An excruciating pain in your lower back that goes all the way down to your hips, buttocks and legs could be sciatica. Sunny Rodricks tells you more about the condition and brings you tips to deal with it
Sciatica sounds like a scientific description of a very scary condition... or a cool-sounding made-up word for something out of the Harry Potter universe! But, the truth is far simpler. It is associated with a back pain that radiates to the lower half of the body. Here we’re telling you about the condition, its signs, what causes it and what you can do to relieve the pain.
WHAT IS SCIATICA?
The sciatic nerve is a nerve that runs from the lower back down the back of each leg. If something injures the nerve or puts pressure on it, a characteristic pain results. “Sciatica is a condition that causes pain in the back, buttocks, hips or legs due to pressure on the sciatic nerve. In this condition, pain originates in the spine and can radiate to the lower extremities,” says Dr. Sukeshini Ramtake, physiotherapist at AXIS Hospital, Andheri (w). Sciatica pain usually improves within four to six weeks, but it can sometimes take longer to show signs of improvement. In extreme cases, when people experience significant leg weakness or bowel or bladder issues, surgery may be advised. However, it is estimated that up to 90% of people recover from sciatica without surgery.
Those with sciatica feel a pain in their lower back and bottom, at the back of their legs and in their feet and toes. The pain may be stabbing, burning or tingling — like pins and needles when a body part goes numb. It may get worse when you move, sneeze or cough, and it may even be felt in your back. Dr. Imran S. A. Ansari, consultant orthopedic surgeon at Ansari’s Orthopedic Clinic, Lamington Road, tells us, “Weakness in the lower limbs, the inability to lift up your legs, the inability to flex your ankles and your big toes and the inability to walk on tip toes are all signs of sciatica.” Common symptoms of sciatica include:
- Lower back pain along with burning or tingling sensation down the leg
- Pain in the buttocks and hip
- Pain in the leg that gets worse when sitting for long hours
- Shooting pain that becomes unbearable and makes it difficult to stand up
- Numbness in the leg and foot
- Internal bleeding around the sciatic nerve
- Infection of or around the lumbar spine
Sciatica by itself is not a medical diagnosis, since it only manifests as pain. There is almost always an underlying cause. “The commonest causes of sciatica include a lumbar herniated disc or a slipped disc, degenerative disc disease (age-related), spondylolisthesis (or the translation of one vertebra over another), lumbar canal stenosis (narrowing of the spinal canal, which is entirely age-related), pyriformis syndrome (pinching of the nerve between the pyriformis muscle) and sacroiliac joint dysfunction,” says Dr. Imran. There are other causes too. “Pregnancy, a fracture in the lower lumbar spine, epidural fibrosis (scar tissue), an infection in the lumbar spine, muscle strain and ankylosing spondylitis can also lead to sciatica,” Dr. Imran adds. We take a look at a few of the major causes of scatica.
A herniated disc is the most common cause of sciatica in the lumbar spine. The vertebral discs act as a cushion for the vertebrae and as they get weaker, they become vulnerable to injury. At times the gel-like centre of a disc pushes through its outer lining and presses on the roots of the sciatic nerve causing pain. About 1 in 50 people suffer from a herniated disc at some point in their life.
The natural wear and tear of the vertebrae can lead to the narrowing of the spinal canal. This is also called spinal stenosis and the condition can put pressure on the roots of the sciatic nerve. The pain is often brought on by activities such as standing or walking, and is relieved by sitting down. It is commonly observed in adults over the age of 60 years.
Another major cause of sciatic pain is the result of a tumour inside or along the spinal cord or the sciatic nerve. As the tumour grows, it puts pressure on the nerves that branch off from the spinal cord. These tumours can either be benign (harmless) or cancerous (malignant). But fortunately, spinal tumours are rare.
