Sciatica

How Does Sciatica Feel?

The following symptoms are often present in sciatica:

• Type of pain. An individual suffering from sciatica usually feels a burning sensation or an excruciating pain in the lower back or buttocks radiating down the leg and/or foot. Occasionally, it may feel like an electric shock or jolt.
• Numbness. Back pain caused by sciatica may also be accompanied by numbness, tingling, or weakness in the legs. 
• One-sided symptoms. A typical sign of sciatica is radiating leg pain from your lower back (lumbar spine) down the back of your leg. Typically, sciatica only affects one leg. As a result, the affected leg often feels heavy. 

It is rare for both legs to be affected simultaneously. This type of pain may be constant or may come and go. You may experience this type of pain continuously or periodically.

Triggers for these symptoms:

Sciatica symptoms may be aggravated by sudden and forceful movements, such as

• sitting, 
• While trying to get up, 
• When you bend your spine forward, 
• When you twist your spine, 
• Coughing and/or lying down.

Factors contributing to sciatica:

The sciatic nerve becomes compressed when the surrounding bones compress it. Compression may occur due to –

• Disk herniation

Cartilage separates your vertebrates from one another. As you move around, these Cartilages will provide flexibility and cushioning. Unfortunately, Herniated Disc sciatic nerves get compressed, causing pain in the legs and numbness in the feet. 

• Lumbar Spinal stenosis

Lumbar spinal stenosis occurs when the lower spinal canal narrows abnormally. Because of this, the sciatic nerve is compressed by causing pressure on the spinal cord.

• Spondylolisthesis

Spondylolisthesis is an associated condition of degenerative disk disorder. Spinal bones can pinch sciatic nerves when one extends forward over the other.

• Piriformis syndrome

Piriformis muscles connect your lower spine to your thighbones.

Sciatica results from involuntary contractions or tightening of your piriformis muscle; this scenario is known as Piriformis syndrome. 

When it tightens, it can put pressure on your sciatic nerve, leading to Sciatica.

• Additional Factors –

Other factors can also cause sciatica. It is as follows:

• • Age- As you age, your bones lose their blood supply, causing weakening. Furthermore, these Bones can become distorted through wear and tear, resulting in Sciatica.
  • Your Profession- Some careers are hard on your back because they involve heavy lifting, standing for long periods, and others that require long hours of sitting.
  • Smoking- Smoking breaks down the outer layer of your spinal disks, causing sciatic nerve compression as a result.
  • Diabetes- Diabetic patients are at greater risk for nerve damage.

What are the risk factors for developing sciatica?

Sciatica is more likely to occur if you:

• Have an injury/previous injury: Injuries to the lower back and spine put you at greater risk for sciatica.
• Ageing: As you age, your bone tissue and disks in your spine naturally wear down. As you age, you may experience bone, disk, and ligament changes that can cause your nerves to be pinched or injured. Herniated disks and bone spurs, both associated with ageing, are the most common causes of Sciatica. Sciatica is more common in people in their 30s and 40s.
• Overweight: The weight you carry on your front body (Abdominal Region) is supported by your spine. Weight puts more pressure on your spine. As a result, the back can be strained and suffer pain. Excess body weight can cause spinal changes that result in sciatica because it increases the stress on your spine.
• Your Posture: Maintain a good posture while lifting weights at the gym or work. The way you also sit matters.
• Diabetes: Sciatica is more likely to occur if you have diabetes, which increases your risk of nerve damage. The way that your body handles blood sugar is affected by this condition, which can damage your nerves.
• Pregnancy: A developing uterus can exert pressure on the sciatic nerve, which may increase the risk of developing this condition during pregnancy.
• Having Osteoarthritis: This condition damages your spine and can injure your nerves.
• Your Lifestyle: Having a desk job, not exercising, and spending most of your time sitting can contribute to Sciatica. Working in a position that requires twisting your back, carrying heavy loads, or driving long distances can cause Sciatica. However, this link has not yet been conclusively proven. The chances of developing sciatica are higher for someone with a sedentary lifestyle or sitting for long periods. 
• Smoking: Smoking can damage spinal tissues, weaken bones, and accelerate bone deterioration, resulting in Sciatica.

