Sciatica, Causes, Symptoms and Treatment
Progression of Herniated Disc
Sciatica is the proverbial pain in the butt, and in more ways than one. As anyone who has suffered from low back pain due to sciatica will agree.
Sciatica refers to a group of symptoms rather than a single problem. Symptoms include pain, tingling sensations and numbness caused by pressure, irritation or compression of the sciatic nerve. Sciatic pain most often affects the lower back, buttocks and outer side of the leg.
True sciatica is a pinched nerve that develops when a herniated disc or osteoarthritis bone spurs compress and pinch a sciatic nerve root. A herniated disc occurs when the cushion between the vertebra of the spine rupture and pushes into the nerve space causing irritation and compression resulting in the symptoms of sciatica. Although rare, compression of the sciatic nerve can also be the result of tumours.
Herniated disc which is also known as slipped disc, doesn't mean that the disc is displaced or shifted, slipped disc indicates that a disc is in one of four stages of degeneration, from a bulging of the nucleus to a ruptured outer ring causing pressure or damage to the sciatic nerve.
Pressure or irritation from a bulging disc results in lower back pain that radiates into the leg and can extend to the toes. Local Inflammation can also lead to pain and discomfort.
Degeneration of the joints caused by disease processes such as osteoarthritis, spondylosis and osteoporosis can also cause sciatica. Research shows that low back pain causes more global disability than any other condition. As the world population of elderly continues to grow, this problem can only get worse
The Sciatic Nerve
The sciatic nerve also known as the ischiadic nerve is a large nerve in the human body. It begins in the lower back, runs along the buttock then descends into the lower limbs; it is the longest and widest single nerve in the human body.
The sciatic nerve contains fibres from the anterior and posterior divisions of the lumbosacral plexus. Like most nerves in the body, the sciatic nerve has two primary functions:
- To send signals from the muscles to the brain
- To collect sensory information and pass it back to the brain
The sciatic nerve originates from the L4 (lumbar nerve 4) to S3 (Sacral nerve 3) segments of the sacral plexus, a collection of nerve fibres that emerges from the sacral part of the spinal cord. Conditions such as sciatica that affects the nerve will also alter its normal function.
Sciatica is a common and debilitating condition affecting between 1% and 10% of the population.
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Who is most at risk for sciatica?
Certain groups of people are more at risk of getting sciatica than others. More often than not, the onset of pain begins after an injury, after lifting or moving heavy objects or in some cases, after a sudden movement. However, in the majority of cases, the cause of lower back pain are unknown.
Age and lifestyle play a huge part in who develops sciatica, degeneration of the intervertebral disc can start as early as the age of 30, therefore, the risk of getting the condition also begins at this age.
Spinal stenosis is a condition that can develop in the over 50s and can cause sciatica when it occurs at the lumbar level of the spine. Changes in the spine due to arthritis and bone spurs can also result in sciatica.
As we age, the fluid and protein content of the body's cartilage changes, discs loses moisture and shrinks, thereby increasing the risk for spinal stenosis. The incidence of low back pain and sciatica in women increases with the onset of the menopause as bone density is lost. Cartilage becomes thinner weaker and much more fragile over time. This process is degenerative changes. Fortunately, while osteoarthritis and osteoporosis are common in older adults, the risk for lower back pain appears to plateau and doesn't seem to increase steadily with age.
Degeneration of the disc tissue makes it much more susceptible to bulging or herniation. Trauma injury to the spine can also result in degenerative disc disease.
The people who are most at risk are those between the ages of 30 to 50. These are the people who are most actively participating in sports, social activities and work, and are on the whole, more active when compared to older age groups. This types of activities increase the chances of injury and damage to the spine.
Excess body weight increases the stress on the spine and may contribute to the changes that can cause sciatica.
High levels of glucose can attack and damage any nerve in the body. Elevated glucose levels are seen in diabetic patients with peripheral neuropathy, a serious condition that typically affect nerves at the periphery of the body and is often confused with sciatica. However, nerve compression such as carpal tunnel and sciatica occurs more commonly in people with diabetes than those without the condition.
People who sit for long periods or live sedentary lifestyles are much more likely to develop sciatica than those who live active lives.
Who is at risk for Back Pain
More men than women experience back pain, one in 10 male workers get back pain lasting for at least one week per year. Lower back pain is a common condition; in the majority of cases, the condition is self-limiting, but it is important to know when this is not the case and when to seek medical help. Back pain assessment will allow your doctor to:
- Recognise and rule out serious conditions
- Relieve the pain
- Assess the level of disability
- Identify any barriers to recovery
- Help to prevent recurrence
Jobs with high risk for back pain includes:
- Car Mechanics
- Machine Operators
- Office workers
- Long distance lorry driver
- Child Care Providers
Occupation, Jobs With High Risk For Sciatica
Jobs that involves lifting bending and twisting into an awkward position, exposure to long periods of whole-body vibration such as long-distance lorry driving are all placing workers at high risk for lower back pain and sciatica. The longer an individual continues this type of work the greater the risk.
