Sciatica

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Overview

Sciatica is a debilitating condition in which the patient experiences pain and/or paresthesias in the sciatic nerve distribution or an associated lumbosacral nerve root. Often, a common mistake is referring to any low back pain or radicular leg pain as sciatica. Sciatica is specific to the pain that is a direct result of sciatic nerve or sciatic nerve root pathology. The sciatic nerve is made up of the L4 through S2 nerve roots, which coalesce at the pelvis to form the sciatic nerve. At up to 2 cm in diameter, the sciatic nerve is easily the largest nerve in the body. Sciatica pain often is worsened with flexion of the lumbar spine, twisting, bending, or coughing.

The sciatic nerve provides direct motor function to the hamstrings, lower extremity adductors, and indirect motor function to the calf muscles, anterior lower leg muscles, and some intrinsic foot muscles. Also, indirectly through its terminal branches, the sciatic nerve provides sensation to the posterior and lateral lower leg and the plantar aspect of the foot. It is an important distinction to know that most cases of sciatica result from an inflammatory condition leading to an irritation of the sciatic nerve. Conversely, direct compression of the nerve leads to more severe motor dysfunction, which is often not seen, and if present, would warrant a more meticulous and expeditious workup.

Symptoms

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.

Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

Moderate to severe pain in lower back, buttock and down your leg.

Numbness or weakness in your lower back, buttock, leg or feet.

Pain that worsens with movement; loss of movement.

“Pins and needles” feeling in your legs, toes or feet.

Causes

Sciatica can be caused by several different medical conditions including:

A herniated or slipped disk that causes pressure on a nerve root. This is the most common cause of sciatica. About 1% to 5% of all people in the U.S. will have a slipped disk at one point in their lives. Disks are the cushioning pads between each vertebrae of the spine. Pressure from vertebrae can cause the gel-like center of a disk to bulge (herniate) through a weakness in its outer wall. When a herniated disk happens to a vertebrae in your lower back, it can press on the sciatic nerve.

Degenerative disk disease is the natural wear down of the disks between vertebrae of the spine. The wearing down of the disks shortens their height and leads to the nerve passageways becoming narrower (spinal stenosis). Spinal stenosis can pinch the sciatic nerve roots as they leave the spine.

Spinal stenosis is the abnormal narrowing of the spinal canal. This narrowing reduces the available space for the spinal cord and nerves.

Spondylolisthesis is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits. The extended spinal bone can pinch the sciatic nerve.

Osteoarthritis. Bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves.

Trauma injury to the lumbar spine or sciatic nerve.

Tumors in the lumbar spinal canal that compress the sciatic nerve.

Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.

Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.

Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.

Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.

Occupation. ...

Prolonged sitting. ...

Diabetes.

Risk factors

Certain behaviors or factors can raise your risk of developing sciatica. The most common factors for developing sciatica includeTrusted Source the following:


As your body ages, it becomes more likely that parts will wear out or break down.

Certain careers place a lot of strain on your back, especially those that involve lifting heavy objects, sitting for extended periods, or twisting movements.

Having diabetes can increase your risk of nerve damage.

Smoking can cause the outer layer of your spinal discs to break down.

Having obesity may also be associated with sciatica.

Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.

Obesity. ...

Occupation. ...

Prolonged sitting. ...

Diabetes.

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Complications

Most people recover fully from sciatica. However, chronic (ongoing and lasting) pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.

Increased pain.

A slipped or herniated disc.

Loss of feeling or weakness in your affected leg.

Loss of bowel or bladder function.

Permanent nerve damage.

Prevention

Some sources of sciatica may not be preventable, such as degenerative disk disease, sciatica due to pregnancy or accidental falls. Although it might not be possible to prevent all cases of sciatica, taking the following steps can help protect your back and reduce your risk:

Maintain good posture: Following good posture techniques while you’re sitting, standing, lifting objects and sleeping helps relieve pressure on your lower back. Pain can be an early warning sign that you are not properly aligned. If you start to feel sore or stiff, adjust your posture.

Don’t smoke: Nicotine reduces the blood supply to bones. It weakens the spine and the vertebral disks, which puts more stress on the spine and disks and causes back and spine problems.

Maintain a healthy weight: Extra weight and a poor diet are associated with inflammation and pain throughout your body. To lose weight or learn healthier eating habits, look into the Mediterranean diet. The closer you are to your ideal body weight the less strain you put on your spine.

Exercise regularly: Exercise includes stretching to keep your joints flexible and exercises to strengthen your core – the muscles of your lower back and abdomen. These muscles work to support your spine. Also, do not sit for long periods of time.

Choose physical activities least likely to hurt your back: Consider low-impact activities such as swimming, walking, yoga or tai chi.

Keep yourself safe from falls: Wear shoes that fit and keep stairs and walkways free of clutter to reduce your chance of a fall. Make sure rooms are well-lighted and there are grab bars in bathrooms and rails on stairways.