord are smaller. This creates compression of the spinal cord, and if the sciatica nerve is involved, we will experience sciatica pain.

However, this is only theory, and the real world is a bit more complex. Sometimes we can see patients with significant degenerative changes in the spine but no pain whatsoever. Other patients do not display any degenerative change or just a mild problem, and they have severe sciatica pain. Thus, the mechanical causes of sciatica are sometimes not enough, and other factors should be considered. They are known as inflammatory or biochemical pathways.

Inflammation is a natural response to defend the body against invaders, but it sometimes turns against us. Cytokines released by white blood cells change the way blood vessels work and cause edema. This creates mechanical pressure upon the surrounding structures and may trigger pain. But cytokines also activate nerve terminals and cause pain without any intermediates. That is why anti-inflammatories are very useful to relieve a headache or the pain you feel after trauma.

Risk factors

Low back pain and sciatica are prevalent health problems in industrialized countries. We may have a higher risk of sciatica if we meet the following conditions:

Genetics: Sciatica may have a specific genetic predisposition, primarily due to its degenerative causes. Some people are more susceptible to spinal degeneration than others, which could be running in our veins as a family inheritance.
Age: Older age is a risk factor. Sciatica can develop at any age, but it is more common as we grow older. At age 40-50 years, the incidence has a peak, especially in women. Some researchers say that sciatica pain is equally common in men and women, but women are more likely to report the problem and look for solutions.
Overweight and obesity: Being overweight increases the load on the spine and increases the likelihood of several spinal problems, including disc degeneration. Obesity leads to chronic loading of the articulations, and it is associated with an increase of systemic inflammation that favors the development of sciatica pain.
Extreme height: In some studies, being very tall has been detected as a risk factor for sciatica pain. Other studies find no relationship, but it is a possibility that we may want to keep in mind.
Cigarette smoking: Tobacco smoke contains hundreds of inflammatory substances and may speed up the development of sciatica pain via biochemical/inflammatory pathways.
Core instability: Fitness levels are sometimes related to the onset of sciatica pain, and some people encounter significant relief after strengthening their core muscles. Core weakness and instability may contribute to wear and tear of the articulations and the development of sciatica pain.
Occupational factors: Depending on your job, you could be exposed to significant spinal stress or not. Carrying heavyweights, standing for an extended period, sitting all day long, being exposed to vibration for extended periods, and constantly twisting and bending may increase the chance of experiencing a compression of the sciatic nerve.
Job dissatisfaction: Not feeling satisfied with one’s job is often seen in patients with sciatica pain. This could become a source of stress and tension that facilitates the development of spinal pain and sciatica.
Emotional issues: Other emotional issues such as financial stressors and social anxiety may also trigger sciatica pain or lead to more severe pain episodes.

Signs and symptoms

The main symptom of sciatica is pain, but it is not any type of pain. In most cases, patients feel both low back pain and leg pain. In sciatica, leg pain is located in the nerve distribution of L4 to S2. In other words, the nerve roots affected by the disease are those that leave the intervertebral space from the fourth lumbar vertebra to the second sacral vertebra. These nerve roots receive impulses from their own areas of the skin and underneath, and that is where it hurts the most. This is known as dermatomal distribution, and it creates a helpful pattern to identify sciatica pain.

In some cases, the dermatomal distribution of pain is not clear, but other elements contribute to detecting the problem. For example, sciatica pain often starts after prolonged loading of the spine, such as standing for a long time or carrying a heavyweight. It may also become triggered by sitting for too long because the sciatica nerve runs down to the legs deep into the buttocks. Bending forward, vacuuming, and other activities can aggravate the pain while changing positions or reclining to unload the spine reduces pain sensation.

Besides pain, other symptoms of sciatica include:

Tingling on the back of the leg: Tingling is an abnormal sensory impulse usually seen when a nerve is compressed against another structure. In this case, it is the sciatic nerve, and the effects can be felt on the back of the leg, the buttocks, and sometimes the foot.
Numbness in your buttocks or legs: Numbness also results from abnormal sensory impulses. In this case, it reduces the sensitivity of the area, and it is sometimes accompanied by vascular changes as well.
Lower limb weakness: The sciatic nerve may also contribute to motor function, and some patients experience weakness in the affected limb.

If you have these symptoms, your healthcare provider will perform a physical exam to see what is causing the pain and rule out sciatica. Your doctor may ask you to walk normally or do the same on your heels. He may also lie you down and raise your straight legs with his hands. This provides a handy sign when it triggers pain and may provide an understanding of where the lesion is located.

Your doctor may also find valuable signs of disease in diagnostic tests such as:

X-rays, especially to find disc problems, tumors, fractures, and other physical or mechanical causes of pain
Magnetic resonance imaging, or a computed tomography scan when they need to evaluate soft tissues or the nervous system
Electromyography and nerve conduction velocity tests to evaluate how far nerves are conducting electrical impulses because an obstruction reduces the nerve impulse timing

Treatment for sciatica pain

Sciatica is a complex health problem, and different treatments can provide pain relief. Not all of them will work for every patient, and doctors often try different methods until finding the one that relieves pain for a longer time and improves the quality of life of the patient.

We can try the following variants:

Medications

There are several medications to improve sciatica pain. Some of them are over-the-counter drugs, such as nonsteroidal anti-inflammatory drugs. Two examples are naproxen and ibuprofen. They improve pain by reducing inflammation and its effects on the sciatic nerve.

Other medications are prescription drugs such as tricyclic antidepressants, anticonvulsant medications, and steroids. Antidepressant and anticonvulsant therapy, in this case, are not prescribed because you have depression or seizure attacks. What they do in sciatica pain is reduce the intensity of the nerve impulses and inhibit certain impulses in the brain. Oral steroids are very potent anti-inflammatory drugs that work better when over-the-counter anti-inflammatories are not enough.

Activity modifications and rest

Identifying the trigger of sciatica pain is an essential part of the treatment. It can be your posture, lifting technique, or a given activity at work or home. Your doctor can help you identify the trigger, which is the first step to recommending activity modifications.

Rest is essential, but we don’t want to have prolonged periods of bed rest. Physical inactivity does not favor the spine’s structures and may increase your susceptibility to suffering a new episode of sciatica pain.

Physical therapy

This is an alternative treatment that also contributes to relieving the pain. It combines stretching exercises, aerobic conditioning of the body, and muscle strengthening. Physical therapy is often guided by a therapy program and performed with a physical therapist. But if your problem is not severe, you could achieve the physical therapy on your own by following instructions.

In this modality of treatment, the main goal is strengthening the spine to protect spinal structures. It strengthens core muscles and increases the flexibility of the hamstrings and other muscles. It can be performed in your own home, in a medical facility, or inside a pool to achieve low-impact exercises.

Stretching and physical activity

One of the best methods for relieving sciatica-related pain is to engage in a stretching routine. Yoga or Pilates are great disciplines that possess sets of moves suited to helping you feel good again. Stretching your lower back muscles and hip flexors will go a long way to lower the pressure on your sciatic nerve.

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However, for this method to be effective, you must make stretching exercises a regular practice. Start a daily routine that includes the following stretches:

Runner’s Lunge: Begin this stretch in a plank position while your hands are positioned directly beneath your shoulders. Step your left foot forward towards your hands and lower your arms to the floor. Relax your hips and lower back. This stretch provides a thorough depressurization of the hip and groin muscles.
Pelvic Tilt: While lying flat on your back, bend your knees and tilt your pelvis and curl the tailbone off the floor. Exhale as you flatten your spine against the floor and inhale as the tailbone comes down.