The piriformis is a muscle found deep inside the buttocks. It connects the lower spine to the upper thighbone and runs directly over the sciatic nerve. A spasm in this muscle can put pressure on the sciatic nerve. Piriformis syndrome is more common in women than in men, but is difficult to diagnose and treat. Strangely, sitting on a fat wallet in your back pocket can trigger the syndrome, as this puts chronic pressure on the piriformis muscle and can aggravate sciatic pain.
Sacroiliitis is the inflammation of one or both of the sacroiliac joints — the spot where the lower spine connects to the pelvis. It can cause pain in the buttocks and lower back, and may even extend to one or both legs. The pain worsens with prolonged standing and you’ll feel it when you’re climbing the stairs. Sacroiliitis may be caused due to arthritis, injury, pregnancy or infection.
ARE YOU AT INCREASED RISK?
Sciatica is not very common, but you may be putting yourself at risk. “Sciatica is uncommon in individuals below 20 years of age and incidence peaks in people who are in their 40s. The most common risk factors for the condition include strenuous physical activity such as frequently lifting heavy objects, driving for many hours each day, being tall, smoking and stress,” says Dr. Pradeep Mahajan, regenerative medicine researcher, Adigos Stem Cells. Here are a few risk factors of the condition
- Age: Your risk for sciatica increases as you get older.
- Height: Taller individuals are at greater risk of sciatica.
- Stress: High levels of psychological stress can increase your chances of suffering from sciatica.
- Weight: Those who are overweight have increased risk.
- Driving: It is believed that high levels of vibration from vehicles are with greater risk of sciatica. For example, those who drive a truck for a living.
- Smoking: Smoking increases your risk.
- Sitting: Sitting for long periods can put you at greater risk of sciatica.
Since sciatica results from a pinching of a nerve, there are some things that you can do to reduce your chances of suffering from the pain.
- Always maintain good posture.
- Exercise regularly.
- Learn the correct form when exercising, says Dr. Ashok.
- Dr. Sukeshini suggests performing exercises such as back muscle stretching, the cat and camel stretch and stretching your arms and calf muscles.
- Bend at the knees when lifting heavy objects.
- Practise yoga or Pilates to prevent injuries to your lower back.
- Physical activity and patient counselling is important to prevent further damage to the affected nerve or nerve root, says Dr. Pradeep.
- Avoid sitting for long periods. If you have a sedentary job, get up and move around every now and then.
- Reduce your weight if you’re overweight.
- Avoid smoking.
DIAGNOSING THE CONDITION
“Sciatica is commonly diagnosed by a physical examination and by evaluating the medical history of a person. MRI scans, CT scans or X-rays of the lower back are common methods for diagnosing the underlying cause,” says Dr. Ashok Hande, neurosurgeon at Hiranandani Hospital, Vashi.
Other causes of sciatica include muscle inflammation, infection or injury, such as a fracture at the spinal cord. Any condition that irritates or compresses the sciatic nerve or puts pressure on the nerve can trigger symptoms. Sciatica can also occur during pregnancy if the weight of the foetus presses on the sciatic nerve. Although there is no direct harm to the mother or the foetus, indirect harm can occur in the form of a numbing effect on the legs, which can lead to a loss of balance.
WHEN MIGHT SCIATICA SURGERY BE NEEDED?
Although the symptoms of sciatica appear abruptly and last for a few days or weeks, it’s best to consult a doctor if the pain persists. A loss of bladder or bowel control is a sign that it is serious, sometimes even a medical emergency, which would require surgery in order to avoid permanent damage. Although the need for surgery with sciatica is rare, it is not unheard of. Here’s where surgery might be required.
- If you have a bowel or bladder dysfunction, surgery may be required, as the cause may be a spinal compression.
- If you have spinal stenosis, your doctor might feel the need for surgery.
- If you experience other neurologic dysfunctions, such as severe leg weakness and are unable to stand up at all, surgery might be required.
- If your pain persists and the symptoms become severe, or when non-surgical treatment is no longer effective, you might need to go under the knife.