When to see a doctor

If these symptoms develop, you should seek medical attention immediately. Symptoms may include, but are not limited to:

• A feeling of pain going down the legs below the knees
• It is difficult for you to control the flow of urine or stool (incontinence)
• You experience sudden, severe pain in your lower back, buttocks, thigh, leg, or pelvis, either accompanied or unaccompanied by numbness or muscle weakness. 
• A red or swollen back or spine
• Back pain and an unexplained fever
• An injury or accident causes you pain.
• Your pain is worse when you are lying down, or you can’t sleep because of it.
• Sexual dysfunction
• Symptoms are felt in both legs.

Additionally, you should contact your doctor if:

• If you lose weight unintentionally. 
• The drugs you use are steroids or intravenous drugs.
• Back pain is not new to you, but this episode feels worse and is different.
• It has been more than four weeks since you have experienced this back pain.

What Is the Diagnosis of Sciatica?

Medical History-

To diagnose the patient, it is important to understand the patient’s medical history. These may include:

• Be sure to include all of your medical histories, including past surgeries.
• During your consultation, you will be asked about how your pain developed, where it travelled, and what it felt like. 
• Have you been injured recently?

Physical Examination-

To pinpoint the exact cause of your pain, your doctor may ask you to perform some activities like stretch and move.

Some of these activities may include –

• Standing up and squatting.
• Walk on your toes and heels.
• Test your ability to raise your leg straight
• By bending your knees

Lab tests –

Depending on your Medical History and Physical Examination, Your Doctor may Require Some Tests to Understand Your Condition Better. Among these tests are

• Blood tests – To determine if there is any inflammation in your body.
• X-ray – An X-ray determines whether there is any bony growth pressing on a nerve.
• Computed Tomography (CT) Scan – A CT scan is a continuous X-Ray set to determine any compression or abnormalities in the spinal cord and nerves. It can be done with and without contrast. Damage to the sciatic nerve cannot be seen on a standard X-ray, and Hence CT Scan is Recommended.
• CT Myelogram – With this special type of CT scan, a dye is injected into the spinal cord to produce a clearer image of nerves and the spinal cord.
• Magnetic Resonance Imaging (MRI) Scan – MRIs produce high-quality images of the bone and tissue in your spine, which can be used to diagnose specific ailments.
• Electromyography (EMG) – This test measures electrical impulses and muscle responses in the area to determine if the nerve compression is related to narrowed spinal canals or herniated discs. 

Sciatica Treatment – 

To treat sciatica, one must identify and treat the underlying cause. Sciatica Pain can be treated based on its cause. Treatment is not always necessary, and recovery may happen by itself.

Types of Treatments-

Conservative Treatments –

• Consider over-the-counter painkillers like ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
• The affected area can be treated with heat or ice. For 48 to 72 hours, use ice, then heat.
• Start by reducing your activity for a couple of days. Then slowly begin stretches. The pain would be worsened by complete bed rest.
• For the first six weeks following the onset of pain, do not lift heavy objects or twist your back.
• Your doctor may also recommend physical therapy. 
• Acupuncture, yoga, and other alternative therapies are helpful too.

Note: Not every OTC drug is suitable for everyone. Before taking it, seek the advice of your doctor.

Medical Treatments –

Non Surgical Treatments –

• Medications –Your doctor might recommend anti-inflammatory medicines and pain relievers. Depending on your condition, muscle relaxants and nerve-related medicines may also be recommended.Not all painkillers are appropriate for everyone. It would be best if you discussed your options with your doctor.
• Injections-Alternatively, treatments like corticosteroids Injections may be recommended if the above treatment does not Help.
• Cognitive Behavioral Therapy (CBT)-  CBT allows people to cope with chronic pain by teaching them new ways of reacting to the Pain.

Surgical Treatments –

Surgery is the Last Option for Patients with Sciatica. Surgical treatment is recommended if the above treatment does not yield satisfactory results even after three months. The compression of spinal nerves can be eased with surgery. Surgery includes the following types:

• Lumbar laminectomy – This type of surgery enlarges the spinal canal by removing part of a vertebra. This results in less pressure on the nerves caused by the narrowing of the spinal canal.
• Discectomy – The surgical procedure of removing a herniated disk, either partially or completely, is known as Discectomy. The type depends on the risks and benefits which the Surgeon decides. Microdiscectomy decreases pressure on the nerves by clearing out part of a herniated disc.

Rehabilitative treatment –

• Strengthening your back may be recommended by your doctor. 
• It is important to move and walk without overbending or twisting. 
• Cleaning and cooking are acceptable household tasks.