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Sciatica – Causes, Symptoms and Treatment
Sciatica refers to pain along the sciatic nerve, radiating from the lower back through the buttock and down the leg. It is most commonly caused by a herniated disc or spinal stenosis.
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Sciatica refers to pain along the sciatic nerve, radiating from the lower back through the buttock and down the leg. It is most commonly caused by a herniated disc or spinal stenosis.
What is Sciatica?
Sciatica (also known as sciatic nerve pain or ischialgia) describes pain caused by irritation or compression of the sciatic nerve (nervus ischiadicus), the longest and widest nerve in the human body. The sciatic nerve runs from the lower back through the buttock and down the back of each leg to the foot. Sciatica typically causes a shooting, burning, or aching pain that radiates along the path of the nerve, usually affecting one side of the body.
Causes
Sciatica is a symptom rather than a diagnosis in itself and can result from several underlying conditions:
- Herniated disc: The most common cause. A bulging or ruptured intervertebral disc presses on the nerve roots that form the sciatic nerve.
- Spinal stenosis: A narrowing of the spinal canal that compresses the nerve.
- Piriformis syndrome: Spasm or tightness of the piriformis muscle in the buttock, which can irritate or compress the sciatic nerve.
- Spondylolisthesis: A condition in which one vertebra slips forward over an adjacent vertebra, pinching the nerve.
- Muscle spasms and inflammatory processes around the lumbar spine.
- Less commonly: tumors, abscesses, or trauma affecting the spine.
Symptoms
Symptoms vary depending on the cause and severity but commonly include:
- Sharp, burning, or shooting pain from the lower back through the buttock and down the leg
- Numbness or tingling (paresthesia) in the leg or foot
- Muscle weakness in the affected leg
- Worsening pain when sitting, coughing, or sneezing
- In severe cases: muscle paralysis or loss of bladder and bowel control (medical emergency)
Diagnosis
Diagnosing sciatica typically involves:
- Medical history: A detailed discussion of the onset, duration, and nature of the pain
- Physical examination: Neurological tests such as the straight leg raise test (Lasegue test), which stretches the sciatic nerve to provoke symptoms
- Imaging: MRI (magnetic resonance imaging) or CT (computed tomography) scans to visualize disc herniations, nerve compression, and spinal canal narrowing
- X-rays of the spine to assess bone alignment and structure
Treatment
Conservative Treatment
Most cases of sciatica resolve with non-surgical approaches:
- Physical therapy: Targeted exercises to strengthen core and back muscles and relieve nerve pressure
- Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac to reduce pain and inflammation
- Heat or cold therapy to ease muscle tension and discomfort
- Corticosteroid injections: Epidural steroid injections to reduce local inflammation around the nerve
- Manual therapy, osteopathy, and chiropractic care
Surgical Treatment
Surgery is rarely needed but may be considered in cases of persistent severe pain, progressive muscle weakness, or failure of conservative treatment. Common procedures include microdiscectomy (removal of the herniated disc material) and laminectomy (widening of the spinal canal).
When to See a Doctor
Medical attention should be sought promptly if pain is severe or worsening, if there is significant numbness or muscle weakness in the leg, or if bladder or bowel function is affected. The latter may indicate cauda equina syndrome, which is a medical emergency requiring immediate treatment.
References
- Ropper AH, Zafonte RD. Sciatica. New England Journal of Medicine. 2015;372(13):1240-1248.
- National Institute of Neurological Disorders and Stroke (NINDS): Sciatica. U.S. Department of Health and Human Services, 2023. Available at: https://www.ninds.nih.gov/health-information/disorders/sciatica
- WHO: Musculoskeletal conditions. World Health Organization, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
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