Sciatica (Pain in Buttocks & Leg)
Sciatica (pronounced sigh-at-eh-kah) is a term that describes symptoms of pain, numbness, and/or weakness that radiates along the sciatic nerve from the lower back to the buttocks and leg.
Sciatica is most often caused by a disc problem, such as a degenerated disc pressing against a nerve root. It can also occur when a disc herniates, releasing inflammatory proteins which irritate the adjacent nerve. Sciatica or Lumbar Radiculopathy, are symptoms of underlying medical conditions, not a diagnosis in itself. The majority of symptoms which result from lumbar spine disorders, occur between the L4 and S1 levels.
Sciatica becomes more commonplace in middle age, most likely to develop around ages 40 – 50. Symptoms are typically felt on only one side of the body and often described as searing or sharp, as opposed to achy and throbbing. Depending on where the sciatic nerve roots are compressed, symptoms may be felt in different areas of the leg and into the foot. A combination of leg and foot pain, weakness, tingling or numbness can occur.
Sciatic Nerve Pain
Sciatica is often characterised by one or more of the following symptoms:
- Persistent pain radiating down one side of the buttock or leg (rarely in both legs) and often described as tingling, burning, or searing (versus a dull ache).
- Pain that is worse when sitting and a sharp when standing up or walking.
- Numbness, weakness and difficulty moving the leg, foot or toes.
- Pain that radiates down the leg and possibly into the foot and toes (it rarely occurs only in the foot).
Sciatica Pain Anatomy
The sciatic nerve starts in the lower back, typically at lumbar segment 3 (L3) and is the largest single nerve in the body. At each level of the lower back, a nerve root exits from the inside of the spinal canal. Each of these respective nerve roots then combine to form the large sciatic nerve. Portions of the sciatic nerve then branch out into a network of nerves in each leg, to areas such as the thigh, calf, foot and toes.
Sciatica symptoms occur when the large sciatic nerve (which runs from the lower back, through the buttock and down the back of each leg) is irritated or compressed at or near its point of origin.
Sciatica symptoms for each nerve root
Sciatica symptoms vary and are based on where the compressed nerve root is located.
- L4 nerve root sciatica symptoms may be felt in the thigh, feeling weakness in straightening the leg and a diminished knee-jerk reflex.
- L5 nerve root sciatica symptoms may reach the ankle and big toe, known as foot drop, where pain or numbness is felt on top of the foot, particularly between the big toe and second toe.
- S1 nerve root sciatica symptoms are felt on the outer part of the foot, which may radiate to the little toe or toes. Weakness when raising the heel off the ground, trying to stand on tiptoes and ankle-jerk reflex may also be reduced.
Patients may experience a combination of the above symptoms, as more than one nerve root may be compressed.
For some people, the sciatica symptoms might be infrequent and irritating, but have the potential to get worse. For others, the sciatica pain can be severe and debilitating.
Lower back and leg pain may be experienced together but typically the leg pain is markedly more severe than lower back pain. Leg pain is often described as electrical shocks running down the leg, like a searing or burning sensation.
Common Sciatica Symptoms
Sciatica symptoms are usually felt only on one side of the lower body, from the lower back to the back of the thigh and down the leg. A combination of the following symptoms are most common:
- Persistent pain in only one side of the buttock or leg (rarely in both sides) originating in the lower back or buttock and continuing down the back of the thigh and into the lower leg and foot, along the path of the sciatic nerve.
- Pain worsens when standing or sitting and typically described as sharp or searing, rather than dull.
- Weakness or numbness when moving the leg or foot with a “pins-and-needles” prickling sensation down the leg.
- Difficulty standing or walking from severe or shooting pain in one leg and in the toes, depending on where the sciatic nerve is affected.
Sudden movements, such as sneezing or coughing, or when moving from a sitting position to standing, may intensify symptoms.
Common Causes of Sciatica
6 Most Common Causes of Sciatica
These six lower back problems are the most common causes of sciatica:
- Lumbar herniated disc. A herniated disc occurs when the soft inner material of the disc leaks out or herniates through the fibrous outer edges, irritating or pinching the adjacent nerve root. Other terms used to refer to a herniated disc are: slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve.
