Sciatica is one of the most common causes of shooting pain in low back and legs. Some sources say that from 3 to 40 % of people encounter this problem at least once in their life.
To make your visit to the doctor more effective, let us consider the symptoms and treatment of sciatica. When patients are aware of their condition, its causes, and treatment options, they present their complaints more clearly and consistently. Accordingly, the physician has more time to examine them and ask specific clarifying questions.
What is the sciatic nerve?
The human spine consists of 33-34 vertebrae which are conventionally divided into five divisions: cervical, thoracic, lumbar, sacral, and coccygeal. Within the spinal column is the spinal cord, an organ of the central nervous system. There are openings between each two adjacent vertebrae on the sides. The nerve roots that connect the spinal cord to all the other nerves in the body pass through them.
Fig.1 Sciatic nerve
The sciatic nerve is formed from the two lumbar and three sacral spinal nerves (LIV, LV, SI -SIII). It is the largest nerve in the human body: it is as thick as an index finger. And also the longest one: the muscle branches of the sciatic nerve innervate the muscles of the gluteal region and the leg, starting from the thigh and ending with the toes. Thanks to this nerve bundle we can move the foot, feel where we step, feel pain if we hit our knee or get a blister. It means that all the information about the condition of the skin, muscles, bones, and joints of the leg is transmitted to the brain through the branches of the sciatic nerve, and the movements are provided by them.
Depending on the degree of nerve injury, the patient's complaints may differ. The doctor's task is not just to relieve the symptoms but to find out what caused sciatica in order to get rid of it.
Causes of sciatic nerve compression and inflammation
Sciatica from Greek is inflammation of the sciatic nerve. However, compression of the nerve is not necessarily accompanied by inflammation. But for the sake of simplicity, sciatica and sciatic nerve compression are considered equivalent terms.
Sciatica is not a disease, but a syndrome. In other words, it is a group of symptoms that may conceal a number of pathologies.
Main causes of sciatica:
It is found in 90 % of cases of sciatic nerve compression. However, the reverse condition "if there is a herniated disc, then there will be a pinched nerve" is not true. Hernias can be asymptomatic.
- Herniated disc.
Age-related changes in bone tissue and ligaments. The openings between the vertebrae become smaller in diameter due to bone growths, and the nerve roots become crowded and this causes their impingement.
- Spinal stenosis, spondylarthritis.
- Tumor. It squeezes the nerve with its volume. It is a rare but dangerous pathology.
- Esophageal spasm
The sciatic nerve runs inside the sternum muscle, so it is compressed when it is strained.
- Nerve injury from intramuscular injections. Injections are given only into the upper outer quadrant of the buttock because the sciatic nerve runs deep into the muscles below. Medical professionals know about this.
- Nerve injury caused by a trauma, hip fracture, and joint prosthetics.
- Infections (influenza, malaria, etc.). Inflammation occurs as a result of the general impact of microbial toxins.
An enlarged uterus in the second and third trimester puts pressure on the pelvic muscles leading to muscle spasm. The redistribution of the center of gravity and displacement of the lumbar vertebrae predisposes to impingement at the level of nerve roots. In the pelvic region the nerve is pressed against the growing head of the fetus. All of these may occur during pregnancy. Low back pain bothers 40 to 80 % of pregnant women. But according to examination results, only 5 % of them have sciatica.
Sciatica risk factors
Risk factors do not necessarily result in a disease, but they increase the likelihood. There are risk factors that we cannot influence, such as gender and age. And there are some that we can change. For example, quit smoking or start stretching in the morning.
Factors increasing the risk of sciatica:
- Age 45-64. However, there is a tendency of developing sciatica at a younger age and today sciatica is not uncommon in people aged 30-40 years old.
- Male gender. Statistically, men are more likely to have sciatica than women.
- Excess weight
- Extra kilograms increase the load on the spine and there is a greater risk of deformation, hernias and compression of the nerves.
- Smoking, alcohol. Toxins cause oxygen starvation of nerve tissue, resulting in nerve inflammation.
- Diabetes mellitus. Excess glucose also leads to inflammation in the nerve endings.
- Strenuous physical activity, frequent bending, lifting weights.
- Driving. It is the duration and level of vibration that matters.
- Sedentary life-style, standing for long periods of time.
A neurologist treats back pain. But if the situation is urgent and the specialist is busy, a general practitioner or internist can also schedule an examination.
To make a diagnosis, the doctor finds out the complaints in detail, collects the anamnesis and conducts an examination. All three points make it possible to determine the symptoms, i.e. the characteristic signs of the disease.
- Pain in the back, lower back, or gluteal region. Patients describe the pain as sharp, burning, shooting. It occurs suddenly, spreads to the leg below the knee and all the way to the toes. The pain is most often unilateral. The pain increases when standing for long periods and changing the body position, as well as when sneezing, coughing and laughing. Rarely, the pain syndrome begins gradually with a dull, aching pain that increases with physical exertion.
