Sciatica is commonly referred to radiating leg pain, starting in the lower back radiating to buttocks, back of the thigh down to leg occasionally to foot and toes. Sciatica is caused due irritation or inflammation of lumbosacral nerve roots (sciatic nerve), attributing to pinched nerve resulting in pain and sometimes weakness in leg.
Sciatica pain can be in form of burning and electric shock like sensation or tingling and numbness or the classical radiating pain.
- Rarely seen in younger population – less than 20 years of age
- No gender predominance
- 5%-10% of patients with low back pain have sciatica
- Annual incidence of 1% to 5 %
- Lifetime prevalence of 10% to 40 %
- Strenuous physical activity increases incidence in those with prior sciatic symptoms
- Up to 30 % of patients may have pain for one year or longer
Risk factors for sciatica:
- Increasing age (peak 45- 64 years)
- Obesity / Overweight – mechanical stress on spine – degeneration of intervertebral disc
- Strenuous physical activity – heavy manual labour, lifting heavy weights, sudden bending and twisting
- Smoking – decreased pain threshold through sensitizing pain receptors from nicotine
- Sedentary lifestyle
- Wear and tear from sports and gyming
Causes:
- Herniated lumbar disc (slip disc) – bulging or herniated disc – Disc are like jelly like soft substance covered by outer rim. Jelly – like inner material can come out of its confines and pinch or inflame the nearby nerve
- Lumbar Degenerative disc disease – tear and break down of disc leads to bulging disc with loss of height thereby compressing the nerve
- Lumbar spinal stenosis- narrowing of spinal canal – As a part ageing process the space for the nerve to pass become narrower leading to stenosis and leg pain
- Lumbar Spondylolisthesis – when two vertebrae slip or slide over one another to produce the abnormal positioning of two vertebrae leading to compress the nerve
- Tumors of spine – spinal tumors are abnormal growth of cells that may be either benign or cancerous. However, when spinal tumor develops in the lumbar region it may compress the nerve producing sciatica
- Synovial cyst of facet joint – abnormal fluid filled sacs in facet joints of spine causing spinal stenosis and sciatica
- Piriformis Syndrome- Piriformis muscle helps in hip extension and rotation of leg, attached sacral spine to the upper portions of the femur. Due to the proximity of the sciatic nerve, any injury or inflammation to the piriformis muscle can cause sciatica like pain
- Pregnancy- especially during third trimester – Obstetrical sciatic nerve compression
- Pelvic floor tumours
Treatment options:
It’s not life life-threatening conditions, but it’s always good a visit a doctor.There are various and non-surgical and surgical options, later being considered when abnormality is detected on imaging
- Home remedies
- Hot or cold compression packs for comfort and reduce the pain
- Bed rest with minimal activity (sitting up, walking in the house, use of rest room) until the acute pain subsides, prolonged best red is not recommended; a few hours of bed rest may provide some symptomatic relief but does not result in faster recovery
- Pharmacological intervention
- Analgesic – oral or injection (in severe cases) after consultation with doctor
- Muscle relaxants will be of benefit, But no role of steroid
- Traction – Not effective; Not recommended for spinal tumours
- Non-surgical intervention
- Local epidural steroid injection if not relived by medications
- Electrotherapy – Percutaneous electrical nerve simulation (PENS) and transcutaneous electrical nerve simulation (TENS)
Worsening and progressive pain not relieved by above measures warrants a hospital visit.
Presence of following symptoms needs emergency consultation by a spine specialist – RED FLAGS
- Weakness in the legs
- Numbness around the genitals or around the anus
- Difficultly in passing urine
- Loss or difficultly in controlling when there is an urge pass urine (cauda equina syndrome)
- Prolonged duration of pain (> 6 weeks)
- Recurrent episodes of pain
Presence of these symptoms needs through emergency examination and MRI
The primary goal of treatment is to relieve pain, to achieve this goal, each patient’s treatment plan should be individualized based on the source of the pain and pathology identified
