What it is
Sciatica is the
name people give to a pain in the buttock, leg or foot brought on as a direct
result of some form of irritation to the sciatic nerve. The sciatic nerve is
the longest nerve in the body. It runs all the way from the lower back
splitting at the base of the spine and terminating in the foot.
The discs which
cushion the vertebrae in the lower back become progressively thinner and harder
as we get older. This stresses the lower back and often causes a variety of
lower back pain disorders, including sciatica.
Sciatica is
usually caused by a prolapsed or 'slipped' disc bulging and pressing on to a
nerve. It doesn't usually cause permanent nerve damage since the spinal cord is
not present in the lower part of the spine and a prolapsed or herniated disc in
this area does not pose a risk of paralysis.
The cause
The most common
cause of sciatica is a prolapsed (slipped) disc, pinched nerves or some form of
arthritis. It usually starts with back pain which sometimes improves only to be
followed by hamstring or calf pain. It may also include numbness in the toes
depending on which branch of the sciatic nerve is irritated.
Piriformis
syndrome is a condition in which the piriformis muscle irritates the sciatic
nerve. The piriformis muscle is a small muscle behind the gluteus maximus.
Piriformis syndrome is most common among women, runners and walkers.
Spinal stenosis
is the name given to the narrowing of the nerve channel (vertebral canal) of
the spine. This narrowing causes compression of either the spinal cord within
the vertebral canal, or the nerve roots that exit the spinal cord. People with
spinal stenosis experience sciatic pain symptoms in the legs and feet. It
usually results from degenerative arthritis causing a narrowing of the spaces
in the vertebral canal. Manual workers are more prone to developing symptoms of
spinal stenosis but it seldom affects people under 30 years of age - unless it
is due to traumatic injury to the vertebrae.
The spine is made
up of a series of connected bones called "vertebrae."
Spondylolisthesis or isthmic spondylolisthesis occurs when a cracked vertebra
slips over the vertebra below it. Poor posture and curvature of the back or
weak abdominal muscles can contribute to this slippage, which can press on the
nerve. The presence of this spondylolysis usually does not represent a
dangerous condition in the adult and most treatments concentrate on pain relief
and increasing the patient's ability to function.
The Cure
Some cases of
sciatica which result from inflammation get better with time and heal
themselves perhaps within six weeks to three months.
Recent studies
have shown that bed rest is not necessarily the best way to treat sciatica. It
is better to remain active, starting off with some gentle stretching and exercise.
Swimming is particularly useful, as it is not a weight bearing exercise. The
good news is that herniated spinal discs usually do heal on their own, given
time.
There are many
different treatments for sciatica and it is important to discuss these with your
health practitioner. Accurate diagnosis to determine the exact cause of sciatic
pain is also equally important. The most conclusive diagnosis is usually gained
by a having an MRI scan. However having said that skilled medical
practitioners, and I include Osteopaths and Chiropractors, are often able to
determine the suspected cause by carrying out a physical examination
Stretching and
exercising are a must if you really want to progress along the road to
rehabilitation and if you are in extreme pain this is probably the last thing
you will contemplate doing.
Since getting
mobile and becoming flexible is extremely important you might require some pain
management to help you get going. For mild cases of sciatica your doctor may
start off by recommending non prescription medications like aspirin, ibuprofen,
or naproxen, known as non steroidal anti-inflammatory drugs, or NSAIDs. A
downside of these drugs is that they may cause stomach upsets or bleeding.
If your pain is
not relieved by analgesics or NSAIDs, your doctor might prescribe narcotic
analgesics (such as codeine) for a short time. Side effects of these include
nausea, constipation, dizziness and drowsiness, and continued use may result in
dependency.
Sciatic pain is
usually nerve related and responds well to treatment with low doses of
tricyclic anti-depressant drugs like amitriptyline, dothiepin, nortriptyline,
lofepramine, desipramine, clomipramine or imipramine combined with acupuncture
or the use of TENs machines. The low dosage of the tricyclic drug acts by
closing "a pain gate" blocking the message to the brain.
Other medications
like Corticosteroids taken orally or by injection are sometimes prescribed for
more severe back and leg pain because of their very powerful anti-inflammatory
effect. Corticosteroids also have side effects and the pros and cons of taking
them should be fully discussed with your doctor.
In extreme cases
spinal injections of corticosteroid into the epidural space (the area around
the spinal nerves) or facet joint (between vertebrae) may be given. This is
usually carried out by a specialist with follow up injections at a later date.
Other treatments
to manage sciatica include traction; manipulation by a skilled osteopath,
physio therapist or chiropractor; Chemonucleolysis (injection of a special
enzyme into the disk).
There is a fairly
new procedure called IDET which stands for Iintro Discal Electrothermy). When a
disc is herniated the water content of the inflamed disc causes it to bulge and
press against the nerve. IDET dries up the disc very quickly, in less than 20
minutes, a process which might take weeks or months if left to dry up naturally
As a last resort
you may consider surgery to remove fragments of the prolapsed disc are then
removed.
As I mentioned
earlier it is important to stay active and continue with an exercise and
stretching program. Especially do exercises to develop your back and stomach
muscles. This will help stabilize your spine and support your body.
It is also
important to maintain a reasonable body weight, ensure you have a good posture,
sleep on a mattress that is neither too soft nor too hard, be careful when
bending or lifting heavy weights.
This information
in this article should not be used to diagnose, treat, or prevent any disease.
You should always consult with your health care professional especially
relating to the suitability of supplements or drugs and on all health matters
that may require diagnosis or medical attention. If you suffer from progressive
weakness in the leg or bladder or bowel incontinence this constitutes a medical
emergency and you should seek immediate medical attention - you may have cauda
equina syndrome a serious condition due to compression of the nerve roots in
the lower end of the spinal canal.
Bill Morrison has
his own website http://www.help4urback.com where he describes his own personal
experiences coping with lower back pain and sciatica. He also includes personal
recommendations for people who suffer from sciatica or lower back pain
including what books to buy, TENs machines, and what web sites to check out.
