What is sciatica?
Sciatica refers to pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the largest nerve in the human body. It runs from your lower back, through your hips, buttocks and down your legs.
Sciatica is a fairly common condition. Research has shown that there is a 13 to 40 percent chance that you will develop sciatica in your lifetime , and about 40% of the adult population can be affected by sciatica at one time . However, sciatica often goes away on its own, and pain will usually subside within a few hours or days. Though, sciatica attacks may come and go every few months or so.
How will having sciatica affect me?
There are ways in which having sciatica may affect you. With sciatica, you will likely experience pain and difficulty moving around. Daily activities such as sitting, bending over and rising from a chair may cause the pain to flare up. Even coughing and sneezing can become very painful. As a result, this may bring great discomfort and inconvenience to your life.
What does having sciatica feel like?
Pain and discomfort. With sciatica, you may experience a burning or shock-like pain in your lower back that shoots down your buttocks, legs and even toes. The severity and duration of pain varies from person to person. Some people may experience extremely intense pain, while others may only experience a slight pain that comes and goes.
Weakness and tingling. Besides pain, you may also experience muscle weakness or a tingling pins-and-needles sensation in your legs and feet.
Sciatica typically affects only one leg at a time. However, there are instances in which it occurs in both legs. This is usually dependent on the location at which the sciatic nerve is irritated or compressed.
What are the causes of sciatica?
Medical conditions. Sciatica can be a result of underlying medical conditions, such as:
A herniated disc
- Your spine is made up of 24 small bones, known as vertebrae, stacked on top of each other. In between each vertebrae, there is a rubbery pad known as a disc that acts as a cushion and prevents the vertebrae from rubbing against each other. Each disc has a harder exterior, known as the annulus, which surrounds an inner core, known as the nucleus. The nucleus contains loose fibers that are suspended in a gel-like substance.
- A herniated disc occurs when a fragment of the nucleus pushes out through the annulus as it is weak or torn
- When a herniated disk happens in your lower back, it could compress on the sciatic nerve, resulting in sciatica
- Spinal stenosis occurs when spaces within your spine, known as the foramen, begin to narrow, thus putting pressure on the nerves that run through your spine.
- When stenosis occurs in your lower back, this could once again place pressure on the sciatic nerve, causing sciatica
- Spondylolisthesis happens when one of the vertebrae slips out of position
- This commonly occurs in the lower back
Trauma. Traumatic events, such as a fall or car accident, may result in injury to the sciatic nerve.
Tumours. Abnormal growths such as tumours within or near the spine may also press on on the sciatic nerve.
What are the risk factors of sciatica?
Age. As you age, parts of your body naturally begin to degenerate, including your spine. As a result, this would increase your risk of conditions such as a herniated disc, stenosis and spondylolisthesis, all of which would put you more at risk of developing sciatica.
Other known risk factors of sciatica include :
Occupation (awkward working position)
How can sciatica be diagnosed?
Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing you with sciatica. Your doctor may ask you about your medical history, family history and test your strength and reflexes.
Imaging. In addition, your doctor may make use of spinal imaging such as X-Ray, MRI and CT scans to have a detailed look at the spine and surrounding nerves. This will allow your doctor to locate your sciatic nerve and see if it is being compressed.
EMG. In addition, your doctor may conduct an electromyography (EMG) which measures the electrical activity of your nerves and muscles. There are two parts to an EMG.
The first part comprises nerve conduction studies (NCS), which measures the rate at which electrical impulses move through your nerves. During this test, small patches which deliver electrical pulses will be attached to your skin. This process may cause you some discomfort depending on the strength of the electrical pulse but is generally painless.
The second part is known as a needle electrode examination, which measures the electrical activities in your muscles. During this test, five or more thin needles will be inserted into your muscle. You may experience a slight pain during the insertion of the needles. However, this test is otherwise painless as well.
How do I prevent myself from developing sciatica?
There is no certain way to completely prevent sciatica. However, some ways to reduce your risk of developing sciatica include:
Exercising regularly. Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.
Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of developing sciatica.
How can sciatica be treated?
Physiotherapy. There are several ways in which sciatica can be treated, the first of which being physiotherapy. For this, your doctor will likely refer you to a physiotherapist. Although not a cure, physiotherapy is important in helping you to remain active and build strength in your back.
Epidural steroid injections. Alternatively, your doctor may make use of epidural steroid injections. This is a minimally invasive procedure whereby your doctor, with the guidance of X-ray imaging, will first carefully insert a needle into a fat-filled area between the bone and the protective sac of the spinal nerves within your spine. Your doctor will then inject a medicine to help reduce pain and inflammation in your spine.
Surgery. Lastly, your doctor may opt to treat your sciatica surgically by removing whatever is compressing on your sciatic nerve.
If you are currently experiencing any lower back pain or think that you may be experiencing sciatica, visit a doctor and seek medical attention immediately.
- Stafford, M. A., Peng, P., & Hill, D. A. (2007). Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. BJA: British Journal of Anaesthesia, 99(4), 461–473. https://doi.org/10.1093/bja/aem238
- Frymoyer, J. W. (1992). Lumbar disk disease: epidemiology. Instructional Course Lectures, 41, 217–223. https://pubmed.ncbi.nlm.nih.gov/1534104/
- S Ramachandran, T. (2019). Disk Herniation Imaging: Overview, Radiography, Computed Tomography. EMedicine. https://emedicine.medscape.com/article/340014-overview#a4