Sciatica

Pain along the sciatic nerve is commonly referred to Sciatica. Sciatic nerve is a nerve which branches from the back, through the hips and travels down to each leg. Such pain usually appears in side of the body which is accompanied by inflammation and numbness.

Some conditions like herniated disk, bone spur (overgrowth of bone) on spine and narrowing of spine (spinal stenosis) may compress the nerve and lead to Sciatica.

Surgery is required only in case of severe sciatica which can be the cause of significant leg weakness or bladder changes.

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the main symptom of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected. Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

When to see a Doctor?

Mild sciatica usually goes away over time. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than a week, is severe or becomes progressively worse.

Get immediate medical care if you have:

• sudden, severe pain in your low back or leg,
• numbness or muscle weakness in your leg,
• the pain follows a violent injury, such as a traffic accident,
• you have trouble controlling your bowels or bladder.

Sciatica is caused when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.

Making a diagnosis of sciatica is usually done during physical examination.

The doctor would perform a thorough physical examination during which he or she would check the muscle tone, muscle bulk, muscle strength and reflexes of the injured leg.

The patient may be asked to do certain activities like walking on toes and rising from squatting position, and sciatica pain usually worsens during such activities.

Sometimes the following tests are recommended:

• X-ray- An X-ray of the spine may reveal conditions that led to compression of the sciatic nerve.
• MRI- This gives a detailed image of bone and soft tissues.
• CT myelogram- a contrast is injected into the spinal canal and then computed tomography is performed in which cross-sectional images are received.
• Electromyography- the electrical impulses produced by the nerves and the response of the muscle is measured. 

Treatments for sciatica varies according the severity.

Some of the treatment method include:

• Medications- Anti-inflammatory, muscle relaxants, narcotics, tricyclic antidepressants are commonly given to reduce the symptoms.
• Physical Therapy- performing exercises to prevent further injuries.
• Steroid injections- Sometimes, corticosteroid injections are directly given into the area around the nerve root.
• Surgery- Surgeries are performed only in extremely severe cases where other treatment options have failed. Procedure to remove the overgrown part of the bone or herniated disk are performed.  

The following steps can play an important role in preventing sciatica:

• Exercise regularly-especially of those exercises required for maintaining a proper posture.
• Maintain posture- maintaining comfortable posture while sitting, keeping the knees and hips in a level and using proper body movements.
• Using footrest during prolonged standing.
• While lifting a heavy object, putting load on the lower extremities by bending at the knees only. Finding another person to help carry the heavy object.     

The alternative remedies for sciatica include acupuncture (using special needles to relieve pain) and chiropractic (spinal adjustments), but these might not cure sciatica pain.   

Lifestyle modifications are necessary in order to improve sciatica.

In maximum cases, sciatica responds to home remedies, personal care and resolves without doctor’s consent.

Cold packs, hot packs, stretching exercises, avoiding jerking movements and over-the-counter analgesics (anti-pain) may help to improve the condition.

The most common risk factors for the development of sciatica include:

• Age (older age related changes like herniated disk),
• obesity,
• occupation (jobs requiring twisting of back, carrying heavy loads),
• prolonged sitting and diabetes.

Mostly people recover from this condition without medical help but sometimes untreated sciatica may lead to permanent damage to the affected lower leg, complete loss of sensation in lower leg and loss of bladder functions.