Sciatica Pain: All You Need to Know

Pains and aches get more prevalent as one starts ageing. The trick to managing them better is proper diagnosis and treatment. The sciatic nerve present in the leg is one of the longest and largest nerves in the body. Sciatica or sciatica pain results from injury, degeneration, or compression of the sciatic nerve. Since sciatica pain originates in the lower back, many people confuse it with lower back pain.

Sciatica pain radiates toward the hip and down the leg, imparting a tingling or numbing sensation. An individual has a 10 to 40% chance of experiencing sciatica in their lifetime.

Anatomy Of The Sciatic Nerve

Before going into the details of sciatica pain, it is essential to understand the structure of the nerve associated with it. Five nerve roots of the lower spine join together to form the large sciatic nerve. This 2-cm-wide nerve is essential for movement and sensation.

Location and Pathway

The sciatic nerve originates in the lower back. It extends posteriorly through the back of the thigh to the foot. It arises from the lumbosacral region and enters the popliteal fossa (space behind the knee joint), where it branches. The following points illustrate the pathway of a sciatic nerve:

• The nerve leaves the pelvis through the sciatic foramen (opening) below the piriformis (flat, pyramidal muscle in the gluteal region of the lower limb).
• It enters the gluteal region and passes to the posterior part of the thigh.
• The nerve then reaches the back of the mid-thigh area (popliteal fossa). Here, it divides into two branches (tibial and fibular) that extend down the foot.

Nerve Roots

The sciatic nerve starts from the ventral rami of the L4 (lumbar region) and extends to S3 (sacral region). These spinal nerves belong to the lumbosacral plexus. It consists of a combination of both motor and sensory fibres.

Innervation by The Sciatic Nerve

The sciatic nerve innervates (supplies with nerves) the lower leg muscles and those in the back of the knee. Although the sciatic nerve does not perform any cutaneous function, its terminal branches (tibial and fibular) provide indirect sensory innervation to the leg and foot muscles. The tibial part of the sciatic nerve innervates the posterior calf muscles and some foot muscles. The fibular branch innervates the anterior and lateral calf muscles and the remaining foot muscles.

Symptoms of Sciatica Pain

How do individuals know that the pain they are experiencing is not just back pain but may be sciatica? While a professional diagnosis is essential, here is a list of common symptoms.

Pain

Most people feel pain on one side of the leg, accompanied by numbness in other parts. The pain radiates from the hip region and may pass down to the feet.

Numbness and Tingling

Sciatica pain starts as a tingling ache and may soon feel like a burning sensation. Since signals from the back of the leg do not reach the brain properly, there may be little to no sensation in the affected area.

Muscle Weakness

Compressed nerves can cause severe sciatica pain, causing the muscles to weaken. It starts with slight difficulty in walking, which may worsen over time.

Bowel and Bladder Function

Sciatica pain can affect the nerves controlling bladder and bowel function. The individual may experience sudden difficulty in controlling urination or bowel movements. These symptoms require immediate medical attention.

Causes Of Sciatica Pain

Generally, irritation or compression of the sciatic nerve leads to sciatica pain. However, there are more factors associated with it. The following section describes the probable causes.

Herniated Disc

A slipped or ruptured disc (especially lumbar) is one of the primary causes of sciatica pain. A herniated disc occurs due to a spinal injury. The injury impact can displace the soft inner core of the disc towards the outer fibrous layers. These discs lie close to the spinal nerve root. Since the sciatic nerve is one of the nerve roots, herniated discs may compress and cause pain.

Spinal Stenosis

Narrowing of spaces in the spine can compress the spinal cord and nerve roots. This condition is called spinal stenosis. Due to the narrowing of space, the vertebrae may apply pressure on the sciatic nerve, causing sciatica pain. Therefore, one may consider sciatica as one of the symptoms of spinal stenosis.

Degenerative Disc Disease

As one starts ageing, the spinal cord progressively degenerates. The discs between the vertebrae lose their cushioning effect. This wear and tear of the spinal discs cause degenerative disc disease. When this disc degeneration affects the lumbar region, it compresses the sciatica nerve root in the lower back, causing sciatica pain.

Spondylolisthesis

When one vertebra of the spinal cord slips over the adjacent one, it causes lower back pain. This condition is called spondylolisthesis. The displacement of vertebrae causes spinal nerve root compression, affecting the sciatic nerve. It leads to numbness down the lower back to the feet, leading to sciatica pain.

