Sciatica, Causes, Symptoms and Treatment

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Progression of Herniated Disc

Sciatica Causes

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:

  1. To send signals from the muscles to the brain
  2. 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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Risk Factors

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

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.

Obesity

Excess body weight increases the stress on the spine and may contribute to the changes that can cause sciatica.

Diabetes

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.

Prolonged sitting

People who sit for long periods or live sedentary lifestyles are much more likely to develop sciatica than those who live active lives.


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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:

  • Carpenters
  • Car Mechanics
  • Machine Operators
  • Office workers
  • Long distance lorry driver
  • Nursing
  • Cleaners
  • Caterers
  • Hairdressers
  • 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.

Piriformis Syndrome

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

  • Muscle weakness

  • 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

  • bending backwards

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

Treatment
Action
Rationale
Self-Help
Stay active, try over-the-counter pain killers like paracetamol or ibuprofen, hot or cold compresses
Relieve symptoms of pain and inflammation
Analgesia
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
physiotherapy
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.
Spinal Injection
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.
Surgery
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
The medications mentioned above may not be suitable for everyone with low back pain and sciatica, especially in the long term. It is important to discuss your condition with your doctor, some of these drugs can cause significant adverse side effects.

© 2014 Jo Alexis-Hagues

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44 comments

tobusiness profile image

tobusiness 3 weeks ago from Bedfordshire, U.K Author

Hola MARYLU, prueba la extension de la traduccion de Google.

Gracias por Detenerte.


MARYLU 3 weeks ago

ME GUSTARIA ESTA MISMA INFORMACIÓN EN ESPAÑOL.


tobusiness profile image

tobusiness 19 months ago from Bedfordshire, U.K Author

Hi Kelsey, thank you so much for stopping by, I'm glad you found the hub informative, pinched nerve is no fun at all. Take care and my best to you.


Kelsey Farrell profile image

Kelsey Farrell 19 months ago from Orange County, CA

Great information. While it's not typically my sciatica that gives me problems, it has been known to experience the occasional pinched nerve that just won't give. Very informative article, thanks!


tobusiness profile image

tobusiness 24 months ago from Bedfordshire, U.K Author

DJ, you always manage to make me laugh.... just like a man indeed. We get the sniffles they get "Man Flu," we get muscle aches, they get "real back pain." The human race would cease to exist if those darlings were the ones to have the babies.

I'm sorry about the problem with the disc, unfortunately, it is something we will all experience to a greater or lesser degree as we get older. The degenerative process catches up with us eventually, but the pain from degenerative disc disease may not necessarily get worse, in fact, it may even get better given sufficient time. Thank you so much for taking a look at this and for the much needed laugh, much appreciated. I hope you're doing well, best wishes to you both.


DJ Anderson 24 months ago

Great information on back pain. You have given causes and help to

recognize the problem along with stretches to help alleviate the pain.

I have degenerative disc disease and know it will only worsen with age.

I have always sought out chiropractors through the years. My husband has never share my faith in chiropractors. One year, his back went out on him and he was bedridden for weeks. I told him I was very sorry that he was having back troubles, but maybe, now, he would have a little better understanding of the pain I had suffered throughout the years.

He looked me straight in the eyes and said, "There is no way that your back aches hurt as badly as mine hurts right now." I broke out into laughter. Just like a man!!

This is a great article, Jo.

DJ.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Suzette, sciatica is no fun at all. I've been known to take to the floor halfway through my shift to do stretches, thankfully, I've had no problem lately. Always good to see you, visit and insightful comment much appreciated. Let's hope we've seen the last of those awful symptoms, take care and my best always.


suzettenaples profile image

suzettenaples 2 years ago from Taos, NM

Hi Jo: What a great article chock full of great information, tips and advice. I suffer from sciatica sometimes. When I feel the pinch coming on, I immediately stop and do my stretching exercises and that usually helps to stop a full blown attack. Fortunately, (knock on wood) I haven't had back problems with discs or spinal problems. But, this article certainly one I would reference if I did. Thanks so much for sharing your knowledge with us. You do great research too on your hubs and articles.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Sciatica is no fun at all. Keep that back healthy. Thank you for taking a look and for the comment. Much appreciated.

