What does sciatic pain mean? Why does it happen? What are the symptoms? When should you see a doctor? How and treated? Does exercise work? You can find the answers to all these questions and much more below.
What is Sciatica?
Sciatica is a large nerve that runs from the area of both hips to the legs, and then to the feet. Sciatic pain is a symptom of a problem with this nerve. Your sciatic nerve controls the muscles in the back of your arm and lower leg and provides sensation to the back of your thigh, lower leg, and sole of your foot.
When you have sciatica, you experience pain, weakness, numbness, or tingling. It can start in the thin waist and is often described as pain that extends from the hip to the foot . It usually occurs on only one side of your body.
What causes sciatica?
Here are the causes of substance sciatica:
1- Herniated disc
The bones (vertebrae) that make up the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it can swell or break. This is called a herniated disc.
Any of the 5 pairs of nerve roots that form the origin of the sciatic nerve can be compressed by a damaged disc in the spine. Not only does a herniated disc press on the nerve root, but chemicals leaking from the soft center of the disc irritate the nerve root, causing inflammation.
This combination of compression and inflammation can cause pain in the sciatic nerve. This is one of the most common causes of sciatica, a herniated disc.
2- Bone spurs
Bone spurs or osteophytes are bony protrusions at the edges of joints. Bone spurs form where cartilage wears away and bone rubs against bone. New bone forms at the edge of the joints to protect the body. This is called a bone spur or spur.
Bone spurs are not painful on their own, but unfortunately, bone spurs can rub against nearby bone or nerves, causing problems. In the spine, bony prominences can enter the area normally reserved for nerves, causing sciatica.
3- Piriformis syndrome
Piriformis syndrome is a rare cause of sciatica. The piriformis is a muscle located deep within the gluteal muscles of the hip. The function of the piriformis muscle is to externally rotate and stabilize the hip. The sciatic nerve passes directly under the piriformis.
Piriformis syndrome occurs when the piriformis muscle becomes tight, spasmed, or swollen. When this happens, it compresses the sciatic nerve underneath. In about one in 7 people, the sciatic nerve runs through the piriformis, and these people may be prone to sciatic nerve problems.
4- Lomper spinal canal stenosis
Stenosis means narrowing, and lumbar spinal canal stenosis is a narrowing of the space available for nerves in the lumbar spine. Narrowing of the lumbar spinal canal can put pressure on the nerves, causing back pain, pain in the sciatic nerve, numbness and weakness in the legs.
If you have lumbar spinal canal stenosis, you may have no symptoms. However, you may also have lower back pain radiating from the hips to the legs or just leg pain. The pain usually occurs when you stand or walk. This condition tends to affect the elderly, not the young.
In this case, one vertebra slides forward over the vertebra below it. This disrupts the spinal canal and can cause compression of the nerve roots of the sciatic nerve.
In adults, the fourth and fifth lumbar vertebrae (L4 and L5) are most commonly affected, with the L4 vertebrae moving forward in the L5 vertebra. It can be caused by degenerative diseases of the spine, such as spondylolisthesis, arthritis.
6- Other reasons
Sciatica can be caused by tumors hitting the spinal cord or nerve roots. Severe back pain that extends from the hips to the feet, loss of bladder or bowel control, or muscle weakness can be caused by spinal tumors. Spinal trauma, such as a car accident, can also cause sciatica.
What are the symptoms of sciatica?
Pain from sciatica is felt along the path of the sciatic nerve and can be felt deep in the hip. It descends from the hip and the back of the leg, sometimes all the way to the foot. The pain may be accompanied by tingling or numbness and sometimes muscle weakness in the leg.
This problem is usually felt in only one leg at a time. Sometimes an electric shock-like sensation can be felt along the nerve. Nerve pain can be mild or severe. Sciatic nerve pain is usually felt when you sneeze, cough, go to the toilet or sit, and may be accompanied by lower back pain.
When should you see a doctor?
Most sciatica heals within a few weeks and does not cause permanent damage. If your pain does not go away after a few weeks, you should see your doctor. If you lose control of your bladder or bowels, experience severe pain, muscle weakness or numbness, you should seek immediate medical attention.
How is sciatica diagnosed?
Your doctor will take into account your medical history and perform a physical exam, especially of the spine and legs. You may be asked to perform a few movements so your doctor can check your muscle strength, flexibility, and reflexes.
