Sciatica

Causes of sciatica

Sciatica is caused when the sciatic nerve becomes pinched. This can occur from the following conditions:

• Lumbar herniated disc — sciatica is the most common symptom of a lumbar herniated disc.
• Bone overgrowth or spurs — can put pressure on the sciatic nerve.
• Tumors — the sciatic nerve may be compressed by a tumor.
• Lumbar spinal stenosis — as the spinal canal narrows, this puts pressure on the sciatic nerve.
• Piriformis syndrome — as the piriformis muscles run down the buttocks into the leg, the sciatic nerve can get irritated and pinch the nerve.
• Scar tissue — patients who have had previous spinal surgery may have scar tissue that has built up and is affecting the nerve root.

Risk factors for sciatica

As you get older, you are more prone to get herniated discs, bone spurs and other spine conditions that could irritate the sciatic nerve and cause sciatica.

Other risk factors for sciatica include:

• Obesity — excess weight can increase stress on the spine and cause sciatica.
• Occupation — jobs that require sitting for long periods or carrying heavy loads can contribute to sciatica.
• Extended periods of sitting — people who sit for long periods of time or are sedentary are more likely to develop sciatica.
• Posture — people with poor posture are at greater risk of developing lumbar radiculopathy.

Symptoms of sciatica

The most common symptom of sciatica is pain that radiates down the lumbar spine (lower back) to your buttocks and down the back of your leg. Pain can occur at any point along the pathway from the lower back to the calf and can vary from mild to severe pain. Extended sitting can aggravate pain symptoms of sciatica.

Other symptomatic indications of sciatica include:

• Back or leg pain that worsens when you sneeze or cough
• Numbness, tingling or muscle weakness in the affected leg or foot
• Localized back pain 
• Sharp pain that is so intense that walking is difficult
• Hypersensitivity to light touch

Diagnosis of sciatica

Sciatica can be diagnosed in a physical exam with a spine specialist. Your doctor will do a physical exam to test your range of motion, feel your spine, look for muscle spasms, test reflexes, muscle strength or nerve changes. Your doctor will get a medical history by asking what your symptoms are, determine what caused the initial symptoms and when the symptoms are worse.

The doctor may also order diagnostic testing to determine the cause of the sciatica, including:

• X-ray — can help determine if there is a bone growth that is pressing on the sciatic nerve.
• MRI — can determine if you have a herniated disk.
• CT scan — can show more details of what is happening in the spinal cord and spinal nerves.
• Electromyography (EMG) — tests the impulses in the muscles and can confirm if a nerve is compressed caused by spinal stenosis or a herniated disc.

Together, this information will help your doctor diagnose your sciatica and develop a treatment plan specially created for you.

Treatments for sciatica

Previously, physicians recommended rest to treat sciatica. Newer research indicates that activity can speed recovery. Additional treatments may include:

• Steroid injection — may help reduce pain by reducing inflammation around the sciatic nerve.
• Physical therapy and rehabilitation — a combination of stretching, aerobic condition and strengthening exercises can help you recover more quickly from sciatica pain.
• Surgical decompression — removal of the bone spur or herniated disc that is pinching the sciatic nerve; surgery is typically recommended when sciatica causes loss of bowel control or progressively worsens with therapy.

Recovery from sciatica

If you follow your physician’s or physical therapist’s instructions, most people will recover from sciatica without surgery. Your physician may also recommend lifestyle changes that can help relieve unnecessary stress to the spine.

To prevent future cases of sciatica, it is important to exercise regularly, maintain proper posture when sitting and use good body mechanics.