If you’ve had it, you know what it is. It’s literally a pain in the butt on one side or the other that radiates down the back of the thigh and into the leg. It hurts! Read below for more information about the anatomy, symptoms and causes of sciatica.
Anatomy
The spinal cord begins at the base of the brain and runs down the cervical and thoracic spine. Nerve roots from the lumbar and sacral spine can become irritated causing sciatica. The sciatic nerve, about the thickness of a finger, is the longest nerve in the body. It controls the muscles in the back of the knee and lower leg, and provides sensation to the back of the thigh, lower leg, and the sole of the foot.
The sciatic nerve runs right through or under the piriformis muscle. Sciatica is called radiculopathy because it causes pain, numbness, tingling and weakness in the affected leg.
Symptoms
Sciatica is a symptom of a pinched or impinged nerve, which can feel like a deep and steady burning, or sharp shooting pain that runs along the spinal nerve root down the back of the thigh and into the calf. Compression of the nerve root also causes numbness, tingling, muscle weakness and a loss of reflexes. The pain of sciatica can be severe. Importantly, most patients will experience back pain in addition to buttocks and leg pain.
Causes
Sciatica nerve pain is a symptom. It is the result of compression of nerve roots in the lower back. Generally, people between 30 and 50 are most likely to get sciatica. Sometimes it can be due to aging and wear and tear. However, the most common cause is a herniated disc in the lower back. About 1 in 50 people will experience a herniated disc some time in their lives.
Other causes:
- A bone spur on the spine
- Piriformis syndrome
- Spinal stenosis-narrowing of the spinal canal
- A slipped vertebra
- Trauma such as a pelvic fracture
- Pregnancy can cause sciatic nerve symptoms as well, due to the relaxation of hip ligaments.
Diagnosis
Each of these conditions must be explored and ruled out to determine appropriate treatment options. A physical exam can identify the nerve root that is irritated. Imaging studies may be needed to confirm a diagnosis. The hip and spine specialists at Orthopedic Specialists of SW Florida will help you by determining the best treatment plan.
Treatment
Sciatica is often treated with conservative measures to reduce pain, including, medications for nerve pain, and physical therapy exercises. Exercise including yoga can help relieve symptoms. Most times the pain will subside within six weeks. Despite these conservative measures, approximately 20-30% of people can suffer for years. Numbness can indicate nerve damage, which can become permanent.
Treatment is intended to help you manage your pain without long-term use of pain medication. The ultimate goal of treatment is to relieve pain and improve mobility. Initially, pain and anti-inflammatory medications are prescribed and if you have muscle spasms, you may be prescribed a muscle relaxant. Lastly, X-ray guided epidural steroid injections can also help to reduce swelling and inflammation of the nerve.
80-90% of sufferers can achieve pain relief without surgery. For those who find no relief from conservative treatment, or when the pain progresses or is excruciating, surgery may be necessary.
A herniated disc may be treated with a microdiscectomy- removal of part of the disc that impinges on the nerve. If the cause is spinal stenosis, a laminectomy will release pressure on the nerve.
People who have severe sciatica with leg weakness and bowel or bladder changes may need surgery.
What is Piriformis Syndrome?
Hip pain that occurs when moving the leg out or behind the body is felt in the buttocks and lower back is often caused by Piriformis syndrome. Inflammation in the Piriformis muscles puts pressure on the sciatic nerve causing sciatica.
At Orthopedic Specialists of Southwest Florida, our physicians are fellowship-trained and provide exceptional care. Caution: Untreated chronic sciatica can result in chronic muscle weakness and foot drop. Call us now, to get the appropriate diagnosis and care.