- Degenerative disc disease is a phenomena of ageing and is the natural process that occurs when one or more degenerated discs in the lower back irritates a nerve root and causes sciatica. Degenerative disc disease is diagnosed when inflammatory proteins from inside the disc become exposed and irritate the nerve root(s), due to a weakened disc. Bone spurs, may press against a nerve, resulting in sciatica.
- Isthmic spondylolisthesis. When one vertebral body slips forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra. The nerve can get pinched and cause sciatica when: the disc space collapses, there is a fracture, or the vertebral body slips forward.
- Lumbar spinal stenosis. Lumbar spinal stenosis is related to natural aging (relatively common in adults older than age 60) and is due to a narrowing of the spinal canal. The condition typically results from: overgrowth of soft tissue, enlarged facet joints and a bulging disc, placing pressure on the nerve roots, causing sciatica pain.
- Piriformis syndrome. The sciatic nerve passes under the piriformis muscle in the buttock. Sciatica-type pain can be felt if the piriformis muscle irritates or pinches a nerve root that comprises of the sciatic nerve.
- Sacroiliac joint dysfunction. If the sacroiliac joint is irritated, this can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.
More Causes of Sciatica and Sciatica-Type Symptoms
In addition to the most common causes, a number of other conditions can cause sciatica:
- Pregnancy. The changes the body goes through during pregnancy, including weight gain, a shift of one’s centre of gravity and hormonal changes, can cause sciatica.
- Scar tissue. Also called epidural fibrosis. If scar tissue compresses a lumbar nerve root, it can cause sciatica.
- Muscle strain. In some cases, inflammation related to a lower muscle strain and/or muscle spasm, can put pressure on a nerve root and cause sciatica pain.
- Spinal tumour. A spinal tumour, in rare cases, can impinge on a nerve root in the lower back and cause sciatica symptoms.
- Infection. An infection that occurs in the lower back, while rare, can affect the nerve root and cause sciatica.
- Fracture. It is possible for symptoms to include sciatica if a fracture occurs in a lumbar vertebra. Most fractures occur because of a serious trauma (such as a fall), another underlying condition, medication or because the bone has become weaker from osteoporosis.
- Ankylosing spondylitis. This condition is characterised by chronic inflammation (often in the sacroiliac joints, causing sacroiliitis) in the band around the spine and symptoms may include sciatica.
The above is not a complete list and it is important to know that treatments, rehabilitation programs and exercises will often differ depending on the underlying clinical diagnosis.
Diagnosing sciatica usually starts with a physical exam where your doctor may check for muscle strength and reflexes. You may be asked to walk on your toes or heels, or rise up and stand upright from a squatting or seated position. Alternatively, you may be asked, while lying on your back, to lift your legs one at a time. If there is pain from this, it may indicate sciatica, as sciatica will usually worsen during these activities.
Many people with no symptoms of sciatica may have herniated discs or bone spurs that show up on X-rays and other imaging tests. These tests aren’t typically requested unless your pain is severe, or does not improve within a few weeks.
An x-ray of your spine may be used in diagnosing sciatica as it can reveal an overgrowth of bone, also know as a bone spur, that may be pressing on a nerve.
MRI, or magnetic resonance imaging, is a procedure that uses a powerful magnet and radio waves to produce cross-sectional images of the spine, showing a detailed image of bone and soft tissue such as herniated discs. You may lie on a table that moves into the MRI machine or have an Upright MRI (MRI while seated).
The good news is that for most people, Sciatica typically gets better on its own and the healing process will usually only take a few days or weeks and sciatica pain should subside within 6 to 12-weeks.
A program of physical therapy and exercise should usually be pursued to alleviate, prevent or minimise any ongoing sciatic pain. An ergonomic assessment of the workplace also may be helpful in recommending safer lifting or posture, depending on the nature of the job, and/or the patient’s education on lifestyle factors that contribute to spinal problems.
Readily available nonsurgical remedies and regular exercise, will go a long way toward relieving the pain most people experience.
For others, when the pain is severe or does not get better on its own, a more structured treatment approach may be the best option for finding relief from the pain and preventing or reducing future pain and/or dysfunction.
Nonsurgical Treatments for Sciatica
There are broad range of options available for sciatica treatment. The goal of nonsurgical sciatica treatment is to relieve pain and any neurological symptoms caused by a compressed nerve root. A combination of the treatments below are typically recommended in conjunction with specific exercises.
