Sciatica

What is Sciatica?

Sciatica is not a medical diagnosis in itself but rather a symptom of an underlying medical condition. It refers to pain that radiates along the path of the sciatic nerve, which is the longest and widest nerve in the human body. The sciatic nerve begins in the lower back, runs through the buttocks, and extends down the back of each leg to the feet.

The pain typically affects only one side of the body and can range from a mild ache to a sharp, burning sensation or excruciating discomfort. Some people describe the pain as similar to an electric shock. Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in the spine or by an overgrowth of bone (bone spur) on the vertebrae.

While sciatica can be significantly painful and disabling, most cases resolve with non-operative treatments in a few weeks. Understanding the condition, its causes, and treatment options is crucial for effective management and recovery. In rare cases where conservative treatment fails or neurological symptoms progress, surgical intervention may be necessary.

Common Symptoms

Causes and Risk Factors

Sciatica occurs when the sciatic nerve is compressed or irritated. Understanding the various causes helps in proper diagnosis and treatment:

Primary Causes

Herniated or Bulging Disk (90% of cases)

• Soft inner material of spinal disk protrudes through outer ring
• Puts pressure on nerve roots forming the sciatic nerve
• Most common at L4-L5 or L5-S1 levels
• Can occur from injury or degenerative changes

Spinal Stenosis

• Narrowing of the spinal canal
• Compresses nerve roots
• More common in older adults
• Often develops gradually

Spondylolisthesis

• One vertebra slips forward over another
• Can pinch nerve roots
• May be congenital or acquired
• Common in athletes

Piriformis Syndrome

• Piriformis muscle spasms and compresses sciatic nerve
• Accounts for about 6% of sciatica cases
• More common in runners and athletes
• May cause buttock pain

Risk Factors

• Age: Peak incidence between 30-50 years
• Occupation: Jobs involving heavy lifting, twisting, or driving
• Prolonged sitting: Sedentary lifestyle increases risk
• Obesity: Increases stress on the spine
• Diabetes: Increases risk of nerve damage
• Smoking: Reduces blood flow to spinal disks
• Previous back injury: Increases susceptibility
• Poor posture: Adds stress to spine

Less Common Causes

• Spinal tumors (rare)
• Infection in the spine
• Cauda equina syndrome (medical emergency)
• Trauma or injury to the spine
• Pregnancy (temporary sciatica)

Diagnosis

Accurate diagnosis of sciatica involves identifying both the symptoms and the underlying cause:

Medical History

• Detailed description of pain location and pattern
• Onset and duration of symptoms
• Activities that worsen or relieve pain
• Previous back problems or injuries
• Current medications and treatments tried

Physical Examination

Neurological Tests

• Straight leg raise test: Pain between 30-70 degrees indicates sciatica
• Crossed straight leg raise: Pain in affected leg when opposite leg raised
• Muscle strength testing: Checks for weakness patterns
• Reflex testing: Diminished reflexes indicate nerve involvement
• Sensory testing: Maps areas of numbness or altered sensation

Imaging Tests

When Imaging is Needed

• Symptoms persist beyond 6-8 weeks
• Severe or progressive neurological deficits
• Suspected serious underlying condition
• Planning for surgical intervention

Types of Imaging

• X-rays: Show bone abnormalities but not disk problems
• MRI: Best for visualizing soft tissues, disks, and nerves
• CT scan: Good for bone detail, may use contrast
• CT myelogram: Contrast dye injected into spinal canal
• Electromyography (EMG): Measures electrical impulses in muscles

Treatment Options

Most cases of sciatica improve with conservative treatment within 4-8 weeks. Treatment focuses on pain relief and addressing the underlying cause:

Exercise and Stretches

Specific exercises can help relieve sciatica pain and prevent recurrence:

Recommended Stretches

• Knee to chest: Stretches lower back and glutes
• Piriformis stretch: Targets piriformis muscle
• Seated spinal twist: Improves spinal mobility
• Cat-cow stretch: Increases spine flexibility
• Child's pose: Gentle back stretch
• Hamstring stretches: Reduces tension on lower back

Strengthening Exercises

• Core stabilization exercises
• Pelvic tilts
• Bridge exercises
• Bird dog exercise
• Partial crunches
• Wall sits

Activities to Avoid

• Heavy lifting without proper form
• Twisting movements under load
• High-impact activities during acute phase
• Prolonged sitting
• Toe touches or full forward bends

Prevention

While not all cases of sciatica can be prevented, these strategies can reduce your risk:

• Exercise regularly: Focus on core strength and flexibility
• Maintain good posture: Especially when sitting for long periods
• Use proper lifting techniques: Bend knees, keep back straight
• Maintain healthy weight: Reduces stress on spine
• Quit smoking: Improves disk health
• Ergonomic workspace: Proper chair and desk setup
• Regular breaks: Avoid prolonged sitting or standing
• Sleep position: Use supportive mattress and pillows
• Stay active: Regular low-impact exercise
• Manage stress: Tension can worsen back problems

Recovery and Prognosis

The outlook for sciatica is generally good with appropriate treatment:

Recovery Timeline

• Acute phase: 1-2 weeks of most severe pain
• Improvement: 50% better within 6 weeks
• Full recovery: 80-90% recover within 3 months
• Chronic cases: 10-20% may have persistent symptoms

Factors Affecting Recovery

• Early treatment intervention
• Adherence to exercise program
• Overall health and fitness level
• Severity of nerve compression
• Presence of neurological deficits
• Psychological factors and stress

Long-term Management

• Continue preventive exercises
• Maintain healthy lifestyle
• Regular follow-up for chronic cases
• Address ergonomic factors
• Manage flare-ups promptly

When to See a Doctor

While mild sciatica often improves on its own, certain situations require medical attention:

See a Doctor If

• Pain persists beyond 1 week of self-care
• Pain is severe or progressively worsening
• Numbness or weakness in the leg
• Difficulty walking or standing
• Pain following trauma or injury
• Associated fever or unexplained weight loss

Seek Emergency Care For

• Sudden, severe weakness in the leg
• Loss of bladder or bowel control
• Numbness in groin or genital area
• Pain in both legs
• Progressive neurological symptoms

Living with Sciatica

Managing sciatica effectively involves lifestyle adaptations and ongoing care:

Daily Management Tips

• Plan activities to include regular position changes
• Use supportive seating with lumbar support
• Apply heat or ice as needed for pain relief
• Practice stress-reduction techniques
• Keep a pain diary to identify triggers
• Stay connected with support groups

Work Modifications

• Ergonomic workstation setup
• Standing desk options
• Regular stretch breaks
• Proper lifting equipment
• Job modification if needed

Related Conditions

Several conditions may occur with or mimic sciatica:

• Piriformis Syndrome: Similar symptoms but different cause
• Spinal Stenosis: May coexist with sciatica
• Herniated Disk: Most common cause of sciatica
• Degenerative Disk Disease: Can lead to sciatica
• Spondylolisthesis: Vertebral slippage causing nerve compression
• Sacroiliac Joint Dysfunction: Can mimic sciatica symptoms
• Hip Bursitis: May be confused with sciatica
• Peripheral Neuropathy: Different nerve condition with similar symptoms