Sciatica

Sciatica is a condition characterised by pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips, buttocks, and down each leg.

It typically occurs when the nerve is compressed or irritated due to a herniated disk, bone spur, or spinal stenosis, leading to symptoms such as sharp pain, numbness, tingling, or muscle weakness in the affected leg.

The pain can range from mild to severe and is often worsened by prolonged sitting, sudden movements, or certain postures. Treatment options include physical therapy, pain management, lifestyle modifications, and, in severe cases, surgery.

Causes of Sciatica

These are the following causes.

Herniated or Slipped Disc

One of the most common causes of sciatica is a herniated or slipped disc in the lower spine. When the soft inner material of a spinal disc pushes through its outer layer, it can press against the sciatic nerve, leading to pain and inflammation.

Spinal Stenosis

Narrowing of the spinal canal, known as spinal stenosis, can put pressure on the sciatic nerve. This condition often develops due to aging and can cause nerve compression, leading to symptoms of sciatica.

Piriformis Syndrome

The piriformis muscle, located deep in the buttocks, can sometimes tighten or spasm, irritating the sciatic nerve that runs beneath it. This condition, known as piriformis syndrome, can cause sciatic pain, especially after prolonged sitting or physical activity.

Degenerative Disc Disease

As spinal discs naturally wear down over time, they may lose height and cause the vertebrae to shift slightly. This degeneration can lead to nerve compression, contributing to sciatica symptoms.

Spondylolisthesis

When one vertebra slips forward over another, a condition called spondylolisthesis, it can compress the sciatic nerve. This misalignment often occurs in the lower spine and can result in persistent nerve pain.

Trauma or Injury

Accidents, falls, or sports injuries can cause direct damage to the sciatic nerve or the structures surrounding it. A fractured vertebra or a sudden impact can lead to nerve compression and sciatica symptoms.

Tumors or Growths

Although rare, tumors or abnormal growths in the spine can press against the sciatic nerve, leading to pain and other neurological symptoms. These cases typically require medical intervention for diagnosis and treatment.

Pregnancy

The added weight and changes in posture during pregnancy can put extra pressure on the lower spine, sometimes leading to sciatic nerve irritation. Hormonal changes that loosen ligaments may also contribute to nerve compression.

Types of Sciatica

These are the different types of Sciatica.

Acute Sciatica

Acute sciatica develops suddenly and typically lasts for a short period, often a few days to a few weeks. It is usually caused by a temporary injury, muscle strain, or inflammation that irritates the sciatic nerve.

Chronic Sciatica

Chronic sciatica is a long-term condition that persists for more than three months. It is often linked to underlying spinal issues such as degenerative disc disease, spinal stenosis, or spondylolisthesis. The pain can be persistent or recurring, sometimes requiring ongoing treatment, including physical therapy, medication, or even surgery in severe cases.

Alternating Sciatica

Alternating sciatica affects both legs but not at the same time. It is relatively rare and often results from conditions like sacroiliac joint dysfunction or degenerative changes in the spine. Since the pain shifts between legs, it can be challenging to diagnose and may require specialised medical evaluation.

Bilateral Sciatica

Bilateral sciatica occurs when both legs experience sciatic nerve pain simultaneously. This type is less common and is often associated with serious conditions such as central disc herniation, spinal stenosis, or cauda equina syndrome.

Neuropathic Sciatica

Neuropathic sciatica results from direct nerve damage or dysfunction rather than mechanical compression. Conditions such as diabetes, infections, or neurological disorders can lead to this type of sciatica, causing burning pain, hypersensitivity, or unusual sensations in the affected leg. Treatment focuses on managing the underlying condition and relieving nerve pain.

Symptoms of Sciatica

Radiating Pain

Sciatica is primarily characterised by pain that radiates from the lower back down through the buttock and into one or both legs. The pain usually follows the path of the sciatic nerve and can vary in intensity, ranging from a mild ache to a sharp, burning sensation.

Numbness and Tingling

Many individuals with sciatica experience numbness or tingling sensations along the affected leg. These sensations may start in the lower back or buttock and extend down to the foot and toes, often following the nerve pathway.

Muscle Weakness

Weakness in the affected leg can occur when the sciatic nerve is compressed. This may lead to difficulty in moving the leg, foot, or toes, making walking or standing challenging. In severe cases, muscle atrophy can develop due to prolonged nerve compression.

Increased Pain with Movement

Certain activities and movements can worsen sciatic pain. Prolonged sitting, standing for long periods, bending forward, twisting the spine, or sudden movements can intensify symptoms. The pain may also flare up after physical exertion.

Difficulty Standing or Walking

Sciatica can make it difficult to maintain balance and stability, leading to challenges in walking or standing for extended periods. Some individuals may experience a sensation of their leg “giving out” due to nerve-related muscle weakness.

Burning or Electric Shock Sensation

In some cases, sciatica causes a burning or electric shock-like sensation along the sciatic nerve. This symptom can be particularly distressing and may occur suddenly or in response to certain movements or pressure on the lower back.

Loss of Bladder or Bowel Control (Severe Cases)

In rare but serious cases, sciatica may be accompanied by a loss of bladder or bowel control. This symptom, often associated with cauda equina syndrome, requires immediate medical attention, as it may indicate severe nerve compression requiring urgent treatment.

Treatment for Sciatica

Self-Care and Home Remedies

Mild cases of sciatica often improve with self-care measures. Applying hot or cold packs to the affected area can help reduce inflammation and relieve pain. Resting for a short period may be beneficial, but prolonged inactivity can worsen symptoms. Gentle stretching exercises and maintaining good posture can also aid in recovery.

Physical Therapy

A structured physical therapy program can strengthen the muscles supporting the spine and improve flexibility.

Therapists often recommend specific exercises to reduce nerve compression, improve mobility, and prevent future flare-ups. Techniques such as manual therapy, stretching, and core stabilisation exercises are commonly used.

Medications

Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and inflammation. In more severe cases, doctors may prescribe muscle relaxants, corticosteroids, or nerve pain medications. If sciatica is caused by an underlying condition, targeted treatments may be necessary.

Injections

For persistent or severe pain, corticosteroid injections may be administered directly into the affected area. These injections help reduce inflammation around the sciatic nerve and provide temporary relief. While effective, they are typically limited to a few treatments to avoid potential side effects.

Chiropractic Care

Chiropractic adjustments can help realign the spine and relieve pressure on the sciatic nerve. Spinal manipulation techniques may improve mobility, reduce pain, and enhance overall function. Many individuals find relief through chiropractic care, especially when combined with other treatments.

Acupuncture and Alternative Therapies

Acupuncture, an ancient Chinese therapy, involves inserting thin needles into specific points on the body to promote pain relief and healing. Other alternative treatments, such as massage therapy, yoga, and osteopathic manipulation, may also help alleviate symptoms and improve overall well-being.

Surgery

In severe cases where conservative treatments fail, surgery may be necessary. Procedures such as a microdiscectomy or laminectomy aim to relieve pressure on the sciatic nerve by removing a portion of a herniated disc or bone spur.

Surgery is typically considered when pain is debilitating, or nerve damage, such as weakness or loss of function, is present.

Lifestyle Modifications and Prevention

Maintaining a healthy weight, staying active, and practicing good posture can help prevent sciatica from recurring.

Regular exercise, particularly activities that strengthen the core and support the spine, can reduce the risk of future episodes. Proper ergonomics at work and home can also minimise strain on the lower back.