Nerve Pain – Sciatica

Overview

Sciatica refers to irritation or pain that radiates along the sciatic nerve, which branches from the lower back through the hips and buttocks and down the thigh. Typically, sciatica affects only one side of the body.

Distinctive symptoms of sciatica include pain, inflammation, tingling, weakness, and numbness that radiates down the sciatic nerve along the lower back or side to the leg. Pain may be worsened by prolonged standing, sitting, coughing, sneezing, twisting, lifting, or straining. The intensity of pain can vary dramatically, ranging from mild to severe.

Spine anatomy

The spinal column comprises of the vertebra, nerves, and discs.

Vertebra

The vertebrae are bones that make up your spine. They are separated and cushioned by the discs.

Discs

Discs comprise of cartilage, which is a resilient and robust material. The cartilage act as a cushion between each vertebra and endows spinal flexibility.

When a disc is worn down – either due to an injury or overuse – its soft center can protrude out from the hard outer ring, exerting pressure on the nerves around it. The compression of the sciatic nerve can cause extreme pain.

Nerves

The sciatic nerve extends from either side of your lower spine through your hips and buttocks down the back of each leg, ending just below the knee. It controls several muscles in the lower legs and supplies sensation to the lower leg and foot.

Symptoms

Sciatica is defined by shooting pain that radiates along the sciatic nerve, from your lower spine to your buttock and down the leg, sometimes into your foot. Other common symptoms include numbness and tingling sensation in the leg. The discomfort is usually felt on one side of the body. It can vary from mild to severe.

The following symptoms often characterize sciatica:

  • Pain that originates in the lower back or buttock and radiates along the sciatic nerve path down the back of the thigh and into the calf and foot (it rarely occurs only in the foot)
  • Chronic pain on only one side of the buttock or leg
  • Pain can be aggravated by prolonged sitting or standing, and you feel better when you lie down or walk
  • Pain intensifies during sudden movements, such as a sneeze or cough
  • Pain described as burning and tingling sensation which can sometimes feel like electric shock or jolt
  • Pain on one part of the leg and numbness in another part
  • Muscle weakness and numbness, or rigid movement in the affected leg or foot

For some people, sciatica pain can be severe and debilitating. For others, the sciatica symptoms might be infrequent and irritating but have the potential to get worse.

Causes

Sciatic nerve pain is caused by irritation of the root of the lower lumbar and lumbosacral spine. It occurs when the sciatic nerve becomes pinched, usually by a bone overgrowth (bone spur) on your vertebrae or by a herniated disk in your spine or by spondylolisthesis. More rarely, the nerve can be damaged by a disease such as diabetes or be compressed by a tumor.

Risk Factors

There are numerous risk factors for sciatica.

Age

Age-related changes in the spine, such as bone spurs and herniated discs, are the most common causes of sciatic nerve pain. People between the age of 30 and 50 have a higher risk of developing sciatica.

Obesity

By increasing the pressure on your spine, excess body weight can contribute to the spinal changes that cause sciatic nerve pain. This means that obese people have a higher chance of experiencing sciatica.

Pregnancy

Hormones produced during pregnancy (e.g., relaxin) can cause ligaments to loosen and stretch, which can potentially cause back pain in some women.

Occupation

A job that requires heavy lifting or frequent driving might trigger sciatic nerve pain.

Sedentary lifestyle

People who have a sedentary lifestyle or sit for prolonged periods are more prone to develop sciatic nerve pain compared with active people.

When to seek medical attention

Although most people fully recover from sciatica without treatment, it could potentially cause permanent nerve damage.

Consult your doctor if you experience:

  • Sudden, severe pain, numbness, or weakness in your lower back or leg
  • Pain that follows a traumatic injury, such as a car accident
  • Loss of bladder or bowel control – this may be caused by sciatica in both legs (bilateral sciatica)
  • Symptoms that continue to get worse, which may indicate possible nerve damage
  • Loss of sensation in the affected leg

Diagnosis

Medical history

Your doctor will gather your complete medical history by asking several questions, including:

  • Do certain positions ease your discomfort?
  • Do you have weakness or numbness in your legs?
  • Has the pain kept you from doing any activities?
  • Do you sit for long periods?
  • Do you do a lot of physical work, like heavy lifting?
  • How often do you exercise?

Physical examination

Next, your doctor will want to give you a physical exam. He may check your reflexes and muscle strength by asking you to do some exercises to see if they make your pain worse. If you have shooting pain down the leg while performing these exercises, it usually indicates sciatica.

Imaging tests

If pain is chronic or severe, imaging tests such as an X-ray, CT scan, or MRI may be necessary to help identify the underlying cause.

Treatment

Most cases of sciatica will improve in several weeks with proper treatment.

Pain medications

Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and narcotics are examples of pain medications that can help relieve sciatica pain.

Heat and ice packs

For acute sciatic nerve pain, alternating between heat and ice packs can help alleviate initial pain and inflammation. Wrap the cold compress around the lower back for up to 20 minutes and repeat every 2 hours. After 2-3 days, switch to hot packs or heating pads for a few days after that. The heat dilates blood vessels, increasing blood flow and relaxing your muscles, thereby relieving the pain.