I hope you're having a terrific day, my best.


FlourishAnyway profile image

FlourishAnyway 2 years ago from USA

Wow, those emergency symptoms are enough to scare anyone! Luckily my back is a-ok.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi aesta1, thanks for the visit, comment and share. Sciatica can be very painful. I'm glad you found the article helpful.

Take care and my best to you.


aesta1 profile image

aesta1 2 years ago from Ontario, Canada

You made this sciatica so clear to me. I used to think I had a kidney problem. I know of people who really are suffering from this. I just have to share this with them.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

ChitrangadaSharan, I appreciate you reading the hub, so glad you found it helpful. I'm sorry to learn about your relative, sciatica is indeed a painful condition. Many thanks and my best to you.


ChitrangadaSharan profile image

ChitrangadaSharan 2 years ago from New Delhi, India

Very useful and informative hub about Sciatica!

One of my relative has this painful disease. Your hub is quite helpful to those who are facing this problem in the initial stages and even to those who want to prevent it from happening.

Thanks and voted up!


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Eddy, it's wonderful to see you!! Your fans have been searching high and low for you, great to see you back. I'm sorry to know that you also suffer from sciatica, I knew this was a common condition but it seem to affect everyone at some time in their lives. I'm glad you found the article useful. Great to have you back, I hope all is well, you were surely missed. :)


Eiddwen profile image

Eiddwen 2 years ago from Wales

I suffer from this condition after two back operations and found this great hub interesting and very useful . Thanks for sharing tobu and voting up.

Eddy.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Jim, your comment is spot on.

Sciatica pain can bring us right down but the experts advise that the best thing is to keep moving.

I'm sorry to learn that you also suffer from this condition, I hope the article helps. Take care and my best to you.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Shara63, I hope you're well and the sciatica is not a problem right now. Thank you for stopping by, it's lovely to see you.

Take care and my best to you.


shara63 profile image

shara63 2 years ago from Delhi

tobusiness, done a great job as ever...as so many people now a days are suffering from this problem and myself too is a vuictim of it...i'm sure your hub will prove very useful & beneficial to all including me...God bless you dear!


Pawpawwrites profile image

Pawpawwrites 2 years ago from Kansas

I don't have a problem with this often, but when I do, it can get me down for a few days. I try to keep active, because it seems that I have more problems when I sit too much.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Cat, sometimes it's difficult to tell the difference between hip pain due to arthritis and true sciatica. Sciatica tends to radiate along the nerve, pain can be felt in the butt and down the legs. It's good to know that the hip operation was successful. I'm really glad that you found the hub useful and easy to understand. It's lovely to see, take care and best wishes.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Frank, those health hubs are a good way to keep my little grey cells active and I enjoy writing and sharing them.

Thank you for stopping by, always a pleasure.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi Devika, Walking upright is one of the things that makes us human the most successful primate on earth, however, there's also a down side, ' back pain.' The effects of gravity plays havoc with the spine. :)

Always lovely to see you, my best to you and your family.


cat on a soapbox profile image

cat on a soapbox 2 years ago from Los Angeles

Good morning, Jo! Thank you for this very informative and easy to understand discussion about sciatica. Before I had my right hip replacement, I used to really suffer from this pain at night, unable to get comfortable, and couldn't sleep. Putting an ice bag under my butt cheek was very helpful. Your explanation of the piriformis syndrome really makes sense, and I can see now why I hurt so much. Sciatica is miserable and debilitating for those I know who suffer. Understanding its dynamics is the first step to successful treatment. Excellent hub!

My best to you,

Cat :)


Frank Atanacio profile image

Frank Atanacio 2 years ago from Shelton

tobusiness your health hubs are always right on.. easy to follow and loaded with tips voted up and useful :)


DDE profile image

DDE 2 years ago from Dubrovnik, Croatia

A very helpful hub on back pain now I know of why most people complain about such pain. You always inform me of the most important, thank you. Voted up, useful, and interesting.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

MsDora, from you, this means a lot. I'm glad that I was able to shed some light on this very painful and common problem. Thank you for stopping by. My best to you.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Nell, lovely to see you. Appreciate the visit and comment. I hope the pain isn't to bad. Sciatica is what was once referred to as lumbago, lower back pain caused by muscle strain or herniated discs. So glad you found the hub useful. take care and my best to you.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Hi John, so glad you found this useful, sorry to learn that your wife also suffers from this problem, I hope she's coping well. Sciatica can be exceedingly painful. Always lovely to see you, stay well, my best to you and your family.


