Sciatic Pain

Definition

Sciatica is the inflammation of the sciatic nerve, usually marked by pain and tenderness along the course of the nerve on through to the thigh and leg.

Description

Sciatic pain usually starts in the buttocks and extends down the rear of the thigh and lower leg to the sole of the foot and along the outer side of the lower leg to the top of the foot. Pain may also be present in the lower back.

Several nerve roots leave the spinal cord and exit through holes in the sacrum to combine and form the sciatic nerve, which then passes between layers of the buttock muscles into the deep muscles of the back of the thigh.

A primary cause of sciatica is a herniated or bulging lower lumbar intervertebral disk that compresses one of the nerve roots before it joins the sciatic nerve. Sometimes, irritation of a branch of the sciatic nerve in the leg can be so severe as to set up a reflex pain reaction involving the entire length of the nerve. For example, if the nerve is pinched or irritated near the knee, you may feel the pain in the hip and buttock.

Another cause of sciatica is the Piriformis syndrome. The piriformis muscle extends from the side of the sacrum to the top of the thigh bone at the hip joint, passing over the sciatic nerve in route. When a short or tight piriformis is stretched, it can compress and irritate the sciatic nerve. Because the piriformis muscle acts to rotate the leg outward, people who habitually stand with their toes turned out often develop Piriformis syndrome, as do runners and cyclists, who over use and under stretch the piriformis muscle.

Ruptured Intervertebral Disk

This may be the most painful, yet easiest, condition to identify. A ruptured or herniated disk is one that bulges and extends into the spinal canal, pressing on the nerve roots. This causes the nerve root to become irritated. On occasion, a ruptured disc can occur after bending over and lifting, however, it usually occurs for no apparent reason.

A ruptured disk may cause back pain and muscle spasms, but a more common complaint is sciatic pain. This is severe pain spreading down one leg and often into the foot. Sometimes, it is the only symptom of a ruptured disk. A ruptured disk can generally be detected by a physical examination alone. Occasionally, a myelogram, CT scan or magnetic resonance imaging (MRI) are necessary to confirm diagnosis and determine if surgery is required.

Causes and Risk Factors

Sciatica is usually a symptom of a bulging lumbar disk. Its distinguishing feature is greater pain in the posterior thigh and lower leg or foot over time, rather than in the lower back. Usually, no specific trauma can be blamed. An action as simple as bending over may bring on sciatic pain. Standing, lifting, sitting or straining may aggravate it.

Treatment

The primary treatment of sciatica is rest, to allow the inflammation of the nerve to subside. In an effort to alleviate the pain, various medications (such as analgesics and muscle relaxants) may be prescribed, or anesthetic agents may be injected into the area around the spinal cord. In cases that do not respond to such conservative measures, surgery may be necessary.

Recently, new surgical techniques, such as microsurgery and the percutaneous (through the skin without cutting, as with a needle) removal of disk fragments, have been developed. These techniques have considerably decreased hospital stays and loss of work time. So far, success at relieving pain and neurologic symptoms has been good. Not all individuals with disk problems, however, are suitable for this surgery.

Physical therapy under a doctor's supervision or prescription is often used to relieve the pain of sciatica. Many therapists advise their patients to overcome the effects of a ruptured disk by developing the core muscles (the four muscle groups that form at the waist) in order to provide a supportive column of muscle that will help keep the disk in place.

Questions to Ask Your Doctor

What tests are needed to diagnose the cause of the pain?

What created this problem?

Should a specialist be consulted?

What treatment is needed? Are there any side effects to the treatment?

How effective is the treatment?

If rest is required, how much rest is needed and for how long?

Are there any alternative treatments?

Will you be prescribing any medications? What are the side effects?

If nothing is done about this problem, what is likely to happen?

Can this happen again?

How can this be prevented?

Are there any activities that seem to aggravate the condition more?

Will surgery be necessary?