Back pain is one of the most common complaints people experience as they age. Though certain back conditions like sciatic can strike at almost any age. The pain, discomfort, numbness, and potential loss of strength in the lower extremities can significantly hamper your quality of life.
What Is Sciatica?
Sciatica is a back condition that describes significant nerve pain in the legs and lowers back. It is caused by compression, irritation, or inflammation of the sciatic nerve. It originates in the lower back, and typically radiates deep into the buttock region, and often radiates down into one of the legs.
What Are Common Symptoms Of Sciatica?
Sciatica has a few common symptoms to watch out for. This includes the following:
Pain
Many sciatica sufferers describe pain that feels like a constant burning sensation and may also be associated with a shooting pain starting in the lower back, that descends into the buttock on the affected side. Many sciatica cases also experience pain that runs down the front or back of the thigh which might extend all the way down to the lower leg or the foot.
Numbness
Many people dealing with sciatica pain also experience some degree of tingling or numbness that can sometimes extend to the back of the leg or lower portion of the leg on the affected side.
Symptoms Are Limited To One Side
Sciatica typically affects only one leg. It is often accompanied by a feeling of heaviness in the affected leg. Most cases of sciatica do not affect both legs.
Posture Issues
Many sciatica sufferers note that they feel worse while sitting, standing up, or bending their spine forward. Some cases also cause pain when twisting the spinal column, trying to lay down, and may also feel lower back pain when coughing or sneezing.
What Causes Sciatica?
Sciatica can be caused by a few different things. It can also occur in conjunction with another type of back injury or chronic condition. Some of the most common causes of sciatica include the following:
Direct Compression
Injuries and medical conditions that compress the sciatic nerve can cause the lumbar disc to bulge, causing it and surrounding structures to press on the nerve impeding the signals to the lower back, buttock, and lower extremities on one side.
Herniated Disc
When a vertebral disc herniates it can compress one side of the sciatic nerve causing symptoms in one leg. In a severe case, the disc might herniate from both sides. This is known as “Bilateral Sciatica” and can affect both legs and both sides of the lower extremities. Though this is relatively rare.
Degenerative Disc Disease
As we age it’s possible for the discs and tissues of the lumbar spine to degenerate, which causes compression and irritation of the sciatic nerve. This typically affects the facet joints of the synovial tissue in the joint’s capsule. This can lead to further complications caused by inflammation. In some of these cases, abnormal bone growths, known as osteophytes can worsen irritation of the sciatic nerve causing periodic “Flare-Ups” of symptoms.
Lumbar Spinal Stenosis
This is a condition that causes a gradual narrowing of the spinal canal and is relatively common in older adults. It can cause contact, compression of irritation of the sciatic nerve in the lower back.
Spondylolisthesis
This is essentially a small stress fracture in one of the vertebral bodies, that causes it to slip forward on another vertebral body. This in turn leads to compression in the lower back which can affect the sciatic nerve. It can also cause bilateral sciatica that affects both legs.
How Is Sciatica Diagnosed?
Your physician will likely start the diagnostic process with a physical examination. This will also be strongly influenced by your medical history. Be sure to let your doctor know about any past back problems such as herniated discs, old back injuries, or a family history of lower back problems.
During the exam, you will likely be asked to perform a “Straight Leg Raise test, where you lay on your back and lift up one leg at a time with the other leg flat or bent at the knee.
Next, your physician will probably ask you to perform a “Slump Test” where you are seated upright with both of your hands behind your back. You will then be asked to slumps forward at the hip. Your neck is bent down with your chin touching your chest while one knee is extended out as far as possible. If pain occurs in this position it typically indicates that the sciatic nerve is being affected.
After the physical examination, your physician will likely recommend diagnostic imaging. This might involve an MRI or a discogram to visually assess the cause and how severely affected the sciatic nerve is.
How Is Sciatica Treated?
The treatment strategy that your physician presents will be based on the severity of your symptoms as well as the suspected underlying cause. This might include the following things.
Anti-Inflammatory & Pain Medications
This will help reduce pain while the affected structures in the lower back are healing. Effective pain management strategies can also improve physical therapy’s range of motion.
Physical Therapy
Most cases of sciatica require an extended period of physical therapy. Your physical therapist will develop a course of exercises and stretches customized to your symptoms and the severity of your sciatic symptoms. This might involve outpatient therapy sessions as well as stretches and exercises that you can do at home.
Chiropractic Therapy
Chiropractic adjustments and other therapeutic measures such as therapeutic massage might also help sciatica suffers from symptom reduction. Especially in cases of a bulging or herniated disc that is causing physical compression in the lumbar region.
Epidural Steroid Injections
These injections might help to relieve sciatic pain that is related to other conditions such as spinal stenosis, disc herniation, or degenerative disc disease. They are designed to help manage pain while also helping to control the inflammatory response in the tissues around the sciatic nerve from chemical and mechanical sources of pain, such as a herniated disc or a degenerated disc.
Selective Nerve Root Blocks
This is another type of injection that is administered near the spinal nerve where it exits the intervertebral foramen. This effectively helps reduce inflammation while also serving to numb the pain transmitted by the nerve. It may need to be performed near multiple vertebral structures for complete effectiveness.
Surgical Treatment For Sciatica
In some severe cases of sciatica surgical intervention might be needed to repair the affected structures or to treat a related condition that is causing sciatica. The following are some of the most common surgical remedies for sciatica.
Microdiscectomy
This procedure is often used to treat sciatica that is caused by a herniated lumbar disc. It involves removing a small portion of the disc material under the nerve root and might also call for removing a small amount of bone over the nerve root.
Laminectomy
This procedure is designed to remove a significant portion of the lamina to provide more room for the spinal nerves. This is more common for sciatica pain that is caused by lumbar spinal stenosis.
Foraminotomy
This surgical procedure is designed to address sciatic problems where the neuroforamen is enlarged. It essentially removes the bony overgrowth, which then provides more room for the nerve root as it exits the spinal column.
Facetectomy
This surgical procedure is used to relieve compression on compressed nerves that are caused by degenerated facet joints. The facet joints are precisely trimmed, undercut, or removed to significantly reduce nerve pressure.