Sciatica: Symptoms, Diagnosis and Treatment
Medically Reviewed By : Dr Sravya, MBBS, MS
Introduction
Do you experience intense pain in the lower back region that radiates down one leg? Then, you are most probably suffering from a condition called sciatica.
Sciatica is not a disease but rather a symptom of an underlying condition that may
compress, pinch, or irritate the sciatic nerve.
Most cases of sciatica improve within a few weeks with rest and medication.
However, some may present with persistent pain and complications and require
surgery.
This blog post will focus on the causes, symptoms, diagnosis, and management of
sciatica.
What is sciatica?
The sciatic nerve is the largest nerve in the body and has a thickness of about 2 cm. It exits the backbone (vertebral column) in the lower back region and runs through the hips, buttocks, thighs, and up to the foot.
It controls the motor functions of the hips and thighs; that is, it helps to move your thighs and knees. The sciatic nerve is responsible for the sensation of touch that you may feel on the back of the thigh, part of the lower leg, and the sole.
Thus, any disease or injury that affects the sciatic nerve causes pain and numbness in these areas. This condition is called sciatica. It is also sometimes coupled with a tingling or pins-and-needle sensation. The pain is usually felt in the lower back and travels down to one leg.
Sciatica is not seen in children or young adults unless there is a history of trauma. The chances of developing the condition increase with age. Most cases of sciatica have been reported among 40-year-olds.
Sciatica affects both men and women equally. It is reported more in professionals who sit in awkward positions for longer hours, such as truck drivers, machine operators, etc.
Causes of Sciatica
You might have heard of the term “slipped disc”? It is the most common cause of sciatica. When the intervertebral disc, or the disc found between
the bones of the backbone, bulges out, it compresses the sciatic nerve, leading to pain.
Other diseases or conditions that may cause sciatica include:
- Spinal stenosis or the narrowing of the canal through which the spinal cord runs
- Change in the arrangement of bones in the vertebral column (misalignment) due to poor posture, obesity, bone resorption, or trauma
- Pressure on the sciatic nerve due to growths such as tumors, abscesses, or hematomas.
- Trauma due to injury
- Spasms or inflammation of muscles of the lower back and hips can irritate the sciatic nerve, causing pain.
- Spinal tuberculosis is also a rare cause of sciatica.
An injury to the piriformis muscle (another muscle of the hips and legs) may also produce sciatica-like symptoms. However, this usually happens due to muscle overuse and is more common in athletes.
Symptoms
Pain in the lower back that travels down one leg is the most common complaint of a patient with sciatica.
People often describe the pain as a sharp, burning sensation in the hip muscles.
Some people may experience a dull ache and complain that their leg feels heavy. The symptoms of sciatica may worsen at night, and the pain may increase while bending, twisting, or coughing.
Tingling or numbness in the legs and weakening of leg muscles are other complications seen with sciatica.
There is a loss of bladder and bowel control in very severe cases.
Diagnosis
Consult an orthopedist if you are experiencing symptoms of sciatica, especially if the pain is unbearable or persistent even after a week of self treatment with NSAIDs.
A healthcare professional will first take a detailed medical history and then perform a physical examination. They may ask you to do the following activities:
- Lie down on your back and raise one leg at a time (pain usually worsens between 30 and 70 degree)
- Get up from a squatting position
- Walk on your toes or heels
If your pain worsens during these activities, your doctor will do further tests to confirm the diagnosis of sciatica.
X-rays
These will identify if any bone overgrowth or fracture is responsible for the pressure on the sciatic nerve.
CT Scans
If the doctor cannot identify the cause with an X-ray, they may request a non- contrast CT scan to locate a fracture. A contrast CT scan is used to diagnose abnormalities in the nerve pathway and includes injecting dyes.
MRI Scans
The MRI scans provide a clear picture of the bone and soft tissues, such as the muscles and intervertebral discs. It helps to diagnose a bulging disc and pinching of the sciatic nerve.
They are usually performed in cases where the pain is persistent and is not relieved even after 6–8 weeks of rest and treatment.However, the doctor may advise an immediate MRI if they suspect a mass or an abnormality in the nerve.
Electromyography
Electromyography evaluates whether the nerve can transmit impulses and whether the muscles are responding to these impulses. This test can confirm if there is a nerve root injury.
Management
Once the doctor confirms the diagnosis of sciatica, the treatment will mainly include pain management with NSAIDs and adequate rest. You can also apply topical muscle relaxants and get deep-tissue massages for pain relief. Remember to use cold compressions for the first 48 hours after an injury or in the case of acute pain, and hot compressions if the pain continues.
If the pain persists, the doctor will add short-term oral steroids or corticosteroid injections to ease the inflammation. Once the symptoms have settled, the doctor will advise that you carry out simple movements but avoid sitting and standing for long hours, bending and lifting objects, etc.
Patients with sciatica should follow certain dos and don’ts. These include:
- Limiting bed rest
- Avoid dependence on opioids
- Maintain good posture while sitting and standing
- Gently stretch the spine at regular intervals
- Regular light exercises
- Use proper lifting methods
- Maintain optimum body weight
- Quit smoking
Most cases of sciatica get better within 4-6 weeks with rest, medication, and physiotherapy. The recovery may take longer if there is a nerve root injury, but in most cases, it does get better.
However, a surgical procedure is required if the pain is due to a tumor, abscess, or hematoma, or in cases of complications like bowel and bladder incontinence.
If the condition causing sciatica is left untreated, it may result in permanent nerve damage.
Conclusion:
The pain due to sciatica can severely affect the quality of life. However, most patients feel better within weeks of starting the treatment. You may need to consult different specialists, like an orthopedist, neurologist, radiologist, and physiotherapist,for effective management.