Sciatica

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the low back and travels through the buttock and down the large sciatic nerve in the back of the leg.
The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical sciatica treatment. For others, however, sciatic nerve pain can be severe and debilitating.

Sciatica is often characterized by the following symptoms:

  • Pain on one side of the buttock or in one leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A sharp pain that may make it difficult to stand up or to walk

The clinical diagnosis of sciatica is referred to as a “radiculopathy”, which simply means that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve.
Note that sciatica is not a medical diagnosis, but rather a symptom of an underlying problem in the lower back (such as a herniated disc or spinal stenosis that is compressing or irritating the nerve roots). This is an important distinction because it is the underlying diagnosis (vs. the symptoms of sciatica) that often needs to be treated in order to relieve sciatic nerve pain.
Sciatica occurs most frequently in people between 30 and 50 years of age. Often a particular event or injury does not cause sciatica, but rather the sciatic pain over time tends to develop as a result of general wear and tear on the structures of the lower spine.

Sciatica Symptoms

For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse.
While sciatica can be very painful, it is rare that permanent sciatic nerve damage (tissue damage) will result. Most sciatica symptoms result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.
While relatively rare, two sciatica-related symptoms that warrant prompt medical attention and possibly emergency surgery, include: progressive weakness in the leg, and either bladder or bowel incontinence or dysfunction. Patients with either of these symptoms may have cauda equina syndrome and should seek immediate medical attention.

Sciatica Medical definition: radiculopathy

To clarify medical terminology, the term sciatic (often misspelled as ciatica or siatica) is often used very broadly to describe any form of pain that radiates into the leg, however, this is not technically correct. True sciatica occurs when the sciatic nerve is pinched or irritated and the pain along the sciatic nerve is caused by this nerve(radicular pain) and is called a radiculopathy. When the pain is referred to the leg from a joint problem (called referred pain), using the term sciatica is not technically correct. This type of referred pain (e.g. from arthritis or other joint problems) is quite common.

Sciatica treatment

Sciatica nerve pain is caused by a combination of pressure and infammation on the nerve root, and treatment is centered on relieving both of these factors. Typical sciatica treatment include:

  • Non-surgical sciatica treatments, which may include one or a combination of medical treatments and alternative (non-medical) treatments, and almost always includes some form of back exercises and strechting. The goals of non-surgical sciatica treatment, such as sciatica exercises, should include both relief of sciatica pain and prevention of future sciatica pain.
  • Sciatica surgery, such as microdiscectomy or lumbar laminectomy and discectomy, to remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.
Sciatica Symptons
For some people, sciatica pain can be severe and debilitating. For others, the sciatica symptoms might be infrequent and irritating, but have the potential to get worse. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg.
Depending on where the sciatic nerve is affected, the pain and other sciatica symptoms may also radiate, prompting foot pain or pain in the toes.
There is a wide range of possible sciatica symptoms. One or more of the following sciatica symptoms are typical:
  • Pain in the buttock or leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A shooting pain that makes it difficult to stand up, and for some makes difficult to walk
Sciatica Symptoms occur when the large sciatic nerve is irritated. The sciatic nerve is the largetst single nerve in the body and is composed of individual nerve roots that start by branching out from the spine in the lower back and combine to form the “sciatic nerve”.
  • The sciatic nerve starts in the lower back at lumbar segment 3 (L3)
  • The sciatic nerve roots run through the bony canal in the spine, and at each level in the lower back a pair of nerve roots exits form the spine and then comes together to form the large sciatic nerve that runs all the way down the back of each leg
  • Portions of the sciatic nerve then brach out in each leg to innervate certain parts of the leg (e.g. the calf, the foot, the toes).
  • The nerve roots that originate in the lower back are named for the upper vertebral body that they run between ( for example, the nerve that exits at the L4-L5 segment in the lower spine named L4). The nerve passing to the next level runs over a weak spot in the disc space, and the discs tend to herniate (leak out) at this weak spot right under sciatic nerve roots and can cause sciatica.
The sciatica symptoms (e.g., leg pain, numbness, tingling, weakness, possibly foot pain) are different depending on where the pressure on the nerve occurs. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle(foot drop).
For most people, the good news is that sciatica usually will get better on its own, and the healing process usually only takes a few days or weeks. Overall, the fast majority of episodes of sciatica pain heal within a six to twelve week time span.
However, occasional flare-ups of sciatic nerve pain may be an indication of a condition that should be managed so that is does not get worse over time.