The Sciatic Nerve starts right outside your lower spine and runs through your buttock and down your leg. However, it does not mean that you have sciatica just because you have back, buttock or leg pain. You can have pains in these areas from other low back conditions. Sciatica pain is distinctly different because of its symptoms identified below. Sciatica is not a disorder in and of itself. Instead, sciatica is a symptom of another problem involving the nerve, such as a herniated disk.
Sciatica symptoms include:
- Pain is most likely to occur along a path from your low back to your buttock and the back of your thigh and calf.
- Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another.
- Tingling or a pins-and-needles feeling, often in your toes or part of your foot.
Many cases of sciatica there is little to no back or buttock pain. Sometimes the pain and tingling seems to skip the thigh but is present in the calf. If you are just having pain without the tingling in your back, buttock and leg, most likely you do not have sciatica.
Sciatica pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting also can aggravate symptoms. Usually only one lower extremity is affected.
The most likely cause of sciatica is a herniated or ruptured disc in your back that compresses the Sciatic Nerve.
Other conditions also can put pressure on your sciatic nerve, including:
Lumbar spinal stenosis. This is a narrowing of your spinal canal. Think of your spinal canal as a pipe. When it gets older, it corrodes and the inside of the pipe gets a buildup narrowing the center hole. As the hole gets smaller, there is less room for the nerves. Eventually this can lead to compression of the nerves.
Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves your spine.
Piriformis syndrome. The Piriformis muscle is a muscle in your buttock and runs from your tailbone to your hip. It helps to rotate your foot out. Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the Sciatic Nerve. Prolonged sitting, car accidents, and falls also can contribute to Piriformis syndrome. Typically, there is not much if any back pain.
Spinal tumors and cysts. In the spine, tumors can occur inside the spinal canal, in the space between the spinal cord and the vertebrae. As it grows, a tumor or cyst can compress the cord itself or the nerve roots. Tumors are rare but spinal cysts seem to be becoming more common. Spinal cysts are associated by disc degeneration and cortisone use.
Trauma. A car accident, fall, or blow to your spine can injure the lumbar or sacral nerve roots.
Other causes. In some cases, your doctor may not be able to find a cause for your sciatica. A number of problems can affect your bones, joints and muscles, all of which could potentially result in sciatic pain.
Frequently, two or three of these causes can occur at the same time.
Major risk factors for sciatica include:
· Age. Age-related changes in the spine are a common cause of sciatica. You’re likely to have some deterioration in the discs in your back by the time you’re 30, and most people who develop herniated discs are in their 30s and 40s. You likely had problems before and they may not have been very painful. But if your biomechanics (the way you move) are bad, your spine will degenerate faster and lead to these types of problems.
· Occupation. A job that requires you to twist your back, carry heavy loads, or drive a motor vehicle for long periods makes you more prone to develop sciatica.
· Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are. I see many long distance truck drivers with Piriformis Syndrome.
· Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.
· Poor nutritional state. Deficiencies, especially nutrients that help relax muscles, can also lead to tightness in the Piriformis Muscle leading to Sciatica.
Tests and diagnosis
To help diagnose sciatica and pinpoint which nerves, if any, are affected your non-surgical chiropractic physician specialist will obtain a medical history and perform a thorough physical exam, paying special attention to your spine and legs. He or she will check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position, and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during these activities. This type of examination is a neurological and orthopedic examination.
You may have one or more imaging tests to help identity why the Sciatic Nerve is compressed and to rule out other causes for your symptoms.
These tests include:
· Spinal X-ray. Because ordinary X-rays can’t detect herniated disc problems or nerve damage, they’re not usually helpful for pinpointing the cause of sciatica. A spinal X-ray can show most cancers affecting the bony structures of the spine, narrowed discs, and spondylolisthesis, however, and can help rule out other causes of sciatica.
· Magnetic resonance imaging (MRI). This is probably the most sensitive imaging test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your discs as well as the presence of tumors. MRI is noninvasive and has no harmful side effects. But MRIs can reveal many abnormalities that may have no significance on the cause of your sciatica. For example, the MRI may find herniated discs in your low back. It is well known that about 60% of herniated discs on MRIs produce no symptoms. MRI findings have to be correlated with the findings of the neurological and orthopedic examination. I have seen many cases of sciatica that were previous treatment failures because the prior doctor assumed the Sciatica was caused by the herniated disc when in fact the herniated disc had nothing to do with the Sciatica. The Sciatica was due to a Piriformis Muscle shortening.
· Nerve tests. To confirm that the Sciatic Nerve is functioning abnormally a nerve test is performed. A neurologist, physiatrist, or a chiropractic physician performs the nerve test. There are two parts to the nerve test. A Nerve Conduction Study is performed by passing an electrical current between two points a known distance apart and the speed on the transmission is measured. The second test is an EMG. During that test very small needles are inserted into specific muscles to determine if there are abnormalities in the electrical signals. Typically I do not order these tests unless the sciatica is not resolving as expected.
Treatments and drugs
If you have a physical cause of your sciatica such as a herniated disc, spondylolisthesis, or Piriformis Syndrome, treatments from a non-surgical spinal specialist, a chiropractic physician or physical therapist can play a vital role in your recovery. Non-surgical spinal decompression is a cornerstone treatment for disc problems. Once acute pain improves, your specialist will design a personalized rehabilitation program to help correct the underlying problems and prevent recurrent injuries. (See: Schuylkill County: LOW BACK PAIN: PATIENTS REPORT WHAT WORKED)
Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back, and improve your flexibility. The Medx Lumbar Extension has a proven record for helping back pain and weak low back muscles. (See: If You Have Chronic Back Pain, You Have To Read About These Remarkable Treatment Results) Pain relief is important, but it is only the first step in correcting the Sciatica problem. There may be stretches and/or exercises that you will be asked to do at home
Prescription drugs. In some cases of severe pain, medication may be necessary. Common medications include anti-inflammatory medication along with a muscle relaxant.
More aggressive treatments When conservative measures don’t alleviate your pain within a few months, one of the following may be an option for sciatica treatment:
· Epidural steroid injections. In some cases, your specialist may recommend a corticosteroid injection into the affected area. Epidural steroid injection is contraindicated as a first line of treatment. This option may be helpful to relive persistent pain and allow rehab to continue. Epidurals without rehab do nothing but temporarily relive pain. (See: Schuylkill County: What You Need to Know About Steroid Shots in the Spine (Epidurals))
· Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel, or bladder incontinence, or you have pain that gets progressively worse or doesn’t improve with other therapies.
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Doctors’ Choice Physical Medicine and Rehab
Dr. David Novatnak
Glee Pascual, Physical Therapist
Pottsville, Schuylkill, PA