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You are here : Treatments » Spinal » Sciatica

Sciatica

Description and Diagnosis
The term sciatica is commonly used to describe pain traveling in the distribution of the sciatic nerve. Sciatica is a symptom caused by a disorder occurring in the lumbar spine. The sciatic nerve is the largest nerve in the human body, about the diameter of a finger.

Inflammation of the Sciatic Nerve - Sciatica is a condition which causes pain down the back of one or both thighs. Inflammation of the sciatic nerve (which is the largest nerve in the body-about the diameter of your little finger) can be either constant or intermittent. Success in solving this problem is directly correlated to the diagnosis. Sciatica can be caused by a pinched nerve as it exits the low back spine or it can be caused by prostatic cancer. Odds are usually that the cause is some structural imbalance, but there are so many potential causes, some serious and some benign, it is better to at least know that there may be a grave cause to the symptoms.

This doesn't mean that you shouldn't immediately incorporate a strategy to eliminate any structural imbalances. In most cases, this will resolve the problem. If the problem doesn't respond to these basic efforts, then professional assistance may be needed.

Trigger points can accumulate in the piriformis muscle forcing a contraction and strangulation of the sciatic nerve. The tennis ball exercise should be incorporated to help to relax the piriformis muscle. Stretching may be beneficial, but that is more of a "try and see" exercise.

If there are no improvements with this approach, refer to Low Back Pain to better understand the relationship between the sciatic nerve and the low back spine. Seeking help from a chiropractor or orthopedist may be indicated if the sciatica solution can't be found at home.

Sciatic nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum. The nerve passes through the sciatic foramen just below the Piriformis muscle (rotates the thigh laterally), to the back of the extension of the hip and to the lower part of the Gluteus Maximus (muscle in the buttock, thigh extension). The sciatic nerve then runs vertically downward into the back of the thigh, behind the knee branching into the hamstring muscles (calf) and further downward to the feet.

Sciatic Nerve (yellow)	Yellow	Nerves
Sacrum	Red	Arteries
Hip Bone	Blue	Veins

Sciatica Symptoms
Usually sciatica affects one side of the body. The pain may be dull, sharp, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain.

The Cause : Nerve Compression
Compression of the sciatic nerve can cause any of the above-cited symptoms. Rarely is nerve damage permanent and paralysis is seldom a danger as the spinal cord ends before the first lumbar vertebra. However, increasing trunk or leg weakness, or bladder and/or bowel incontinence is an indication of Cauda Equina Syndrome, a serious disorder requiring emergency treatment.

Lumbar spine disorders known to cause sciatic nerve compression include the following :

Herniated discs are the most common cause of sciatica in the lumbar spine.
Degenerative Disc Disease, a natural biological process associated with aging, is known to cause disc weakness that can be a precursor to a disc herniation.
Lumbar Spinal Stenosis is a narrowing of one or more neural passageways due to disc degeneration and/or facet arthritis. The sciatic nerve may become impinged as a result of these changes.
Isthmic Spondylolisthesis results from a stress fracture often at the 5th lumbar vertebra (L5). The fracture combined with disc space collapse may allow the vertebra to slip forward on the first sacral segment (S1). The slippage may cause the L5 nerve root to become pinched as it leaves the spine.

Spinal Tumors and Infections are other disorders that may compress the sciatic nerve, but this is rare.

There are other conditions, which may occur, and may mimic true sciatica but these are difficult to diagnose.

Diagnosis of Sciatica
The physician's examination includes the patient's medical history, a review of current medications, a physical and neurologic examination and, if warranted, x-rays, CT scan and/or MRI. A proper diagnosis requires an analysis of the patient's pain. The patient is often provided a Pain Diagram to illustrate pain distribution and sensation (eg, tingling and burning).

The physician's questions may include :

"How did the pain develop?"
"On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain."
"Is the pain worsened by walking uphill or downhill?"
"How does the pain affect activities of daily living?"
"What type of treatment has been tried and what was effective?"

The patient's range of motion is observed. Reflexes and muscle strength are tested. The physician may use one or more movement tests to determine the source or cause of the pain.

Sciatica : Treatment and Recovery
Treatment - Non-Surgical Treatment
Sciatica often responds well to non-operative forms of treatment and rarely requires surgical intervention. Time, non-steroidal anti-inflammatory (NSAIDs) medication, short-term use of a narcotic for acute pain, lumbar injections, and physical therapy are beneficial.

Although short-term bed rest is recommended during the acute phase, some activity is good. In this scenario "activity" is defined as being up for periods of time that will not cause severe pain. Prescribed exercise may include light stretching, walking, and aerobic type exercise.

