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Sciatica – Symptoms, Diagnosis, and Treatment (2022)

Sciatica symptoms, man on bed

Sciatica is one of the most recognized terms in medicine, and for a good reason – it has been around for a while. The symptoms of sciatica have stayed consistent but the diagnosis and treatment has evolved.

The ancient Greeks used the term “sciatica” to describe pains around the hip, and Italian anatomist Domenico Cotugno wrote the first book on sciatica in 1764. [1] 

Today, the most recent data indicates that up to 40% of people will experience sciatica pain at some point in their lives. [2] Understanding sciatica symptoms, risk factors, and treatment options can help patients feel better about their diagnosis

What is Sciatica?

Sciatica is a condition that can cause pain in your lower back and legs. Symptoms of sciatica include nerve root pain: severe pain, shooting pain, muscle weakness, and leg pain. The sciatic nerve is the longest and widest single nerve in the human body.

The sciatic nerve exits from the lower back, through the buttocks, and down the back of the leg to the foot. Nerve compression at any point along this pathway can cause sciatica symptoms.

There are many causes of sciatica pain

Sciatica is a general term, and it is essential to determine first where along the nerve pathway the nerve is affected and then the extent of the injury. The severity of the nerve pain can range from a mild nuisance to severe and debilitating pain.

Treatment for sciatica will vary based on these two factors. First, let’s look at the most common areas of injury.

Causes and Treatments of Sciatica

There are two common areas of sciatic nerve irritation.

Pain at the lower lumbar spine

The lumbar spine is the most common area of compromise in the low back and can be the most severe as it affects the nerve roots. This can cause lumbar radiculopathy as any of these issues affects the spinal nerve roots. The sciatic nerve can be compromised in the lumbar spine in several ways.

A herniated disc can cause sciatica pain  

A herniated disc can result from an acute injury such as falls, car accidents, sports injuries, or repetitive injury that can happen silently over time.

Herniated discs occur when the outer layer of the disc tears, allowing the inner layer to bulge out. This can put pressure on the roots of the sciatic nerve and can cause severe pain.

The herniated disc does not need to directly compress the sciatic nerve to cause pain. However, nerves are susceptible, and the local inflammation caused by the herniated disc may be enough to irritate the nerve and cause symptoms down the affected leg.

Spondylolisthesis can cause sciatica pain

Core Stability Exercises can improve sciatica

Spondylolisthesis is a condition that occurs when one of the vertebrae in the spine slips out of place. As a result, it can move forward, called an anterolisthesis, or backward, called a retrolisthesis.

This can put pressure on the sciatic nerve roots and may include pain, numbness, or weakness in the legs. Spondylolisthesis is most commonly a result of arthritic changes that happen over time or an acute injury.

Degenerative disc disease and sciatica

Degenerative disc disease is a condition that occurs when the discs in the spine begin to break down or degenerate. This can happen for various reasons, including age, injury, or repetitive stress on the spine. When the discs degenerate, they may lose some of their ability to cushion and protect the spine. This can put pressure on the sciatic nerve.

Lumbar spinal stenosis and sciatica pain

Lumbar spinal stenosis is a condition that occurs when the spinal canal narrows, putting pressure on the spinal cord and nerves. It can cause what is commonly known as “bone spurs.”

This can happen due to age-related changes in the spine, or it may be congenital (present at birth). Symptoms of a bone spur may include pain, numbness, or weakness in the legs.

Treatment for sciatic nerve pain

Treatment for sciatica caused by disc herniations, spondylolisthesis, degenerative disc disease, and lumbar spinal stenosis vary depending on the extent of the injury and severity and complexity of symptoms.

40% of people will experience sciatic nerve pain

An evaluation by specialists such as orthopedic surgeons or neurosurgeons is ideal as they can assess the damage, provide treatment options and recommendations, and manage patient care.

If nonsurgical treatment is appropriate, physical therapy and a home exercise program are recommended. Additional pain management in muscle relaxants, oral pain medication, or steroid injections may be necessary to calm down acute inflammation for physical therapy to be most effective. 

If nonsurgical treatments do not relieve the pain, surgery may be recommended. However, surgery carries a risk of complications, so it is usually only considered when other treatments have failed.

Peripheral nerve entrapments and sciatic nerve pain

The sciatic nerve can also become irritated as it continues through the hip and leg. The two common areas of entrapment are the piriformis and the hamstring.

Sciatic nerve entrapment at the piriformis

This condition, often referred to as piriformis syndrome, occurs when the sciatic nerve becomes compressed or irritated by the piriformis muscle. Piriformis syndrome is also common in pregnancy.

The piriformis muscle is a small muscle located in the buttocks that help to stabilize the hip joint. When this muscle tightens or spasms, it can compress the sciatic nerve, causing pain, numbness, or weakness in the legs. Sciatic nerve entrapment at the piriformis is often caused by repetitive motions such as sitting for long periods or running.

The sciatic nerve in the hamstring

This entrapment is a less common presentation of sciatic pain. It can often be associated with tendinopathy of the hamstring tendon and occurs when the sheath of the sciatic nerve and the sheath of one of the hamstring muscles become adhered due to repetitive stress. [3] 

In this case, the pain will start in the buttock region rather than the back. It can present with numbness, weakness, and pain.

Diagnosis can be made through physical evaluation by a skilled manual therapist such as an evidence-based chiropractor or physical therapist or using a nerve conduction velocity test. Treatment using manual therapy, such as myofascial release, can be very effective.  

Conclusion

Sciatica is a condition that can be incredibly debilitating, causing pain and numbness in the buttocks, legs, and feet. It’s estimated that up to 40% of people will experience sciatica symptoms at some point in their lives, so it’s important to know what causes this condition and how you can get relief.  Natural remedies can also be effective.

Seeking medical attention from a spine specialist who can perform a proper physical exam is essential.

With the right treatment, your sciatic nerve pain can be treated successfully and you can get back to living your life.  

[1] M.A. Stafford, P. Peng, D.A. Hill, Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management, BJA: British Journal of Anesthesia, Volume 99, Issue 5, October 2007, Pages 461-473, https://doi.org/10.1093/bja/aem238.

[2] Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 Feb 4]. In: Statpearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/

[3] Mattiussi, Gabriele, and Carlos Moreno. “Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application.” Muscles, ligaments and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248

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This blog is for informational purposes only and does not constitute medical advice. The information contained herein should not be used to diagnose or treat any health condition or disease without consulting with a qualified healthcare provider.

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