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13 / 12 / 2017
Sciatica
 
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Sciatica

 
BRAIN & NERVOUS SYSTEM

Pain

 
 

Sciatica is a severe pain in the leg caused by compression, irritation, or inflammation of the sciatic nerve.

The discomfort can range from mild to incapacitating, and may be accompanied by tingling, numbness or muscle weakness. Rather than a disorder in and of itself sciatica is a symptom of another problem, such as a herniated disk, that puts pressure on the nerve.

Sciatic pain usually goes away on its own in six weeks or so. In the meantime, hot and cold packs, over-the-counter pain relievers, and exercise or physical therapy can help ease discomfort and speed recovery. Surgery to relieve pressure on the nerve may be an option when symptoms don't respond to conservative treatment and pain is chronic or disabling.

Signs and symptoms

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow one of these routes:

  • From your lower back to your knee

  • From the midbuttock to the outside of your calf, the top of your foot and into the space between your last two toes

  • From the inside of your calf to your inner ankle and sole

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze. Usually only one lower extremity is affected.

In addition to pain, you may also experience:

  • Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another.

  • Tingling or a pins-and-needles feeling. This occurs most commonly in your toes or part of your foot.

  • A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care. If you experience either of these symptoms, seek medical help immediately.

Causes

Sciatica usually results from compression of a nerve root in your lower (lumbar) spine — a condition called a radiculopathy. By far the most common cause of this compression is a herniated disk in your lower back. Disks are pads of cartilage that separate the bones (vertebrae) in your spine. Each disk consists of a ring of tough fibrous tissue (annulus fibrosis) surrounding a jelly-like center (nucleus pulposus). Healthy disks keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move.

Between each vertebra is an elastic pad of cartilage called an intervertebral disk. The disks consist of a tough, fibrous outer covering (annulus fibrosus) and a jelly-like center (nucleus pulposus).

But as you grow older, the disks may start to deteriorate, becoming drier, flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk then often presses on a nerve root, causing pain — which can be excruciating — in your back, leg or both. If the damaged disk is in the middle or lower part of your back, you also may experience numbness, tingling or weakness in your buttock, leg or foot.

Other conditions that may put pressure on the sciatic nerve include:

  • Lumbar spinal stenosis. Your spinal cord is a bundle of nerves that extends the length of your spine. It's housed inside a channel (spinal canal) within the vertebrae. Thirty-one pairs of nerves branch off from the spinal cord, providing communication between your brain and the rest of your body. In spinal stenosis, one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of these branching nerves. When the narrowing occurs in the lower spine, the lumbar and sacral nerve roots may be affected.

  • Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves the spine.

  • Piriformis syndrome. Running directly above the sciatic nerve, the piriformis muscle starts at your lower spine and connects to each thighbone (femur). Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the sciatic nerve. Active women — runners and serious walkers, for example — are especially likely to develop the condition. Prolonged sitting, car accidents and falls also may contribute to piriformis syndrome.

  • Spinal tumors. A tumor is a mass of abnormal cells. In the spine, these growths may occur inside the spinal cord, within the membranes (meninges) that cover the spinal, or in the space between the spinal cord and the vertebrae — the most common site. As it grows, a tumor compresses the cord itself or the nerve roots. This can cause severe back pain that may extend to your hips, legs or feet; muscle weakness and a loss of sensation — especially in your legs; difficulty walking; and sometimes loss of bladder or bowel function.

  • Trauma. A car accident, fall or blow to the spine can injure the lumbar or sacral nerve roots.

  • Sciatic nerve tumor or injury. Although uncommon, the sciatic nerve itself may be affected by a tumor or injury, leading to sciatic pain.

  • Other causes. In some cases, your doctor may not be able to find a cause for your sciatica. A number of problems can affect the bones, joints and muscles, all of which could potentially result in sciatic pain.

Risk factors

Risk factors are health problems, lifestyle choices and inherent qualities, such as age or race that make it more likely you'll develop a particular condition. Major risk factors for sciatica include:

  • Age. Age-related changes in the spine are the most common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 30, and most people who develop herniated disks are in their 30s and 40s. Spinal stenosis, another leading cause of sciatica, primarily strikes people in their 50s and beyond.

  • Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica.

  • Physical activity. Although walking and jogging have been associated with an increased risk of sciatica, exercise in general has not. In fact, people who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.

  • Genetic factors. Researchers have identified two genes that may predispose some people to disk problems.

  • Diabetes. Having this condition, which affects the way your body uses blood sugar, makes you more likely to develop nerve damage.

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Disclaimer
This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

In no event will the DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.
 
 
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Dr. Eddy Bettermann M.D.

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