Nell Rose profile image

Nell Rose 2 years ago from England

Hi, this is fascinating, I have always suffered from it because I worked in an office for many years, and also did a lot of lifting too, boxes and post etc, but I never knew the medical terms or exactly what or how it happened, great explanation and pictures, nell


Jodah profile image

Jodah 2 years ago from Queensland Australia

Wonderful article Jo, full of great advice and details about sciatica. The diagrams are brilliant for helping to convey the information clearly. My wife has scoliosis and also suffers from sciatica occasionally so I found this very helpful. Thanks for sharing your knowledge. Voted up.


MsDora profile image

MsDora 2 years ago from The Caribbean

Really good information and presentation. I hear so many complaints about back pain, and you help us make sense of it. Thanks especially for reminding us of how we can help ourselves: e.g. the way we move, the periods of sitting and standing. Voted Up!


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Mdscoggins, Yoga is a very good way to stretch the pirifomis muscles. For true sciatica lying on the back pulling the knees to the chest can help to increase blood supply when the disc space is opened and closed. But this should really be done under the direction of a professional. I hope the yoga works for your husband to give him some relief. Thank you so much for stopping by, take care and my best to you both.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Faith, so sorry about your hubby, he must be in so much pain when it flares, I hope the doctors are doing something about it. Always lovely to see you, take care and blessings always.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Good morning Brian, such a pleasure to see you.

Thanks for reading this and for the kind comment, much appreciated, my best to you.


mdscoggins profile image

mdscoggins 2 years ago from Fresno, CA

Great article. My husband has sciatica and struggles with finding relief. His doctor just recommended yoga which makes sense because it works to strengthen the core. Thanks for the additional info. Voted up!!


Faith Reaper profile image

Faith Reaper 2 years ago from southern USA

Excellent article as always, dear Jo. My husband has this and his disc has about deteriorated. He manages okay, but it flares up often.

Comprehensive hub here.

Bless you


B. Leekley profile image

B. Leekley 2 years ago from Kalamazoo, Michigan, USA

Up, Useful, and Interesting. This is a very well researched article.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Ruby, for us, this is an occupational hazard. The stretching really helped me also, I still do them when I feel the odd twinge. I found that placing a pillow between the knees when I'm in bed also helped. Anti-inflammatory drugs relieves the pain but can cause problems with stomach ulcers so one needs to be careful.

One of my colleague had a really rough time after taking NSAIDs for a slipped disc. Thank you for taking a look and for the very insightful comment. It's always a pleasure to see you. My best always.


always exploring profile image

always exploring 2 years ago from Southern Illinois

Jo, I am one of the unfortunate nurses who suffer with back pain. I have two herniated discs, L 4 and 5. I used to get the corticocosteroid injections when I was working, they helped a lot, now I manage by stretching exercise, I bring my knee up to my nose and stretch, this works wonderfully. Most of my pain is in the buttock. Thank goodness I only have it periodically. This is another great article, detailed and understandable. Thank you...


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Bill, thank you so much for the continued support, it's always so nice to see you, I hope all's well.

Back pain is no fun at all, good to know that your op was successful. Take care now, my very best as always.


tobusiness profile image

tobusiness 2 years ago from Bedfordshire, U.K Author

Audrey, I'm so glad you found this useful, I really appreciate the visit and comment. This type of pain can be very disabling. Touch wood, I haven't had it in a while. Always a pleasure, my best to you.


billybuc profile image

billybuc 2 years ago from Olympia, WA

I had a back operation in 1989 for a bulging disc....worst pain I've ever experienced, so I know a little about back pain. Great information here, Jo, but then I expect that of you.

Have a wonderful evening my friend.


AudreyHowitt profile image

AudreyHowitt 2 years ago from California

Such a useful article on the subject. I know so many people who suffer from this! So well done Jo!

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