What is Sciatica?
The sciatic nerve is the longest nerve in the human body, connecting the lower back (spinal cord) to a foot, going down the leg along the back of the thigh and calf muscle. Hence, it controls sensations in the muscles of the hip, the pelvis, the back of the thigh, the back of the knee, the back of the calf muscle, and the sole of the foot. It is generally found on one side, not both sides of the body. When a vertebra exerts pressure on this sciatic nerve causing pain, usually due to a slip disc, the ailment is called Sciatica.
Symptoms of Sciatica
Pain: The basic symptom of Sciatica is pain. The pain radiates from the lower back, extends down the back of the thigh and back of the lower leg, right down to the sole of the foot. The pain is similar to a very severe cramp and is felt along all the parts of the body through which it passes. Also, any jerky movements due to coughing or sneezing, or even a simple act of sitting where the leg muscles get pulled, can cause pain.
Tingling: Another symptom of this disorder is the feeling of “ants crawling down the leg”. It is a tingling or burning sensation which seems to travel from the hip to the foot.
The symptoms can take 6-7 weeks to get cured.
Diagnosis of Sciatica
A neurologist will have to go through the complete medical history of the patient to diagnose Sciatica. This would include questions about pinpointing the location in the back from where the pain originates. Also, the patient will be asked to raise the knees, raise the legs, sit, squat, walk putting pressure on the toes and heels alternatively, etc to see which position causes maximum discomfort and accordingly find the root cause of the pain.
MRI tests / X-rays: X-rays and/or Magnetic Resonance Imaging (MRI) tests are undertaken to confirm the diagnosis, once Sciatica is suspected. These would show which vertebral disc(s) is/are exerting pressure on the sciatic nerve. In most cases the culprits are the S1 and/or L5 nerve roots in the spinal cord.
Causes of Sciatica
A herniated disc (prolapsed disc or slip disc) occurs when the jelly-like center of a vertebral disc protrudes through its outer lining and pokes into the spinal cord. Also, chemicals from the center of disc cause inflammation of the nerve roots on the spinal cord. Also, the muscles of the spinal canal get constricted. This disorder is called Stenosis. A herniated disc of lower section of the vertebral column exerts pressure near the sciatic nerve. So, stenosis of the lumbar vertebral canal causes Sciatica.
The most common reason for a herniated disc is normal wearing-down of bones in the lower vertebral column due to age. Hence, it most commonly affects people above the age of 35 years.
Besides aging, there are some other causes why a prolapsed disc occurs. It may be due to a trauma or injury to the vertebra. It could just be a case of one vertebra slipping over the other (Spondylolisthesis). A fracture in the pelvis has been known to cause sciatica. Also, in some cases a spinal tumor is the cause.
Caution: If a herniated disc compresses nerves causing lack of control over bowel movements or bladder, it is a crisis situation and immediate surgery is required.
Types of Sciatica
Sciatica can be categorized by severity of symptoms and by the cause of the pressure on the sciatic nerve.
A) By severity:
Sciatica pain can be mild if diagnosed early or excruciating if left untreated or doesn’t respond to treatment. This would depend on the level of the damage to the sciatic nerve. In some cases patients have been known to become bedridden with pain. Also, the pain can occur in different patients in different postures. Some experience more pain when standing or moving. Some patients experience pain when sleeping or sitting. But, in either case change in posture eases the pain.
B) By cause:
Isthmic Spondylolisthesis: Sometimes a herniated disc (slip disc) puts pressure on the spinal cord in the lower back and the muscles around it. The canal of the spinal cord gets constricted. The muscles in the area get repositioned in an awkward manner, thus exerting pressure on or irritating the sciatic nerve. This is the most common reason for Sciatica.
Piriformis Syndrome: This occurs when sciatica is a result of pressure on the sciatic nerve by the piriformis muscle. The piriformis muscle exerts pressure because there are some disorders of the pelvic joints and the posture of “sitting” becomes very painful. The patient does not feel the same amount of pain when standing or lying down.
Treatment of Sciatica
To avoid being incapacitated or bedridden, early diagnosis and treatment of Sciatica is very essential. Nearly 85% of the cases can be treated without surgical intervention. Rest is the first thing the patient is advised.
Medication: Pain is the main symptom of this disease, hence prescribing pain relievers and analgesics is the first course of treatment. Also, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are prescribed to reduce muscle inflammation around the spinal cord to release the pressure. If the pain is very severe, a spinal injection of cortisone, a corticosteroid, may also be administered. But these are all short-term symptomatic solutions which only reduce the pain and inflammation. The main cause of the problem needs to be tackled with other methods.
Physiotherapy: There are special exercises which a patient of Sciatica can do in order to maintain flexibility of the muscles and to reduce the pain to some extent. Walking also helps as movement reduces inflammation. But these exercises have to be done under the guidance of a physiotherapist in order that no further inadvertent damage takes place.
Note: A combination of medication and physiotherapy is normally undertaken.
Surgical procedure: This is undertaken only if the Sciatica symptoms do not get cured for more than 3 months and is tending towards disability. The surgical procedure of “Laminotomy with Discectomy” is performed, where a section of the prolapsed disc is surgically removed. This releases the pressure on the spinal cord and the sciatic nerve.
Post-operative care – after surgery, it is advisable to not carry heavy weights, bend in the forward position or sit for too long. Also, driving is taboo. Back-strengthening exercises are taught, which need to be done daily for at least 3-6 months.
Other care: Carrying heavy loads has to be avoided by the patient to prevent relapse of symptoms. A balanced diet can help to improve the general health of the patient and speed up the recovery process. Maintaining proper posture while standing, sitting etc, is very important. A firm (not soft, spongy) mattress should be used while sleeping.
Home remedies: Celery is the most effective home remedy for Sciatica. A tea brewed with celery and potatoes can provide a lot of relief from pain. Also, elderberry tea helps to relax the inflamed muscles. Plenty of water should be consumed by the patient. Water improves blood circulation and is a natural pain relieving agent. Externally, alternate hot-cold compresses will also relieve pain to a great extent.
Dietary supplements: Commercially available garlic capsules and multivitamins help in improving the overall health of the patient; as they act as anti-oxidants, provide energy and alleviate pain.
Caution: Those consuming medications like anticoagulants for other disease; those having disorders with symptoms like bleeding; or patients with ulcers should not have raw garlic or garlic capsules.
Special diet: Vitamins in the body can be increased by maintaining a diet containing whole-grain cereals, legumes and fruits, soy beans, beetroot, nuts, liver, peas, etc. Also, focus should be on greens and reddish vegetables.
Living with Sciatica
Sciatica, if not treated in time, can lead to disability of the legs causing loss of mobility. Also, as the nerve is affected, the legs lose sensation. This can lead to leg injuries which may not be noticed or felt. Some medications may also cause side effects and discomfort. If any self-medication was done by the patient, that can add to the complications.
Prevention of Sciatica
Sciatica can be prevented by ensuring that the lower back (and so the spinal cord) are not damaged in any way. This will prevent any subsequent damage of the sciatic nerve. Always maintain a good posture – whether sitting or standing. This will ensure that there is no undue pressure on the spinal cord or vertebral column causing a slip disc. Exercising regularly and eating a balanced diet can go a long way in maintaining general good health. Hence, sciatica is a preventable as well as curable (if treated in time) disease which is not life-threatening.