Surgery
Surgery is not for all patients. However, in some situations, surgery may be indicated. Patients who have followed a non-surgical course of treatment for four to six weeks without relief certainly require a re-evaluation by their physician. If a MRI scan reveals a herniated disc or spinal stenosis, surgery may provide relief of the leg pain. The type of surgical procedure is dependent in part on the patient's condition and diagnosis

Medicine

Recovery
Whether treatment for sciatica is non-operative or surgical, it is always wise to follow the instructions provided by the doctor and/or physical therapist.

Work toward relieving unnecessary mechanical stress to the spine. For example, when standing, alternate resting one foot on a stool. When driving, place a small pillow or rolled towel behind the back to maintain natural spinal curvature. At bedtime, sleep on the back with a pillow under the knees or between the knees if sleeping on the side.

Strive to eat healthy, work toward your ideal body weight, and avoid smoking. These lifestyle changes all benefit the spine's health.

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Testimonials

Mohsin Ali

Dear Dipa,

Aploogies for the delay in responding but I have only just returned to the UK and a computer which works!

The following is what I wrote in the Apollo Comments Book when we left and please feel free to use any of it on your web page.

"Mohsin is an 8 year old Pakistani orphan from the SOS Village in Karachi. He needed urgent spinal fusion surgery to give him the chance of a normal life. The operation was not possible in Pakistan but we heard about the Apollo Hospital and Dr Yash Gulati through The Taj Medical Group. The care Mohsin has received from Dr Gulati and his team has been exceptional. The individual attention he has received has surpassed anything I have experienced in the UK Health Service in the past 5 years, whether it be National Health or Private.

Mohsin Ali The operation appears to have been a success and the post-operative care given to Mohsin has been meticulous but above all warm and friendly. In spite of the discomfort Mohsin was able to smile because he felt loved. Dr Gulati made a point of visiting Mohsin at least once a day and Mohsin respected him and trusted him absolutely. All the nurses made such a big fuss of Mohsin that we love them all, particularly S/N Sherin who saw Mohsin through the first difficult post - operative nights and gave him the most wonderful soothing bed baths. The housekeeping services were excellent. I wish the UK NHS was half as efficient and clean and everything done with a smile! .......Read more..

Kay Lanes, UK (Mohsin's Guardian)
Spinal Surgery
July 2006

Stephen Mobley

Stephen Mobley, 44 had been suffering with chronic back pain for the last two years. He could not walk (more than 200m), stand or sleep very well and was prescribed high doses of morphine for pain relief.

Shortly after contacting The Taj Medical Group, Stephen underwent spinal surgery at their Specialist Clinic in Cologne, Germany. The operation comprised placing a flexible Dorsal Spacer Implant. Stephen, (left) is pictured here with his parants.

Below is a short note from his father, David soon after the operation.

Dear Dipa,

I thought that it is time I wrote to express our sincere thanks for your kind assistance in arranging surgery for our son Steve aged 44.

If I have worked it out correctly we first contacted you around 20th November 2006 and Steve actually had his surgery in Cologne on Tuesday 23 January 2007.

From our first contact with you we were provided with detailed information about hospitals and surgeons around the world and at one time we thought that we might go to India for the surgery, after you had kindly arranged for us to speak to the surgeon in India, but we felt that the long flight would probably prove very painful for Steve with his Lumbar Disc problem.

We were therefore, very pleased when you mentioned that there was an excellent Dutch Surgeon at the MediaPark Klinik in Cologne who could carry out the operation which Steve needed, known as a Dorsal Spacer Implant, at a much lower cost than the UK, had it been available in the UK, which it is not..........Read more...

David Mobley, (Father of Stephen, 44)
Staffordshire, UK
Spinal Surgery, Dorsal Spacer Implant
January 2007

Hello Sabina,

Thanks for the greeting. I am sorry it has taken me so long to respond to your e-Mail. Since the day that I returned to the U.S. I have felt a compelling need to relate my experience to the people in my country as well as the rest of the world.

There are many who feel the sense of hopelessness that I experienced, who also believe they have no options and that their life will lead to a never ending struggle with chronic and debilitating pain. Nothing could be further from the truth !!! The level of care that I received in Bangalore was extremely professional and compassionate. As I reflect back upon my experience several things have become clear to me...... Read more..

Ted Grenier (45)
Austin Texas, USA
Artificial Disc Replacement
November 2007

News Coverage of Ted Grenier's Surgery - Special Health Feature on CBS 42 Medical Watch Texas, USA

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