Sciatica Symptoms – Causes and Treatment
Sciatica symptoms include pain, numbness, and tingling along the sciatic nerve – from the lower back down through the leg. Learn about causes, diagnosis, and treatment.
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Sciatica symptoms include pain, numbness, and tingling along the sciatic nerve – from the lower back down through the leg. Learn about causes, diagnosis, and treatment.
What Are Sciatica Symptoms?
Sciatica (medically known as sciatica or lumbar radiculopathy) refers to symptoms caused by irritation or compression of the sciatic nerve (nervus ischiadicus). The sciatic nerve is the longest and widest nerve in the human body, running from the lower back through the buttock and down the back of the leg to the foot. Sciatica symptoms typically affect one side of the body, although both sides can be involved in rare cases.
Common Symptoms
The symptoms of sciatica can vary widely in intensity and character. The most frequently reported sciatica symptoms include:
- Lower back pain radiating into the buttock and leg
- Burning or shooting pain along the path of the nerve
- Numbness in the leg, lower leg, or foot
- Tingling or pins and needles (paraesthesia) in the affected limb
- Muscle weakness in the leg or foot
- Worsening pain when sitting, coughing, or sneezing
- Difficulty standing or walking for extended periods
Causes of Sciatica Symptoms
Sciatica symptoms develop when the sciatic nerve is irritated, pinched, or compressed. The most common underlying causes include:
- Herniated disc (disc prolapse): A bulging or ruptured disc pressing on the nerve – the most frequent cause.
- Spinal stenosis: Narrowing of the spinal canal, often age-related.
- Piriformis syndrome: The piriformis muscle in the buttock spasms and compresses the sciatic nerve.
- Spondylolisthesis: A vertebra slips forward over the one below it.
- Inflammation or tumours affecting the nerve (rare).
- Pregnancy: The growing uterus can put pressure on the sciatic nerve.
When to Seek Medical Advice
Mild sciatica symptoms often resolve on their own within a few weeks. However, immediate medical attention is strongly recommended in the following situations:
- Sudden, severe pain in the lower back or leg
- Rapidly worsening numbness or weakness in the leg
- Loss of bladder or bowel control (possible cauda equina syndrome – a medical emergency)
- Symptoms following an accident or injury
- Symptoms that do not improve after several weeks of treatment
Diagnosis
Sciatica is diagnosed through a thorough physical and neurological examination. The doctor will take a detailed medical history and assess reflexes, muscle strength, and sensation. The following investigations may also be used:
- Straight leg raise test (Lasegue test): A clinical test in which raising the straight leg reproduces sciatic pain.
- MRI (Magnetic Resonance Imaging): Provides detailed images of discs, nerves, and soft tissues.
- CT scan (Computed Tomography): Used to assess the bony structures of the spine.
- X-ray: Evaluates the vertebral bodies and general spinal alignment.
- Electromyography (EMG): Measures electrical activity in muscles and can detect nerve damage.
Treatment
Treatment depends on the underlying cause and the severity of sciatica symptoms. In most cases, conservative management is sufficient.
Conservative Treatment
- Pain medications: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac help relieve pain and reduce inflammation.
- Physiotherapy: Targeted exercises strengthen the back and abdominal muscles, reducing pressure on the nerve.
- Heat or cold therapy: Can relax muscles and provide pain relief.
- Rest: Short periods of rest may be helpful, but prolonged bed rest is not recommended.
- Corticosteroid injections: Epidural steroid injections can reduce inflammation directly around the nerve in cases of severe pain.
Surgical Treatment
If conservative measures fail or neurological deficits are present (e.g., muscle weakness, bladder or bowel dysfunction), surgery may be necessary. Common procedures include microdiscectomy (removal of disc material) or decompression surgery for spinal stenosis.
References
- Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317.
- Valat JP, Genevay S, Marty M, et al. Sciatica. Best Practice and Research: Clinical Rheumatology. 2010;24(2):241-252.
- National Institute of Neurological Disorders and Stroke (NINDS). Sciatica – Information Page. Available at: www.ninds.nih.gov
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