Sciatica & Radiculopathy
Sciatica refers to pain, numbness, tingling and/or weakness in the leg. It is caused by injury to or pressure on the sciatic nerve or its origin nerve roots. Sciatica is a symptom of a medical problem. It is not a medical condition on its own.
Sciatic nerve is the largest and the longest nerve in our body. The sciatic nerve stretches from the spinal cord to the end of each leg. The sciatic nerve is formed from the L4 to S3 nerve roots of lumbar and sacral plexus. These nerve roots unite to form a single nerve in front of the piriformis muscle. The nerve frequently pierces or passes beneath the piriformis muscle before entering the pelvis. From here, it travels down the back of the thigh to the knee. The nerve divide into two major trunks just behind the knee: the tibial nerve and the common peroneal nerve.
Causes Of Sciatica
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, the outer and back part of the lower leg, and the sole of the foot.
Common causes of sciatica include:
- Slipped herniated disk
- Spinal stenosis – Central or Foraminal
- Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
- Pelvic injury or fracture
Men between 30 and 50 years of age are more likely to have sciatica.
Symptoms Of Sciatica
Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move.
The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. Sometimes, your foot gets caught on the ground when walking.
The pain may start slowly. It may get worse:
- After standing or sitting
- During certain times of the day, such as at night
- When sneezing, coughing, or laughing
- When bending backward or walking more than a few yards or meters, especially if caused by spinal stenosis
- When straining or holding your breath, such as during a bowel movement
Exams and Tests
The health care provider will perform a physical exam. This may show:
- Weakness when bending the knee
- Difficulty bending the foot inward or down
- Difficulty walking on your toes
- Difficulty bending forward or backward
- Abnormal or weak reflexes
- Loss of sensation or numbness
- Pain when lifting the leg straight up when you’re lying on the exam table
Tests are often not needed unless pain is severe or long-lasting. If tests are ordered, they may include:
- Blood tests
- X-ray, MRI, or other imaging tests
As sciatica is a symptom of another medical condition, the underlying cause should be identified and treated.
In some cases, no treatment is required and recovery occurs on its own. Conservative (non-surgical) treatment is sufficient in many cases. Your provider may recommend the following steps to calm your symptoms and reduce inflammation:
- Apply heat or ice to the painful area. Try ice for the first 48 to 72 hours, then use heat.
- Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
Measures to take care of your back at home may include:
- Bed rest is not recommended.
- Reduce your activity for the first couple of days. Then, slowly start your usual activities.
- DO NOT do heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
- Start exercising again after 2 to 3 weeks. Include exercises to strengthen your abdominal (core) muscles and improve flexibility of your spine.
Your provider may also suggest physical therapy. Additional treatments depend on the condition that is causing the sciatica.
If these measures do not help, your provider may recommend injections of certain medicines to reduce swelling around the nerve. Other medicines may be prescribed to help reduce the stabbing pains due to nerve irritation. One of the most effective treatment of radiculopathy, when one or more spinal nerve roots are impinged is selective nerve root block.
Selective Nerve Root Block (SNRB) provides excellent short- to medium-term relief from radiculopathy pain.
If you are unfortunately suffering from chronic sciatica or radiculopathy due to scar tissue (prior surgery), nerve root injury or Complex Regional Pain Syndrome (CRPS, sorely known as RSD), more advanced minimally invasive techniques like pulsed dorsal root ganglion ablation or dorsal root ganglion stimulation might be highly effective in controlling your pain.
Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a pain specialist to ensure that you have access to the widest range of treatment options.
Often, sciatica gets better on its own. But it is common for it to return.
More serious complications depend on the cause of sciatica, such as slipped disk or spinal stenosis. Sciatica can lead to permanent numbness or weakness of your leg.
When to Contact a Medical Professional
Call your provider right away if you have:
- Unexplained fever with back pain
- Back pain after a severe blow or fall
- Redness or swelling on the back or spine
- Pain traveling down your legs below the knee
- Weakness or numbness in your buttocks, thigh, leg, or pelvis
- Burning with urination or blood in your urine
- Pain that is worse when you lie down, or awakens you at night
- Severe pain and you cannot get comfortable
- Loss of control of urine or stool (incontinence)
Also call if:
- You have been losing weight unintentionally (not on purpose)
- You use steroids or intravenous drugs
- You have had back pain before, but this episode is different and feels worse
- This episode of back pain has lasted longer than 4 weeks
Prevention varies, depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.
Source: MedlinePlus Encyclopedia