The term sciatica refers to the pain felt along the path of the sciatic nerve, which starts from the lumbar region and extends lower, towards the thighs and buttocks, reaching the level of the leg. Although in certain situations sciatica can be severe, most of the time the pain subsides with treatment within a few weeks. Patients who present muscle weakness in both lower limbs or who associate bladder or intestinal damage, secondary to inflammation of the sciatic nerve, may require surgical treatment to improve the symptoms.
Causes and risk factors of sciatica
How to relieve the pain caused by sciatica
Can sciatic nerve pain be prevented?
What is the sciatic nerve?
The sciatic nerve is the longest and best-developed nerve that reaches the thickness of a finger, is composed of 5 roots: 2 of the roots emerge at the lumbar level, and the other 3 originate at the level of the last portion of the spine, namely the segment sacred.
The 5 roots together make up the sciatic nerve, one on each side of the body. Below the knee, the sciatic nerve branches, the nerve threads reaching the level of the leg and the fingers of the pelvic limb.
Causes and risk factors of sciatica
Lumbar pain that radiates down to the pelvic limb occurs as a result of pinching the sciatic nerve, most often in the context of a lumbar disc herniation.
Lumbar spondylolisthesis is a pathology of the spine that affects the intervertebral discs and the joints between them, causing the anterior sliding of a vertebral body in relation to the rest of the vertebrae. Spondylolisthesis frequently manifests itself at the level of the lumbar or sacral segment and occurs as a result of the slippage of the L4 vertebra on L5 or the L5 vertebra on S1.
Stenosis of the vertebral canal represents the narrowing of the spinal canal that predisposes to the pinching of the various nerve pathways contained by it.
Piriformis syndrome is a neuromuscular condition generated by irritation of the piriformis muscle, caused by an inflammatory process or muscle spasms that exert compression on the sciatic nerve. The sciatic nerve passes along the piriformis muscle towards the lower part of the pelvic limb and can be compressed during spasms of this muscle.
The cauda equina syndrome is a rare cause of sciatica, in which a series of nerve roots located at the level of the last portion of the spine are affected. Manifestations of cauda equina syndrome include severe pain in the pelvic limb, numbness in the perianal region, and fecal and urinary incontinence.
In less frequent cases, sciatica occurs as a result of the development of a tumor process at the level of the vertebral canal.
Risk factors for sciatica are frequently represented by:
- Age – the structural changes in the spine that occur with advancing age predispose to the appearance of pathological processes affecting the sciatic nerve
- Overweight – obesity is a risk factor for sciatica due to the extra pressure exerted by extra pounds on the spine
- Profession – certain professions require performing sudden movements of the spine or frequent lifting of weights, which predispose to the appearance of lumbar disc herniations with pinching of the sciatic nerve
- Sedentarism – people with a sedentary lifestyle are more prone to the appearance of pain caused by the sciatic nerve compared to those who have an active lifestyle and perform regular physical exercises
- Personal antecedents of accidents or surgeries at the level of the lumbar spine
- Diabetes mellitus – diabetic polyneuropathy can include, in certain patients, damage to the sciatic nerve due to the reduction in the density of myelin fibers
- Osteoarthritis – osteoarthritis can cause damage to the spine with the risk of damaging the sciatic nerve
Sciatica is a frequently encountered symptom during pregnancy caused by the hormonal effect of weakening the ligaments that ensure the stability of the spine and protect the emerging nerve fibers. The change in the center of gravity of pregnant women and the physiological surplus of kilograms specific to the gestation period represent other risk factors involved in the occurrence of sciatica in pregnant women.
How to relieve the pain caused by sciatica
Sciatica is described by patients as an acute, throbbing pain (stabbing and throbbing) that can sometimes manifest as burning or stinging along the nerve path. The pain can be continuous or intermittent, being more severe in the pelvic limb compared to the lower lumbar region. Sciatica can be accentuated by adopting a sitting position, prolonged standing or rotational movements of the spine. Sudden movements or involuntary muscle contractions during coughing or sneezing can accentuate sciatic nerve pain.
The treatment in sciatica has the role of relieving painful discomfort and regaining mobility at the level of the affected pelvic limb and includes:
Application of ice or cold compresses – the pain caused by sciatic nerve damage usually subsides within 20 minutes after applying ice to the affected area.
Performing light stretching movements.
Administration of anti-inflammatory medication such as aspirin, ibuprofen, acetaminophen, non-steroidal anti-inflammatory drugs or sodium naproxen.
In the event that sciatica does not improve within 6 weeks of applying the mentioned methods, it is recommended to see a doctor for reevaluation and development of a new therapeutic plan.
In the case of persistent intense pain due to the sciatic nerve, the doctor may recommend:
- Administering muscle relaxants to relieve muscle spasms that cause compression of the sciatic nerve
- Intramedullary injections with anti-inflammatory corticosteroids to reduce the inflammation of the nerve roots at the lumbar level
- Surgical intervention is reserved for patients unresponsive to the previously listed treatment methods, which associate muscle weakness, functional impotence at the level of the affected pelvic limb and loss of anal and/or bladder sphincter control
- In most situations, surgical treatment is considered when sciatic nerve pain does not improve within 1 year of applying lifestyle change measures and treatment and may consist of:
- Microdiscectomy – a minimally invasive procedure in which fragments of herniated discs that exert pressure on the sciatic nerve are removed
- Laminectomy – a surgical intervention that involves the removal of the lamina that causes pinching of the sciatic nerve
When we turn to the specialist doctor
Most patients who are affected by lumbar pain with radiation along the sciatic nerve recover completely after the administration of specific treatment, but there are also situations in which emergency medical intervention becomes necessary, namely:
Loss of sensitivity in the limb affected by sciatica, sometimes tingling or stinging sensations may be present in the territory served by the affected sciatic nerve.
Muscle weakness in the affected lower limb.
Occurrence of urinary or fecal incontinence.
Can sciatic nerve pain be prevented?
Certain causes that determine the appearance of sciatica can be avoided, but there are also etiologies of this manifestation that cannot be avoided, such as pregnancy, injuries to the lumbar spine or degeneration of the intervertebral discs.
The following preventive measures can be successfully applied to avoid sciatica:
- Maintaining an appropriate posture during work hours, but also during sleep. Avoiding prolonged orthostatism, sudden twisting movements of the leg and lifting heavy objects
- Maintaining an adequate body weight prevents inflammation due to the high level of fats in the blood and reduces pressure on the spine
- Maintaining an active lifestyle with regular physical exercises to strengthen the paravertebral and abdominal muscles
- Practicing sports activities with minimal impact on the spine – swimming, walking, yoga, tai chi
- Sciatica crisis – a symptom of other diseases
The sciatica crisis can also be encountered in other conditions that are not caused by traumatic or inflammatory damage to the sciatic nerve, namely:
- Postherpetic neuralgia
- Grant
- Restless legs syndrome
- Plantar fasciitis
- If you experience any of these symptoms, contact your doctor for a specialist consultation
- Prevention and monitoring of medical conditions reduce the risk of complications and the administration of aggressive treatments
References:
- A comparison of sciatica in young subjects and elderly person, Keyvan Mostofi, Morad Peyravi, Babak Gharaei Moghaddam – https://www.sciencedirect.com/science/article/abs/pii/S0976566219304928
- Physiotherapy management of sciatica, Raymond WJG Ostelo – https://www.sciencedirect.com/science/article/pii/S1836955320300229
- Sciatica, Cleveland Clinic – https://my.clevelandclinic.org/health/diseases/12792-sciatica
