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Sciatica

Sciatica is a medical term used for describing nerve pain that radiates to the leg from the lower back. It is caused by either irritation or compression of the sciatic nerve found in the lower back.

Sciatica originates in the lower back which radiates to the buttock, and down to the leg. It affects either one or both the legs.

One should remember that any lower back or radiating leg pain cannot be called sciatica. Sciatica refers specifically to the pain originating from the sciatic nerve.

Risk Factors

According to some estimations, about 40% of the global population will suffer sciatica at some point in their life.

People in the age group of 40 to 50 are the most affected by sciatica. That said, people in any age group can suffer from sciatica.

Some significant risk factors include:
  • Preexisting spinal degeneration
  • Loss of normal spinal mobility
  • Diabetes
  • Heavy physical work
  • Sedentary Lifestyle

Symptoms of Sciatica

Shooting pain is the main symptom of sciatica. It can occur anywhere in the pathway of the sciatic nerve - starting from lower back radiating to the back of the leg through the buttocks.

Other common symptoms include:
  • Pins and needles (tingling sensation) in feet and toes
  • Numbness in the leg
Sciatica varies in severity and can be aggravated by long periods of sitting.

Types of Sciatica

  • Neurogenic – Compression of the main sciatica nerve or smaller nerve roots. Symptoms vary depending on the pressure put on the nerve.
  • Referred – Joint or muscle pain in the spine or pelvis. It mimics sciatica and proper diagnosis is required. Referred sciatica pain is usually achy and dull, but it can also be sharp sometimes.

Why is My Sciatica Flaring Up

Sciatica can flare up due to a variety of reasons. We will take a look at common and some not-so-common reasons for a sciatic flare-up.

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1. Disc bulge or Herniation

This is one of the most common causes of sciatica. When the disc herniates, the nucleus polyposis (a soft material) escapes through the annular tears present in outer cartilage.

The extremely sensitive nerve roots get irritated by the proteins that are present in the disc material. This, subsequently, results in the development of sciatic pain.

2. Degenerative Joint Disease

Whenever degeneration occurs in the spine as well as the intervertebral discs, spaces present between two vertebrates narrow. This can irritate the nerve root and cause sciatic pain in either one or both legs.

3. Abnormal spinal movement

Sometimes, the lumbar spine has either a restricted or an unnatural movement. When this occurs, there is associated irritation of vertebral joints, muscle tightness, and localized inflammation.

These abnormal changes can irritate the sciatic nerve and result in subsequent sciatica. These unusual changes can be a result of poor posture following trauma to the spine, placing undue stress on the spine.

4. Spinal Stenosis

When a person suffers spinal stenosis, the spinal canal gets narrowed. The restricted canal space can put a lot of pressure on the spinal cord, which can result in sciatica.

A person might get spinal stenosis due to damage to vertebral joints, spinal degeneration, or growth of tumors or cysts within the spinal canal.

5. Piriformis Syndrome

The sciatic nerve either runs through or below the piriformis muscle as the muscle exits the spine.

A spasming or tight piriformis muscle can result in the sciatic nerve getting irritated while passing into the leg resulting in sciatic pain.

6. Spondylolisthesis

A person is said to suffer spondylolisthesis when one vertebra slips forward over another. This is usually associated with the narrowing of the disc space and loss of height.

The lower back is the place where spondylolisthesis happens a lot. The lower back is also the place where the sciatica nerve roots exit from the spine. Any pressure on the nerves can result in radiating sciatic pain.

Arthritis and degeneration, previous surgeries, pathological reasons (infections or cancer), or trauma of the spine are significant causes of spondylolisthesis.

7. Sacroiliac joint dysfunction

- The sacroiliac joint (SI) is located between the sacrum and the pelvis. As the sciatic nerve exit the pelvis, it runs close to the joint.

Any damage, trauma, or inflammation to the SI joint can irritate sciatic nerves and cause sciatica.

8. Muscle strain

Any severe sprain or strain to the muscles surrounding the spine can result in the nerves getting irritated as it exits the spine.

While it is rare for muscle strain or sprain to cause sciatica, muscle spasm and tightness are secondary to a spinal injury or sciatica.

9. Pregnancy

When a woman is pregnant, the center of gravity shifts forward with the increase in the weight and size of the baby.

This can increase spinal curvature which can irritate the nerves present in the area. In most cases, the pain will be in one leg, but a pain in either leg cannot be ruled out.

The baby’s position can also result in irritation of the sciatic nerves and cause sciatica.

10. Tumors, fractures, infection

Damage to spinal structure due to trauma, infection, or even cancer can impinge or put pressure on the lower back nerve roots and can result in sciatica.

While this is not a very common cause for sciatica, it is certainly is one of the potential causes and should be ruled out before starting any treatment.

11. Ankylosing spondylitis

An uncommon arthritic type, it affects both spine and pelvis. This disease results in the development of chronic inflammation both in and around the spine. This can result in the development of sciatica symptoms.

Treatment

Sciatica is treatable. Sciatic treatments can be divided into:
  • Acute sciatica treatment
  • Chronic sciatica treatment
  • Surgery
  • Exercises and stretches

Acute sciatica treatments

Most acute sciatica cases respond to self-care measures that include:
  • OTC painkillers like ibuprofen
  • Walking or light stretching
  • Hot and/or cold compression packs. Alternating between the two is very helpful
It should be noted that not everybody responds well to a painkiller. Consultation with the doctor is important before taking any painkillers.

Chronic sciatica treatments

Treatment for chronic sciatica involves a combination of medical and self-care measures. These include:
  • Physical therapy
  • Painkillers
  • Cognitive Behavioral Therapy or CBT. Helps in better management of chronic pain by training to react differently to pain events

Surgery

The doctor might prescribe surgery if the sciatic symptom fails to respond positively to other measures. Surgical options include:
  • Lumbar laminectomy
  • Discectomy
The surgery type is decided based on the causes of sciatica.

Exercises and stretches

Exercise is one of the many ways of treating sciatica. Exercise allows the person to:
  • Alleviating sciatic symptoms without any medical help
  • reduce or avoiding medications, wherever possible
  • Get long-term relief comfort during flare-ups