SCIATICA
What is Sciatica?
Sciatica is a condition where the sciatic nerve is irritated or inflamed causing nerve pain in the patient. The hallmark characteristics of sciatica is radiating or shooting sharp nerve pain down the entire leg. The sciatic nerve is the largest branch of the sacral plexus and is the largest nerve in the body. It branches from the lower back (L4 to S3), passes through the sacral promontory and ala and descends in front of the piriformis muscle into the posterior thigh. It then continues as the tibial and common fibular nerves travelling down the leg and towards the foot. Lumbar disc herniation or inflammation is one of the most common factors causing compression of the sciatic nerve thus sciatica.
Cause of Sciatica
Sciatica can be caused by multiple factors; spinal disc herniation, spinal stenosis and piriformis syndrome are amongst the most common. As mentioned above, spinal disc herniation in the lumbar spine accounts for about 90% of all sciatica cases under 50. Injury or abnormal increase in pressure loading of the spinal discs can results in herniation and swelling or inflammation of the disc, which can lead to compression of the sciatic nerve root. With lifting injuries, patients commonly report an increase of pain when bending forward or sitting. Pain level is usually very high.
Spinal stenosis is a less common contributor to sciatica; however, it is the most common chronic cause of sciatica; over the age of 50. Lumbar spinal stenosis is a condition where the space where the nerve passes through and exits is narrowed due to osteophytes (bone spurs) or spondylolisthesis etc. With decreased available space for the nerve to exit, the chances of compression or irritation increases. Due to the nature of osteophytic degeneration, treatment can be complicated compared to other causes of sciatica.
Lastly, piriformis syndrome is a less common condition that can contribute to sciatica. It accounts for 8% of lower back or buttock pain and is usually diagnosed as an association with sciatica. In 17% of people, the sciatic nerve runs through the piriformis muscle rather than beneath it, thus when the muscle spasms due to injury or overuse, the sciatic nerve can be irritated, causing sciatic pain. Piriformis syndrome has been referred to as “Wallet syndrome” where carrying a wallet in the rear hip pocket for an extended period of time can compress the piriformis muscle causing inflammation and sciatic pain. Sciatica caused by piriformis syndrome is usually the least severe and easiest to resolve.
Risk factors of sciatic includes smoking, obesity and occupational and physical injuries. Non-modifiable risk factors includes aging, being male and having a history of lower back pain. Less reported risk factors includes a history of hip replacement with an association of 0.5%-2% chance of sciatica as a complication.
Symptoms
Sciatica can last from months to years, most commonly reported by males between the age of 30-50 years old. The male to female ratio of sciatica is 4:1. Due to the presenting sharp radiating pain, patients will experience the inability to bend at the waist and hard to find a comfortable position to sit or stand. Walking can be difficult and weakness in the lower limbs is a common reported symptom. As the condition progresses, patients might experience insomnia due to the sharp and burning pain. Without proper treatment and management, numbness can develop in the lower back and pelvis which can eventually spread into the leg. Muscular atrophy and diminished reflexes are seen in the later stages with reported nervous system complications such as urinary incontinence and impotence.
Treatment Option
There are four major treatment options; chiropractic care, medications, epidural injections and surgery.
Chiropractic care remains one of the most common non-invasive option for lower back pain and sciatica. As the sciatic nerve becomes irritated and compressed by the surrounding structures; muscular tissue and/or spinal discs, chiropractic care helps to stabilize the structures to decrease compression thus inflammation. Our spinal discs and vertebrae are responsible in handling weight bearing and loading in our day to day lives. Stability and proper loading distribution allows the spine to function more effectively. Medication is also another popular option. Patients can be prescribed muscle relaxants and/or NSAIDs to chemically decrease inflammation and swelling.
Epidural steroid injections are usually suggested for more severe cases; especially when medication is not effective. Steroidal injections are given to the area of inflammation or compression to allow direct delivery of the medication in attempt to provide relief. Lastly, spinal surgery can be an option for the patient when other options have failed to provide relief or not recommended. This option is most common with patients suffering spinal stenosis where the sciatic nerve is irritated or compressed by osteophytes or surrounding structures. Surgery can attempt to physically remove the obstacle in order to clear the nerve from further disruption.
In summary, each treatment option can benefit the patient and will depend on the current condition and contributing factors. If you are experience sciatic pain, please contact your healthcare provide to discuss the most appropriate option for you.
Dr. Lai’s Recommendations:
Prevention trumps treatment and therapy. There are many ways to prevent or lower the risks of lower back pain and sciatica. Our spinal health relies on mobility, regularly exercising and maintain a healthy body weight can have a huge impact. Avoid excessive alcohol use and smoking can be beneficial. Long hours of sitting and office work can be combated by intervals of stretching and walking. Apply proper technique when lifting heavy items and bending forward can protect your spine and discs. Lastly, osteophytes and degeneration are signs of chronic problems. Do not wait until a condition becomes severe before seeking professional help, treatment options can be more complicated with time.
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