X-rays are of course not used because they do not show herniated discs or nerve damage. However, it may indicate spondylolisthesis, bony spurs, narrowed disc spaces, and other bone diseases. CT scans or MRI-Emar scans are often used to identify the cause of sciatica whensymptoms are severe, persistent, or worsening
However, it is important to remember that imaging results are not usually related to symptoms. Problems such as disc abnormalities, bony spurs, and spondylolisthesis are often seen on scans, even in people without back pain or other symptoms.
Depending on your symptoms and diagnosis, your doctor may refer you to another specialist for further evaluation and treatment.
How is sciatica treated?
The vast majority of patients affected by sciatica notice a significant improvement in the severity of their symptoms within 6-8 weeks. Therefore, initial treatment should be conservative to avoid unnecessary exposure to treatments.
Instead, patients should be adequately counseled to understand the nature of the condition and equipped with methods to alleviate the associated pain.
During the initial consultation with the patient, information should be given about the limited nature of the condition without specific treatment measures.
In the meantime, it is recommended that affected individuals continue their normal daily activities as much as possible. Rest may provide symptomatic relief, but will not help speed recovery.
Some people may find it helpful to use hot or cold packs for pain relief. Ice packs are recommended initially to help reduce pain and inflammation, but after two to three days a warm pack may provide more beneficial pain relief.
Stretching the painful area can also help relieve pain. In some cases, going to a physical therapist may help, or the person may benefit from simple yoga exercises. Staying active is important and although it is not expected to improve recovery time, it helps to improve natural pain relief mechanisms such as the release of endorphins.
Scientific evidence to support the use of analgesics to relieve the pain of sciatica is not strong. Despite this, analgesic medications are often prescribed to help individuals manage pain.
Paracetamol is often the first choice of pain medication as it is associated with fewer side effects. Alternatively, non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin may be recommended.
In some cases, opioid drugs may be given alone or in combination with simple analgesics. Additionally, botulinum toxin is sometimes used to relieve sciatic pain caused by piriformis syndrome. Antidepressant medications are also occasionally prescribed, as they are thought to help with neuropathic pain.
Epidural corticosteroid injection can help relieve pain in severe cases. However, this only applies to patients with severe symptoms, as possible side effects are significant.
Remember, your doctor will decide which drug you should take and how.
When the symptoms of sciatica continue to cause chronic pain, surgery may be considered as a treatment option.
The most common surgery is discectomy, which involves removing part of the disc that is thought to be causing symptoms. However, the long-term benefits of this procedure do not appear to be any better than for patients treated with conservative care.
There is some evidence that spinal manipulation may benefit the treatment of acute sciatica, but this is not true for chronically affected patients.
Although some patients prefer acupuncture as a pain relief method, its benefit remains unclear. Likewise, chiropractic care can be used to manipulate the spine and improve mobility, but evidence for this application is lacking.
Physical therapy is thought to have some beneficial effects, and massage therapy may help improve acute pain but is not associated with a shorter recovery time.
In sciatica patients, exercise can begin with short stretches, walking, and light exercises. As you become more comfortable, the exercise time can gradually increase.
Types of exercise recommended for patients include stretching, strengthening, and aerobic activity. Once the acute phase is over, performing such exercises every day with the doctor’s approval can prevent further recurrence of pain or at least make relapses less painful and less frequent.
Stretching exercises reduce pain in sciatica caused by the piriformis and hamstring muscles.
Strengthening exercises tighten the paraspinal muscles that support the spine, the surrounding ligaments and tendons, the abdominal muscles and the hip muscles.
The movements of the joints affected by the pain in sciatica are important in relieving low back pain for the following reasons:
- increased mobility
- Decreased sensitivity to pain
- Better adaptation of nervous tissues (less resistance to movement)
Exercise positively affects the pain of sciatica, including the healing of damaged nerves, which results in:
- less pain
- Better range of motion
- Better dynamic adaptability of the nervous system
Different types of exercise that may be beneficial for sciatica include :
- Biomechanical exercise aimed at improving spinal movements (strengthening, stretching, pilates exercises)
- Aerobic exercise for cardiovascular fitness, such as cycling, swimming, or water aerobics
- mind-body exercises like yoga or tai chi
- Mixed exercise combining exercises from two or more other categories