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Sciatica Pain Causes, Symptoms, and Treatments

The sciatic nerve. From the 1918 book Gray's Anatomy

The sciatic nerve. From the 1918 book Gray's Anatomy

What is Sciatica and How Does It Cause Lower Back Pain?

Sciatica is an inflammation of the sciatic nerve, the longest nerve in the body, which runs from the spinal cord across the buttock and hip area and down the back of each leg. Sciatica is actually a secondary symptom of another problem placing pressure upon the nerve, most often a herniated disk. Most prominent among the symptoms of sciatica is pain along the area of the nerve, which may cause considerable discomfort in acute cases. While this pain generally goes away on its own in four to eight weeks or so, it can recur if the underlying problem isn't addressed. In most cases, treatment involves self-help measures to ease the pain. However in severe cases, doctors may suggest more aggressive treatment.

Common Symptoms

Sciatica is most commonly associated with pain radiating from the lower (lumbar) spine to the buttock and down the back of the leg. Discomfort can occur anywhere along the pathway, though it may be localized to a certain area along the pathway, for example the back, buttock or calf.

The pain can vary greatly, from mild aches to sharp, burning sensations, or excruciating discomfort. It may feel like a jolt or electric shock. This discomfort can be aggravated by lack of exercise, prolonged sitting, bad posture, improper lifting techniques, or coughing or sneezing. Usually, only one lower extremity is affected.

Complications of Sciatica Pain

In more severe cases, sciatica can cause additional symptoms including numbness or muscle weakness along the nerve pathway in the leg or foot. Pain may appear in one part of your leg with numbness in another. Tingling or a pins-and-needles feeling in the toes or part of the foot can also occur.

Although such complications are rare, sciatica can potentially lead to permanent nerve damage including loss of feeling and/or movement in the affected leg. Additionally, extremely rare instances result in a loss of bladder or bowel control: a sign of cauda equina syndrome, a serious condition that requires immediate medical care. Untreated, this syndrome can lead to paralysis of the legs.

Spine Conditions That Can Cause Sciatica

Herniated Disks and Other Spinal Conditions That Can Lead to Sciatica Related Lower Back Pain

Herniated Disks and Other Spinal Conditions That Can Lead to Sciatica Related Lower Back Pain

Sciatica pain in the back most frequently occurs as a result of a compressed nerve due to a herniated disk in the lower (lumbar) spine. These disks—pads of cartilage that separate the spinal bones (vertebrae)—keep the spine flexible, acting as shock absorbers to cushion the vertebrae during movement. They consist of a tough, fibrous outer covering with a jelly-like substance in the center.

However, the disks can deteriorate as we age, becoming drier, flatter and more brittle. Eventually, the outer portion of the disk may develop tiny tears, causing the inner material to protrude out (herniate or rupture). The herniated disk may then press on a sciatic nerve, causing pain in your back or leg or both. If the damaged disk is in the middle or lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot.

In addition to herniated disks, several other conditions can lead to sciatica pain, including:

  • Lumbar spinal stenosis, in which one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of the branching nerves.
  • Spondylolisthesis, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves your spine.
  • Piriformis syndrome, which causes the piriformis muscle, that runs directly above the sciatic nerve, to tighten or go into spasms.
  • Tumors inside the membranes (meninges) that cover the spinal cord or in the space between the spinal cord and the vertebrae, Which can compress the cord itself or the nerve roots as it grows.
  • Trauma from a car accident, fall, or blow to the spine.

Risk Factors

Risk factors that make it more likely for a person to develop sciatica-related back pain include:

  • Age: most herniated disks develop among people who are in their 30s and 40s.
  • Pregnancy: due to pressure from the fetus on the spine.
  • Occupations requiring frequent twisting and bending; heavy lifting; or driving for long periods.
  • Sitting for prolonged periods or an excessively sedentary lifestyle.
  • Diabetes which affects the way your body uses blood sugar and often leads to nerve damage.

Medical treatment is not required for mild cases of sciatica-related lower back pain, which usually go away with a little time and patience. However, a doctor should be consulted if self-help measures fail to ease the symptoms, or if the pain gets worse and worse or lasts more than four weeks. In addition, immediate medical attention should be sought in cases that include:

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  • sudden, severe pain or numbness;
  • muscle weakness in the lower back or leg;
  • pain following a violent injury, such as a traffic accident;
  • or trouble controlling the bowels or bladder.

When diagnosing sciatica-related pain, doctors attempt to determine which nerves are affected and how severely. This involves reviewing a patient’s medical history and performing a thorough physical exam, emphasizing the spine and legs. Exams may include basic tests of muscle strength and reflexes, such as asking the patient to walk on their toes or heels, stand from a squatting position, or lift their legs one at a time from a prone position. Pain from sciatica will usually worsen when performing these types of movements.

They may also request one or more imaging tests to help identify what is causing pressure on the sciatic nerve and to rule out other possible conditions. Thes