Sciatica

What is sciatica?

If there is one word which is more widely used when it comes to back pain is sciatica. Every one now claims they have sciatica but what exactly is sciatica? And how different is it from back pain?

Sciatica gets it origin from the sciatic nerve which runs from the lower mid back to the back of the leg. It is the longest and probably the biggest nerve in the body. The term sciatica essentially means that there is pain radiating from your spine to the back of the legs. Whenever back pain radiates to the back of the legs, the term sciatica is used. Sciatica is not a diagnosis but just a symptom. In the majority of cases, the cause of sciatica is a herniated disk- meaning that the nerve is being pinched by the vertebra in the spinal column.

Symptoms

The symptoms of sciatica are pretty straight forward. The majority of individuals will complain of sudden sharp pain shooting from the mid back into the back of the thigh. This pain may radiate all the way below the back of the knee and end at the ankle. The pain is quite intense and uncomfortable. At the first sign of sciatica, most individuals will be disabled. There are some fortunate individual who only get a mild ache or a sharp pain in the buttock area. At other times, the sciatic nerve when compressed can present like a sudden electric shock which is painful. The pain of sciatica is generally worsened with any posture or condition that compresses the nerve. Sitting on a chair or lifting weights can worsen the pain. On the other hand, lying on flat surface eases the pain. In most cases, only one leg is affected. It is very rare for sciatica to occur in both legs at the same time.

Besides pain, some individuals may complain of numbness at the back of the calf or foot. In other cases, the numbness may alternate with the pain.

Often at night, there may be a tingling sensation in the toes or near the ankle area. This tingling is not pleasant and most individuals will toss and turn to be in a comfortable position to decrease this sensation.

When sciatica is severe, one may even have loss of bladder or bowel control. This is an acute emergency often known as cauda equina syndrome. These individuals need emergency care in a hospital setting. At this stage the vertebral column has completely compressed the nerve and one needs to get urgent relief with some type of surgery.

Causes of Sciatica pain

Causes of sciatica include damage to the joint, daily wear and tear, muscle spasms, cartilage damage, tendon and ligament tears, herniation of the disc or a fracture of the joint. Even though herniated disc is one of the most common causes of sciatica, there are other causes that can cause similar symptoms.

- Lumbar spinal stenosis is essentially narrowing of a segment of the spine. The narrowing is usually in the lower back and often compresses the nerve that exits the spinal cord. In most cases only one side of the body may be affected.

- Spondylolisthesis occurs when one vertebra slips slightly forward over another vertebra. The displaced bone fragment can then pinch or compress the sciatic nerve when it exist the spine.

- Piriformis syndrome is a rare disorder when one of the muscles in the lower back goes into spasms and compresses the sciatic nerve. Piriformis syndrome can occur from prolonged sitting, motor vehicle accidents and traumatic falls.

- Trauma is a common cause of lumbar pain. The injury may lead to fractures or sprain which can injure the lumbar nerves.

In some individuals no cause of lumbar pain is ever found despite exhaustive work up.

Most people who develop sciatica are in their 2nd or 3rd decade of life. Individuals, who are obese, lift weights or have trauma to the back are more to developing sciatica. The lumbar spine is a common site of back pain in many people. Of all the causes of lumbar spine problems, sciatica is the most common. Sciatica essentially refers to pain that radiates along the path of the sciatic nerve. The pain in this case travels from the back, into the buttocks and down the back of the leg up to the ankle or foot. In most cases the pain of sciatica affects only one leg. Consumers should understand that sciatica is not a disease but only a symptom of lumbar spine disease. The most common causes of lumbar spine disease are is arthritis, osteoporosis, cancers, herniated discs, infections and a sedentary lifestyle.

Sciatica tells the physician that there is something in the lumbar spine that is compressing a nerve. The most common cause of lumbar disc disease is a herniated disc. Lumbar pain is very uncomfortable and can limit one’s lifestyle. In some cases the lumbar pain disappears on its own in a few months but in other cases, it may persist for many months. In some cases, self-care measures at home can help relieve the lumbar disc pain, but in many cases a visit to a physician is necessary as the pain can be excruciating.

The pain from lumbar spine can vary in intensity. In some cases it may be mild and localized but in others it can be very painful and may feel like an electrical jolt. Often the pain can be worsened by sitting for too long in one position, sneezing, coughing or sleeping on the stomach.