- Impaired joint mobility: it is impossible to fully unbend the leg, as if it were locked into place. Patients may limp.
- Numbness, tingling, goose bumps, uncomfortable feeling cold or hot.
- Change in skin color compared to a healthy leg. There may be pallor or, conversely, redness.
- Increased body temperature and general malaise if the cause of sciatica is an infectious disease.
- The Lasegue or straight leg raise sign is specific to sciatica. The patient lies on his back while the physician lifts up his leg bent at the knee. In a healthy person, the leg goes up 90 °. When the sciatic nerve is pinched, the angle is smaller because the pain does not allow to move the leg higher.
If there are doubts about the diagnosis, additional instrumental diagnosis is necessary magnetic resonance imaging
Fig. 2 Schematic representation of sciatica
What to do about sciatica?
If there is a sudden pain caused by a pinched nerve and the pain is severe, the person should seek medical help as soon as possible. If the symptoms increase gradually or the pain is not constant, the visit to the clinic can be postponed for a long time. At the same time, the patient is still worried about how to get rid of sciatic nerve pain at home. Especially if sciatica occurs in a woman during pregnancy, when treatment options are limited because of the potential risk to the fetus.
The easiest thing to relieve pain is to choose a comfortable position. There is no one-size-fits-all solution. Everyone is guided by his or her own feelings.
How body position affects the pain syndrome:
- The muscles may begin to feel weaker and tired of being in one position for a long time, and then a spasm occurs. The sciatic nerve is pinched by the spasm of the sternum muscle. So, the position that caused the pain should be changed. If you have been sitting for a long time, get up and walk around, if you have been standing for a long time, sit down.
- The position chosen for pain relief should also be changed. Choose two or three positions in which the pain is minimal and alternate between them.
- If you have to stand for a long time, shift your body weight from one foot to the other while standing. This way the tension in your pelvic floor muscles is relieved. If possible, have a walk. Muscles get less tired when you move.
- If you sit for long periods of time, find time to get up, walk around and stretch. Stretch out for five minutes every hour.
- To relieve pain when sitting, get a high chair, put a pillow under your back so that your back is straight with right or obtuse knees angle.
- The supine and semi-reclining positions are the most preferred by patients. Use more pillows under your knees and lower back when lying on your back; use pillows between your bent knees and under your upper arm when lying on your side. Pregnancy pillows are especially effective. They are long, U- or C-shaped, and comfortably support the lower back, legs and arms. In cases of unilateral sciatica, some patients find it comfortable to lie on the healthy side.
- Warming and massage together with relaxing positions relieve muscle tension. In the case of a spasm of the sternum muscle, this may be enough for recovery.
Sometimes pinched nerves do not require any medical care and pain disappears itself. But if there is no improvement within one to three days, a visit to the doctor is essential. The sooner the examination is carried out, the better the chances for effective treatment.
When treating sciatica, doctors try to start with conservative methods, unless surgery is the only option. Usually, a sciatica exacerbation does not last for more than six weeks. If there is no expected improvement, surgical treatment is considered.
1. Sciatica conservative treatment:
- Use medications from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific medication, dosage, and duration will be chosen by your doctor after examination. According to studies, pills are no less effective than shots.
- Therapeutic exercises, including stretch therapy. This method is the safest for pregnant women. Exercises should be aimed at stretching the muscles surrounding the sciatic nerve, especially the piriformis muscle. You can exercise on your own after being instructed by a physical therapist.
- Swimming. It also helps to gently relieve the tension and stretch the muscles.
- Massage and chiropractic care. Relaxes, helps to relieve pain.
- Physiotherapy: magnetotherapy, laser, electrotherapy. These methods are widely used in Russia and CIS countries.
- Epidural injections of corticosteroids and local anesthetics.
It is used for chronic sciatica, when the pain is unrelieved and persists for more than a month. The drug is injected into the spinal canal - the space between the spinal cord and the inside of the spine. Corticosteroids are drugs that relieve inflammation. Sometimes they are given along with a local anesthetic, a drug that reduces sensitivity. Injecting an anesthetic as an independent treatment is called a blockade.
Such injections are given once a month and the therapeutic effect is long-lasting.
2. Surgical treatment for pain caused by nerve compression:
- Minimally invasive surgery. A minimally invasive intervention removes the portion of the disc that is compressing the sciatic nerve and this portion is then replaced with artificial discs. Or during the operation intervertebral ligaments are dissected and adjacent vertebrae are fused. The use of endoscopic instruments helps to reduce the number and size of incisions.
- Laser surgery. It is also a minimally invasive surgery. It allows to remove bone spurs, i.e. bone growth that forms on normal bone and causes narrowing of the spinal canal and intervertebral foramina. The intervertebral discs are completely or partially removed by laser (nucleoplasty).
- Traditional open neurosurgeries. The surgery is performed through a back incision: disc removal and replacement (discectomy), ligament dissection, removal of spinous processes and vertebral arches (laminectomy) and spinal fusion (spondylodesis).