Piriformis Syndrome

It is a condition where the piriformis muscle compresses the sciatic nerve, causing inflammation and sciatica pain. This condition is relatively rare compared to other causes of sciatica. It is one of the causes of non-discogenic (not involving spinal discs) sciatica. Injury, muscle spasms or scar tissue in the piriformis muscle may lead to this condition.

Treatment Options for Sciatica Pain

Usually, sciatica pain may subside in four to six weeks without needing treatment. However, if left untreated for a long time, the condition may become chronic. The treatments listed are based on the underlying cause and individual cases and may vary from one patient to another.

Conservative Treatment

Pain reduction is the main goal of conservative treatments. It is achieved through the following methods:

• Prescription Medicines: Analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs are effective against sciatica pain.
• Spinal Injections: Epidural corticosteroid injections administered directly into the spinal region help reduce inflammation caused by sciatica pain.
• Physical Therapy: Stretching exercises, walking, swimming and aerobics can decrease the pressure on the sciatic nerve. Passive forms of physical therapy, such as McKenzie exercises, are also beneficial for treating sciatica pain.
• Alternative Therapy: Studies have shown acupuncture as an effective alternative therapy for treating sciatica pain. Yoga, massage therapy and chiropractic techniques may also help.

Invasive Treatment

Surgery is typically reserved for cases where conservative treatments have failed or if the condition is worsening. Discectomy (removing affected fragments of a herniated disc) and laminectomy (removing sections of the lamina - the rear section of vertebrae - pressing on the spinal nerves) are the two most commonly conducted surgical procedures to relieve sciatica pain.

Studies have shown that the recovery and pain relief rate was higher and faster for individuals who received early surgery for sciatica pain.

Prevention of Sciatica Pain

Once diagnosed with sciatica, treatment and management of symptoms is the only way forward. The good news is one can prevent sciatica pain (barring accidental circumstances) by making significant lifestyle changes and following healthy practices.

Exercise and Stretching

Regular aerobics, stretching exercises, maintaining flexibility and strengthening the core muscles may help reduce one's chances of developing sciatica pain. These exercises strengthen the core muscles (back and abdomen muscles).

Good Posture

Practising good posture while sitting, standing or sleeping minimises pressure on the lower back, reducing the chances of sciatica pain.

Healthy Weight

Excess weight places excessive pressure on the abdomen and lower back, making one prone to spinal nerve root compression and sciatica pain. A healthy weight can reduce the pressure on the sciatic nerve.

Proper Lifting Techniques

Holding the weight close to the body while lifting, finding help while moving things and using leg movements cautiously are some precautions needed while lifting goods. It prevents injury to the sciatic nerve.

Ergonomic Work Environment

One should avoid leaning or slumping forward while sitting during long hours for work. Taking breaks in between while sitting or standing for long durations is advisable. Keeping the shoulders relaxed and resting the arms and elbow on the desk while sitting eases the pressure off the sciatic nerve.

Conclusion

The compression of the sciatic nerve causes sciatica pain. This condition has an annual incidence rate of 1 to 5%. The pain usually goes away on its own without treatment. However, in severe cases, doctors may recommend conservative treatment or surgery. It is advisable to track the symptoms and consult the healthcare provider if the condition worsens or if the pain lasts longer than usual.

Frequently Asked Questions (FAQ)

Q1: What is The Difference Between Sciatica and Lower Back Pain?

Sciatica pain occurs due to pinching of the sciatic nerve. A shooting ache radiates down the back of the leg to the feet and toes. Lower back pain does not usually radiate down the leg. Pain in the joints, muscles or discs generally causes back pain. Lower back pain starts as a dull, stiff ache and may quickly escalate into a stabbing pain.

Q2: Can Sciatica Pain be Cured?

Non-surgical, conservative treatment of sciatica pain is possible. Most sciatica cases resolve within six weeks without any chronic complications. If the condition is severe, it needs to get cured through surgery. In such cases, the recovery period can be longer.

Q3: Is Sciatica Pain Always Caused by A Herniated Disc?

There are non-disc related causes for sciatica pain too. They include piriformis muscle syndrome, lumbar stenoses and tumours.

Q4: How Long Does it Take For Sciatica Pain to Go Away?

The duration of sciatica pain can vary based on the individual and the cause of their sciatica. However, the umbrella period for sciatica pain to subside is 4-6 weeks. Severe or chronic sciatica conditions may last longer and may require surgery to get cured.