Besides pain, other features of lumbar spine disease include numbness or muscle weakness along the path of the nerve. Other individuals may feel tingling or a sensation of pins and needles in the back of the leg and foot. If the nerve compression is serious, it can also lead to bowel and bladder incontinence.

Sciatica Risk factors & Complications

Risk factors for sciatica and lumbar pain depend on life style, type of work, and whether one is active in sports. While not everyone develops lumbar spine pain, there are risk factors, which will increase the probability of developing the problem later on in life.

- Aging leads to degeneration of the discs and joint and most people have x-ray evidence of joint alterations by age 40.

- Occupation that requires one to lift heavy items or drive for long period can make one prone to developing sciatica.

- Individuals who sit all the time are more prone to sciatica than active individuals.

- Diabetics for some unknown reason are also more prone to sciatica. It is believed that perhaps nerve damage from the high blood glucose may be responsible.

While most people do recover from sciatica, complications can result when treatment is not obtained in time. Permanent damage to the sciatic nerve can result and affect life style. When the nerve is damaged, the individual will have permanent loss of feeling in the affected leg; have weakness and loss of bowel and bladder function.

Tests and diagnosis

Diagnosis of lumbar and sciatic nerve spine pain includes medical history, physical exam and a variety of neurological tests. Some type of radiological study is always done to look for the cause of lumbar pain. The radiological tests include x-rays, MRI, CT scan and nerve conducting studies.

Treatments and drugs

Sciatica and Lumbar pain does respond in most cases to self-care measures. However, besides pain control and ice packs, the SFMMG doctor may also recommend:

- Physical therapy is essential for individuals with lumbar herniated discs. Once the acute pain is relieved, one can start an exercise program to build strength and improve back flexibility. Physical therapy exercises can help improve posture and improve strength of the back. The earlier physical therapy is started, the faster the recovery. Physical therapy is the key to recovery after lumbar spinal pain.

- In most cases of lumbar spine pain, over the counter medications do not help. Thus, SFMMG physicians prescribe a variety of stronger pain medications. Other medications used to treat lumbar spine include anti depressants, anti convulsants and potent narcotics. These drugs do help relieve pain but unfortunately cannot be taken for prolonged periods.

Other treatments

When the above conservative treatments fail to relieve pain, SFMMG Pain Management doctors and Orthopedic physicians may recommend the following options:

- Epidural steroid injections are sometimes used to relieve pain and inflammation of the lumbar spine. There is evidence that these injections can help for a short time but the long-term use of corticosteroid injections is not recommended. There is a limitation on how many injections one can receive because of side effects. In any case, your doctor will determine the safest course of steroidal injections when you have lumbar pain.

- Surgery is never the first treatment in individuals with lumbar pain. Surgery is reserved for individuals who have nerve compression which cause significant weakness, bowel or bladder incontinence and intense pain. Surgery is only considered after other conservative treatment plans have failed.

Alternative medicine

At SFMMG we have successful alternative therapies for lumbar spine pain including:

- Acupuncture. Some studies have shown that acupuncture can help relieve back pain but unfortunately, the technique does not help everyone. If you do decide to select acupuncture, select a licensed therapist with a good reputation and with decent training.

- Chiropractic treatments are another option for lumbar pain. Spinal adjustments performed by these professionals can help decrease pain, increase flexibility and improve spine movements. There is evidence that spinal manipulations when done early can be as effective as conventional medical treatments.

- Massage has not been scientifically evaluated but is widely used to treat spine pain. There are many types of massages and not all practitioners are qualified or experienced. In any case, most people do find massage therapy soothing and calming.

Prevention

It is not possible to prevent all lumbar spine problems, but one can take steps to reduce symptoms and progression of disease. In order to prevent lumbar spine problems (1) exercise regularly and maintain proper posture (2) maintain proper posture when sitting (3) use ergonomically designed furniture to ease pressure off the legs, arms and neck. Keep your hips and knees level. Take frequent breaks from your work and walk around (4) if you lift heavy items learn proper techniques of lifting (5) if you are up on your feet all day, rest the foot on a chair or walk around and (6) keep your weight down and eat right.

San Francisco Sciatica Pain Multi-Disciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your Sciatica or Sciatic Nerve pain. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine
• Physiatry
• Chiropractic
• Podiatry
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely diagnosis and treatment in one place speeds recovery and reduces costs. Please call to schedule an appointment with our physicians at one of our locations.