know what it is and how it can be treated
A sciatica or sciatica is pain affecting the sciatic or ischiatic nerve (the longest nerve in the body, extending from the lumbar spine to the feet). In general, this discomfort is due to inflammation or compression of the nerve roots, which are present in the lower lumbar region.
The main cause results from an intervertebral disc herniation that compresses a nerve root. Other possible causes are narrowing of the spinal canal and compression of nerve roots by tumors or cysts.
Sciatica pain: what are the main symptoms?
The main symptom associated with this condition is pain that radiates from the gluteal region down the back of the lower extremity to the foot. There are also other symptoms, including weakness or numbness, which originate in the lower back and travel down the back of the leg, following the path of the sciatic nerve.
Diagnosis of this problem can be made using magnetic resonance imaging, computed tomography, electromyography, and nerve conduction studies. Treatment can be based on medications that relieve symptoms or, in more severe cases, on surgery.
Nerve root compression causing ischial pain can be caused by intervertebral disc herniation, bony irregularities (such as osteophytes in osteoarthritis, spondylolisthesis, …), spinal stenosis, trauma, piriformis muscle syndrome, abscess or intramedullary tumor.
This compression may involve the interior of the spinal canal, be intervertebral, or involve nerves outside the spine in the pelvis or gluteal region. The L5-S1, L4-L5 and L3-L4 nerve roots are the most frequently affected.
Certain factors can increase the risk of suffering from sciatica. Some of these are:
- Older age: older people usually have more degenerative problems in the spine, such as herniated discs, osteophytes or osteoarthritis. They are therefore more likely to suffer from sciatica.
- Obesity: excess weight causes overload on the lumbar spine, leading to injury or anatomical changes.
- Incorrect or repetitive body postures: people who carry heavy weights daily or spend many hours sitting or standing have a higher incidence of sciatica.
- Sedentary lifestyle: being sedentary and doing little exercise for the muscles of the lumbar region are factors that contribute to the development of back problems, such as sciatica.
- Diabetes mellitus: diabetes increases damage to peripheral nerves, including the sciatic nerve and its branches.
- Pregnancy: sudden weight gain, body changes, and hormonal action all cause tendons and ligaments to relax, leading to anatomical changes in the lumbar spine, which promote compression of the sciatic nerve.
Sciatica pain is usually unilateral and occurs along the ischiatic nerve, particularly below the gluteal region and at the back of the lower extremity, below the knee.
This pain may be characterized by a stabbing or sharp burning sensation and is due to inflammation and swelling of the nerve. The discomfort may be increased by sneezing, coughing or walking, for example.
This discomfort may also be accompanied by back pain, numbness, tingling or a feeling of weakness in the affected lower limb. Sciatica can also cause sensory, motor or reflex deficits.
When symptoms are consistent with sciatic pain, sensation, strength, and reflex tests can be performed.
If pain persists for more than 6 weeks, electrodiagnostic and imaging tests such as MRI or CT should be performed.
Electrodiagnostic studies can determine whether there is nerve root compression, the degree of compression, and whether the injury involves a single or multiple nerves.
Treatment of sciatica pain may involve different types of therapy, namely pain medication, physical therapy or surgery.
In the initial phase, light activities and rest are recommended, raising the head of the bed about 30°. At the same time, anti-inflammatory drugs, analgesics and drugs that reduce neuropathic pain may also be prescribed.
The application of cold, alternating with heat, can also help relieve muscle spasms, as can physical therapy or swimming.
Although not a consensus measure, in some cases, administration of corticosteroids, either orally or epidurally, may be suggested to relieve pain when it is severe and persistent.
Muscle relaxants, benzodiazepines, antidepressants or anticonvulsants may also be prescribed.
Surgery is indicated only when sciatic pain is associated with any of the following conditions:
- Cauda equina syndrome (a serious condition that results from compression and inflammation of the nerve bundle in the lower part of the spinal canal and can lead to paralysis, bowel/urinary incontinence, and other problems with sensation and loss of motion);
- Herniated disc;
- Intolerable and disabling pain that does not yield to other treatments;
- Muscle weakness that does not improve and worsens;
- Other progressive neurologic deficits.
The most commonly used surgical procedures include conventional distectomy with limited laminectomy for intervertebral disc herniation and microdystectomy for localized herniations.
In some situations, the results of surgery are not entirely satisfactory and may have adverse effects:
- Psychiatric disorders;
- Persistence of symptoms for more than 6 months;
- Limitation in performing heavy work;
- Prevalence of low back pain (non-radical).
One of the ways to prevent sciatica is to avoid overloading the spine and to do strength training to adopt correct body postures. Therefore, there are some measures that can help prevent this problem, such as:
- Playing sports or doing appropriate physical exercise: physical activity helps to strengthen the muscles that protect the spine. Dancing, for example, is able to improve the balance and well-being of the muscles and strengthen the calcium levels in the bones.
- Avoid carrying excessive weights: if you have to pick up heavy objects, do so with a defensive posture, that is, bend your knees and contract your abdomen, so that your spine remains straight. In addition, you should hold the weights with both hands, so that the effort and posture are balanced.
- Adopt a correct posture: when we sit, we must support our back on the backrest and make sure that our feet are flat on the ground and our neck is straight. It is also important to constantly change your posture to keep your muscles and joints moving.
- Wear comfortable shoes: we need to wear shoes that make us feel comfortable, regardless of the height of the heel, and that help us maintain correct posture, both when sitting and walking.
- Do not smoke: smoking accelerates the degeneration of intervertebral discs, so it is not recommended as a means of prevention of this problem.