- Heat/ice. For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Heat/ice is usually applied for approximately 20 minutes and repeated every two hours. Ice tends to be used first by most, but some find more relief with heat. The two may be alternated. Remember that it is best to apply ice with a towel or cloth placed between the ice and skin, to avoid an ice burn.
- Pain medications. Prescription medication or over-the-counter medication, are often effective in reducing or relieving sciatica pain. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen) or oral steroids, can reduce the inflammation which contributes to the cause of pain. For the short term (a few days and up to 2 weeks) to alleviate pain, muscle relaxants or narcotic medications may also be prescribed.
- Epidural steroid injections. An epidural steroid injection can reduce inflammation if pain is severe, however unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain. While the effects tend to be temporary (providing pain relief for as little as one week or up to a year), it can provide sufficient relief to allow a patient to progress with conditioning, rehabilitation and or exercise program.
Alternative Sciatica Treatment
Several alternative treatments have also been shown to provide effective sciatica pain relief for many patients, in addition to standard medical treatments.
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- Trained health professionals, such as Chiropractors and Osteopathic Physicians can perform manual manipulation. This provides better spinal column alignment, which is designed to help address underlying conditions that can cause sciatic nerve pain. Manual manipulation can create a better healing environment and should not be painful.
- Acupuncture is the practice centered on the philosophy of achieving or
maintaining well-being through the open flow of energy, via specific pathways in the body.
- Cognitive behavior therapy is therapy for taking control and changing
self-defeating behaviours with a therapist (may be face-to-face or online). This can be helpful in managing sciatica pain, particularly in the short term.
- Massage therapy. Certain types of massage therapy have a number of benefits for back pain, including: increasing blood circulation, muscle relaxation and the releasing of endorphins (the body’s natural pain reliever).
The above list of sciatica treatments represent the most common treatments, but is by no means comprehensive as there are many more options. It is often a process of trial and error for patients to find out what works best for them.
A central component of almost any sciatica treatment plan is physical therapy exercises, which incorporate a combination of stretching, strengthening and aerobic conditioning. Patients can recover more quickly from sciatica pain if they engage in a regular program of gentle exercises. Patients are also less likely to experience future episodes of pain.
General Exercises for Sciatica
The three key areas which Sciatica exercises usually focus on: stretching, strengthening and aerobic conditioning.
1. Stretching Exercises. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible. They are usually recommended to alleviate sciatic pain. Stretching the hamstring is almost always an important part of a sciatica exercise program, as most do not stretch these muscles in the back of the thigh, extending from the pelvis to the knee, in their daily activities.
A stretch that is often helpful in easing sciatica is the Bird Dog move. This is where you get on your hands and knees and extend one arm and the opposite leg. The arm and leg extensions are then alternated. The Plank Bird Dog move is a more advanced version of this exercise, here the extensions are done once a person is in the plank position, on their hands and toes.
2. Strengthening Exercises. There are many exercises that can help strengthen the back (spinal column) and the supporting ligaments, muscles and tendons. Most of these back pain exercises focus not only on the lower back, but also the abdominal (stomach) muscles, gluteus (buttock) and hip muscles. When the abdominal (core) muscles are strong, they can provide back pain relief. The core acts as a spinal support, keeping it in alignment and facilitating movements that twist or extend the spine, with less chance of injury or damage.
3. Low-impact Aerobic Exercise. Walking, swimming or pool therapy are some forms of low-impact cardiovascular exercise, and are usually a component of recovery. Aerobic activity encourages the exchange of nutrients and fluids, to help create a better healing environment.
The unique benefit of aerobic conditioning is that it releases endorphins, the body’s natural pain killer, which helps to reduce sciatic pain. Examples of types of exercises that may include both strengthening and stretching include: Yoga, Tai Chi and Pilates. These types of exercises may be done separately or in combination. For anyone with a relatively high level of sciatica pain or in chronic pain, they may opt for water therapy which is a gentle, controlled and progressive form of exercise program, done in a warm pool.
When nutrients that maintain the health and strength of the spinal discs are at levels inadequate to maintain cellular activity or viability it results in cell death and disc degeneration. Disc degeneration is linked to the loss of disc height, stiffness in the spine, limited range of motion, arthritis of the spinal joints, thinning discs and pain in the sciatic nerve.
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