As nurses, we strive to relieve pain in our patients, but ironically, back pain and sciatica are more prevalent in nurses than in workers in most other professions. In my job as a critical care nurse for more years than I care to remember, it would be an understatement to say that I've spent many long hours on my feet. My job requires much walking, standing, lifting heavy and awkward loads that can cause the spine to twist into some very unnatural positions repeatedly.
So of course, it is no surprise that the average nurse, especially those of a certain age suffers from low back, leg and buttock pain. A study suggests that the lifetime risk of lower back pain for nurses is as high as 90%. However, what surprised me, was how many younger nurses are already experiencing low back pain.
According to research, one-third of adults over the age of 20 are already showing signs of herniated discs. However, only 3% show symptoms. With the benefit of insight gained from various studies, more efficient methods of lifting and handling patients have been implemented in hospitals, many lifting and moving aids and devices are now used to lower the incidence of low back pain and sciatica.
This condition occurs when the piriformis muscle spasm, irritates or compresses the sciatic nerve. The piriformis is a small muscle found deep in the buttock behind the gluteus maximus running diagonally from the lower spine to the upper surface of the femur. The sciatic nerve runs through, or beneath the muscle, and due to its proximity, when the piriformis muscle is irritated or injured, the sciatic nerve is affected causing symptoms similar to sciatica.
Symptoms of sciatica Pain
There are two types of sciatic pain, acute; lasting for a day or two but not exceeding six weeks. Chronic refers to sciatic pain that goes on for much longer, continuing for months if not years.
Sciatic pain is different from your run of the mill back pain. This type of pain rarely affects the back. Pain Radiates down the hips into the buttocks and along one or both legs then through the calf, becoming worse given sufficient time.
Symptoms experienced by people suffering from sciatica can also include:
Pins and needles sensation
Tingling, with difficulty controlling or moving the affected leg
Loss of tendon reflexes
Sciatic pain can be exacerbated by:
Sneezing, coughing or even laughing can cause pain, known as impulse pain
Standing or sitting for extended period
When to seek Emergency help
Seek immediate medical help when the following symptoms occur:
- Numbness in the buttock, in the lower back and the legs
- loss of bladder and bowel control
Weakness in the leg and foot
The above symptoms may be due to the condition Cauda Equina Syndrome or (CES). CES is a rare but serious condition of the nerve root, where there is pressure on the nerves at the bottom of the spinal cord. Damage to the cauda equina causes acute loss of function of the lumbar plexus or nerve roots. CES requires urgent investigation and treatment to avoid permanent damage to the bladder and bowel.
Treatment For Low back pain And Sciatica
Sciatica is a painful condition, treating the pain mostly depends on whether the pain is acute or chronic and from where the cause of the pain originates. It is not always necessary to treat sciatica, the condition can sometimes improve naturally in a matter of weeks. However, where the symptoms are severe a range of treatments are available.
Treatment for Sciatica Pain
Stay active, try over-the-counter pain killers like paracetamol or ibuprofen, hot or cold compresses
Relieve symptoms of pain and inflammation
If paracetamol or ibuprofen fails to ease the pain, opioids such as codeine and in severe cases morphine may be prescribed by a doctors
Used in severe cases only
Get a referral from doctor to see a physiotherapist.
Appropriate plan of exercise may be recommended by the doctor, or patients may be referred to a physio therapist for range of exercises to strengthen the muscles supporting the back and improve flexibility of the spine. Physiotherapist can also teach how to improve posture and reduce any future strain on the back.
Corticocosteroid and/or local anaesthetic injection
When other means of treatment fails to work, a patient maybe referred to a specialist for spinal injection. Strong anti-inflammatory and painkilling drugs are delivered directly to inflamed area around the nerves of the spine to help relieve pressure on the sciatic nerve.
Surgical options includes: Discectomy, Fusion surgery, Laminectomy
Surgery is rare, but can be necessary when there is an identifiable cause, such as herniated or slipped disc that do not responds to other types of treatment..
Tricyclic Antidepressants (TCAs) i.e. amitriptyline
Proven to be effective in treating nerve pain.
Originally intended for use in the treatment of depression but was found to be effective in treating nerve pain
Anticonvulsants like gabapentin
Like TCAs can also used to treat nerve pain
Originally designed to treat epilepsy but can also be effective in treating nerve pain
© 2014 Jo Alexis-Hagues
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