Physical therapy

Once your acute sciatic nerve pain improves, your physical therapist may design a rehabilitation program to help you prevent further injuries. This typically includes exercises to strengthen the muscles supporting your back, correct your posture, and improve your flexibility to take the pressure off the sciatic nerve. The exercises can also provide conditioning to help prevent the pain from recurring.

Chiropractic

Spinal adjustment and manual manipulation can restore spinal movement and decrease sciatica pain. However, it might not be appropriate for radiating pain.

Limit bed rest

Your first instinct might be to rest and take it easy when you have sciatica, but it’s more important to keep moving. If you sit still, the nerve will continue to be irritated in that spot. Three days off your feet is usually sufficient. After that, it’s best to return to your normal activities and stay in motion.

Biofeedback

Biofeedback uses a machine to detect bodily functions such as blood pressure, heart rate, and muscle tension. With the information, you can find ways to achieve conscious control of these otherwise involuntary processes.

Acupuncture

Acupuncture uses fine needles inserted at particular locations on the acupressure points along the meridians or channels. It is thought to stimulate the central nervous system, which in turn would trigger the release of pain-relieving chemicals that could reduce pain sensation and elevate a sense of well-being.

Epidural steroid injections

Your doctor might recommend corticosteroid injection directly into the area adjacent to the injured nerve root. Corticosteroids may help minimize pain by suppressing inflammation around the irritated nerve. While the effects are temporary (usually wears off in several months), and it does not work on everyone, it can provide sufficient relief to allow you to progress with physiotherapy or rehabilitation.

Surgery

Surgery is usually reserved for when the compressed nerves cause significant weakness, progressively worsening pain, or when you lose bowel or bladder control. Early surgery is believed to improve pain relief and perceived recovery.

Exercises for sciatica pain relief

Physical therapy exercises incorporate a combination of stretching, strengthening, and aerobic conditioning to help improve sciatica symptoms. When you engage in physical therapy regularly, you can recover more quickly from sciatica pain and would be less likely to have a future recurrence.

Strengthening exercises

Exercises that strengthen the core muscles can support the spine, keeping it in alignment, and facilitating movements that extend or twist the spine with less chance of injury or damage.

Pelvic tilt

Instructions:

  1. While on your back, exhale and tightening your abdominal muscles while pushing your belly button toward the floor and flatten your lower back. Place your thumb on your lowest rib and pinky finger on your hip bone (same side of your body). As you tighten your abdominal muscles, the space between your pinky finger and thumb should be smaller.
  2. Hold the position for 5 seconds.
  3. Repeat the pelvic tilt ten times while holding the position for 5 seconds each time.

Stretching exercises

Stretching exercises for your lower back might help relax tight and inflexible muscles to relieve nerve root compression.

Reclining pigeon pose

The reclining pigeon pose opens your hips.

Instructions:

  1. Lie on your back and bring your left leg up to a right angle. Clasp your hands behind the thigh, locking your fingers.
  2. Lift your right leg and place your right ankle on top of the right knee.

Hold the position for 10 seconds – this helps stretch the piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve.

  • Do the same with the other leg.

Hamstring stretch

Stretch your hamstring daily.

Instructions:

  1. Elevate your right foot at or below your hip level. Flex your foot, so your legs and toes are straight.
  2. Bend your back forward slightly toward your foot.
  3. Release the hip of your raised leg forward.
  4. Hold for 30 seconds, and then repeat on the other side.

Sitting spinal stretch

This exercise helps create space in the spine to relieve pressure on the sciatic nerve.

Instructions:

  1. Sit with your legs extended straight out with feet flexed upward.
  2. Bend left knee and place your foot flat on the floor on the outside of your opposite knee.
  3. Place your right elbow on the outside of your left knee to help you gently turn your body toward the left.
  4. Hold for 30 seconds and repeat three times before switching sides.

Low-impact aerobic exercises

Some form of low-impact cardiovascular exercises, such as walking or swimming, may encourage the exchange of extracellular fluids and nutrients to help create a better healing microenvironment. Aerobic conditioning also has the unique benefit of releasing your body’s natural pain killers (endorphins), which helps reduce sciatic nerve pain.

Prevention

It’s not always possible to prevent sciatica. Nevertheless, the following measures can help protect your back:

Maintain proper posture when you sit

Choose a seat with excellent lumbar support, swivel base, and armrests. Place a lumbar pillow in the small of your back to support its normal curve. Keep your knees and hips level.

Exercise regularly

To keep your back strong, strengthen your core muscles to maintain proper posture and alignment.

Use proper body mechanics when lifting

When you lift something heavy, let your lower body do the work. Move straight up and down. Keep your back straight and bend only at the knees. Avoid lifting and twisting simultaneously.

2 Responses

  1. Hi there! Great stuff on this site.
    I noticed that none of your interventions include evidenced-based pain psychology information. Also, modern pain science does not focus on structural or nerve/tissue damage – because it is the nervous system. Seek out Lorimer Moseley. FYI: I use to live in Singapore and was born in Kuala Lumpur, Malaysia. In Peace, Les

    1. Hi Dr. Lorimer,

      Thank you for your suggestions! I am currently writing articles about pain psychology, albeit at a slower pace because I’m writing and editing by myself. Also, I’m not an expert in pain science, so I definitely appreciate professional input.
      BTW, please sign up for our newsletter by filling in your information at the bottom of the homepage.

      Thank you! Terima kasih!

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