What is a Sciatica?
Sciatica is a general term used to describe pain in the back, hip, and legs caused by compression of the sciatic nerve that runs from the lower end of the spinal cord down to the lower extremities. This is also know as lumbar radiculopathy. The sciatic nerve is the largest in the human body in diameter and length and is made up of our L4, L5, S1 and S2 nerve roots at the end of the spine. The lower lumbar region of the spine is particularly susceptible to injury because of the wear and tear it takes on a daily basis.
These injuries and abnormalities can impede on the space allotted for the sciatic nerve, therefore compressing it and leading to pain called sciatica. Patients often refer to the pain as radiating, weakness, tingling, numbness or shooting that travels down the back, buttocks and legs. Sciatic pain often affects only one side of the body at a time, but in rare cases can affect both.
Although sciatica often referred to as a “condition” it is actually a symptom of a more severe medical disorder. Herniated discs, bone spurs, spinal stenosis, inflammation and other spinal abnormalities in the lower back can cause compression of the sciatic nerve resulting in sciatic or lumbar radiculopathy.
What are the symptoms of an Sciatica?
Radiating pain is the number one symptom of sciatica. Stemming from the lower back, sciatic pain can travel into the buttocks, thighs, calves and feet. Although sciatic pain is most commonly felt on only one side of the body, patients have experienced bilateral lumbar radiculopathy resulting in pain down both lower extremities. Common symptoms of sciatica include:
- Lower Back Pain
- Leg Pain
- Hip Pain
- Calf Pain
- Foot Pain
- Radiating Pain
- Shooting Pain
- Tingling and Numbness
- Weakness In Legs
- Sharp or Stabbing Pain
- Burning Sensations
What Causes Sciatica?
Sciatica is a description of symptoms occurring from inflammation, pressure or injury to the sciatic nerve. Although lower lumbar radiculopathy, or sciatica, is most commonly caused by a herniated disc, it can also be a result of a bulging disc and degenerative disc disease. It can be a result of stenosis or changes in the vertebra alignment as occurs with a spondylolisthesis or slippage of one vertebra on another. Less commonly, it can be caused by infection or a spinal tumor.
- Herniated Disc
- Degenerative Disc Disease
- Bulging Disc
- Slipped Disc
- Bone Spurs or Osteophytes
- Repetitive Motion or Overuse
- Poor Posture
- Poor Health
Where Sciatic Pain Is Coming From
L4 NERVE ROOT DAMAGE
A pinched nerve root in the L4 section of the vertebral column usually results in radiating pain in the thigh. This pain can come in the form of numbness, tingling, weakness and shooting. Radiculopathy of the L4 nerve root can also cause this pain to extend into the lower leg, ankle and foot. In addition, patients may experience difficultly moving the foot in an upward motion.
L5 NERVE ROOT DAMAGE
A pinched L5 nerve root usually results in radiating pain in the foot. This pain can come in the form of numbness, tingling, weakness and shooting and is commonly felt in the big toe, inside of the foot, top of the foot and ankle. Radiculopathy of the L5 nerve may also cause loss of coordination in the foot and toes.
S1 NERVE ROOT DAMAGE:
A pinched nerve in the S1 section of the vertebral column usually results in radiating pain down the backside of the leg and into the outside of the foot. This pain can come in the form of numbness, tingling, weakness and shooting. S1 nerve root Radiculopathy may cause pain or numbness in the little toe and top of the foot. Consequently, patients find it difficult to stand on their tip-toes or raise their heel off the ground.
How is Sciatica diagnosed?
After a full clinical evaluation and medical history review, your physician may request and x-ray of your lumbar spine to check the alignment and disc height. Further detail of herniated or bulging discs, stenosis or any soft tissue decline is more readily seen on an MRI or magnetic resonance imaging, which will likely be the next step.
He/she may also request a nerve test or EMG (electromyography) or NCS (Nerve Conduction Study), which will identify if the muscle has lost it nerve response. This test can also help to identify if there is permanent damage to the nerve and potentially lead to sciatica surgery.
How is a Sciatica Treated?
If the sciatica is caused predominantly by irritation and inflammation and not severe compression, conservative care is recommended. Physical therapy, chiropractic, massage therapy and interventional procedures such as epidural shots can reduce the inflammation and the symptoms will resolve. Management such as good posture and body mechanics, strengthening core muscles and maintaining spinal flexibility can prevent it from reoccurring. Conservative care options for sciatica are:
If there is compression from a disc herniation, osteophytes, stenosis or mal-alignment of the spine, sciatica surgery may be recommended. Depending on the severity of the pathology surgery may only need to be a minimally invasive procedure such as a laminotomy or microdisectomy to free the nerve or it may require more complex surgery that clears the area around the nerve and maintains this space with a cage or rods and screws as used for a spinal fusion. Your physician will review and discuss your problems and help you to choose the best option for you.