About Sciatica

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of a medical problem. It is not a medical condition by itself.

Types of Sciatica

Sciatica can be classified based on the nerve root involved and the duration or pattern  of symptoms:

• By nerve root affected:
  • L4 nerve root sciatica: Pain in the hip, thigh, and inner knee and calf; weakness in thigh and hip muscles; loss of knee reflex.
  • L5 nerve root sciatica: Pain in buttock and outer thigh/leg; numbness between great toe and second toe; weakness affecting ankle movement and toe lifting.
  • S1 nerve root sciatica (classic sciatica): Pain in buttock, back of calf, and side of foot; numbness on outer foot and toes; difficulty walking on tiptoes; loss of ankle reflex.
• By symptom duration and pattern:
  • Acute sciatica: Sudden onset lasting 4 to 8 weeks, often self-resolving.
  • Chronic sciatica: Lasts more than 8 weeks, often requiring medical intervention.
  • Alternating sciatica: Rare, affects one leg then the other alternately, often due to sacroiliac joint problems.
  • Bilateral sciatica: Rare, affects both legs simultaneously, possibly due to severe spinal degeneration or cauda equina syndrome

Signs and Symptoms of Sciatica

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. Sometimes, your foot gets caught on the ground when walking.

Sciatic nerve

The pain may start slowly. It may get worse:

• After standing or sitting
• During certain times of the day, such as at night
• When sneezing, coughing, or laughing, especially if caused by a herniated disk
• When bending backward or walking more than a few yards or meters, especially if caused by spinal stenosis
• When straining or holding your breath, such as during a bowel movement.

Sciatica Causes

Sciatica occurs when there is pressure on or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, the outer and back part of the lower leg, and the sole of the foot.

Common causes of sciatica include:

• Slipped or herniated disk
• Spinal stenosis
• Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
• Pelvic injury or fracture
• Tumors
• Spondylolisthesis
• Men between 30 and 50 years of age are more likely to have sciatica.

Sciatica Risk Factors

• Age (20-50 years most common for herniated disks).
• Obesity, increasing spinal stress.
• Occupations involving heavy lifting, twisting, or prolonged sitting.
• Sedentary lifestyle.
• Smoking, which impairs healing and increases risk.
• Poor physical fitness and weak core muscles.
• Psychological stress and depression may contribute.

Complications of Sciatica

​Prolonged nerve compression in the spine can lead to serious complications if not addressed promptly. Chronic pressure on spinal nerves may result in persistent pain, muscle weakness, numbness, or even foot drop, where lifting the front part of the foot becomes difficult. In severe cases, this can cause permanent nerve damage, leading to lasting mobility issues and reduced quality of life.

A particularly critical condition arising from severe nerve compression is cauda equina syndrome. This syndrome occurs when the bundle of nerves at the lower end of the spinal cord is compressed, leading to symptoms such as bowel or bladder incontinence, loss of sensation in the saddle area, and potential paralysis of the legs. Immediate medical intervention is crucial, as delays can result in irreversible damage.

Sciatica Diagnosis

​Diagnosing a herniated disc involves a comprehensive evaluation combining clinical assessments and diagnostic tests:​

• Medical History & Physical Examination: Doctors assess symptoms such as leg pain, muscle weakness, reflex changes, and sensory loss. Neurological tests like the straight leg raise may be performed to reproduce symptoms and evaluate nerve involvement.
• Imaging Tests:
  
  • X-rays: Can reveal bone abnormalities but not soft tissue issues like disc herniation.
  • MRI: Considered the gold standard for diagnosing herniated discs, MRI provides detailed images of soft tissues, including discs and nerves, helping to identify the location and severity of herniation.
  • CT Scan or Myelogram: Used when MRI is contraindicated; CT scans offer detailed bone images, and myelograms involve injecting contrast dye to highlight spinal structures.
• Electromyography (EMG): Measures the electrical activity of muscles and nerves to detect nerve damage or compression, aiding in pinpointing the affected nerve roots.

Sciatica Treatment

• Conservative management:
  • Rest and activity modification.
  • Over-the-counter pain relievers and anti-inflammatory medications.
  • Physical therapy focusing on strengthening, stretching, and posture correction.
  • Alternating cold and heat therapy to reduce inflammation and promote healing.
• Medications:
  • NSAIDs, corticosteroids (oral or injections).
  • Muscle relaxants.
  • Neuropathic pain agents (e.g., anti-seizure or antidepressants).
  • Opioids are generally reserved for severe cases and short-term use.
• Injections:
  • Epidural steroid injections to reduce nerve inflammation.

Note: Medications are advisable only under doctor's consideration.

Sciatica Surgery:

• Considered if conservative treatments fail or if there is severe weakness, loss of bowel/bladder control, or progressive neurological deficit.
• Procedures include discectomy or laminectomy to relieve nerve pressure.