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Sciatica is a medical term that refers to pain in the back and legs caused by injury of the sciatic nerve. The term sciatica is often used interchangeably with another medical condition—radiculopathy. Radiculopathy refers to pain that travels along the course of a nerve, from the lumber plexus to the leg. Sciatica is often triggered by injury or compression to the sciatic nerve and can cause discomfort.
The sciatic nerve is the longest nerve in the human body, and it extends from the lower back all the way to the legs. It is also the widest nerve in the body as it splits several times along its course, giving rise to multiple nerves that supply both sensory and motor function to most of muscles and skin of the lower limb. Because the sciatic nerve has such a wide distribution, injuries and pathologies involving it are usually reflected in the entire lower limb, causing great discomfort.
The sciatic nerve has its nerve roots from L4 to S3. Designations like “L4” and “S3” are used to refer to spinal nerves as they leave the spinal cord. The letter refers to the part of the vertebrae the nerve exits from, and the number refers to the vertebrae’s position. So L4 refers to the fourth nerve that exits from the lumbar vertebrae.
These designations are important because they can help diagnose and treat injuries related to the nerves, like sciatica. If a problem occurs along a nerve root, it can be traced to the source and diagnosed properly. This method also helps rule out similar conditions during the examination. (more on this under the diagnosis section).
Sciatica is caused by injury or pressure to the sciatic nerve. This injury usually occurs at the low back, particularly close to the nerve’s origin. This injury could be in the form of irritation at the nerve root(s). Since the nerve originates from both the lumbar and sacral spine, any irritation in these areas can cause sciatica. Other causes of this condition include:
Because the sciatic nerve is such a large and long nerve, it can be damaged anywhere along its path. This damage will lead to symptoms that are similar to those seen in sciatica. However, despite this similarity, the resulting conditions may be called other names besides sciatica. This also depends on how far down the injury occurs.
For example, the common peroneal nerve can be damaged as it winds around the fibula just below the knee. Damage to the nerve at this point is not called sciatica, but common peroneal nerve dysfunction.
How Common is sciatica and who is at risk
Sciatic nerve injuries occur during hip replacement surgeries about 0.5% to 2% of the time. This means that roughly two of every 100 persons that have hip replacement surgery will get sciatica. For non-operative causes, the prevalence has been difficult to determine, although it is estimated that between 13% to 40% of people will get this condition at least once in their lifetime. Most of these occurrences resolve on their own.
Some of the risk factors of sciatica include obesity, prolonged sitting, diabetes, and prolonged sitting. Occupations that require you to sit for prolonged hours, or carry heavy loads have also been indicated to be related to sciatica
Sciatica is like several other conditions that cause low back pain, which makes it very difficult to tell the condition apart from the rest. However, unlike the other conditions mentioned above, sciatica causes a specific kind of low back pain.
In this condition, the pain extends from the hip, down to the buttocks and thighs, and even to the legs. Another unique thing about sciatica is that the pain usually affects one side of the leg. This is different from causes like arthritis that affect both sides of the body. Here are some other symptoms associated with sciatica:
The way sciatica manifests differ from person to person, and some people experience severe and debilitating pain. This often makes them unable to function normally. In some others, the pain may come very seldom, and with mild severity.
There are also extreme cases, in which sciatica can lead to loss of bowel and bladder control and even complete loss of sensation in the upper thighs.
The problem with low back pain is that there are so many different conditions that can cause it ranging from nerve related problems like sciatica and pudendal neuropathy to skeletal anomalies like osteoarthritis and osteophytes. However, the diagnosis of all these conditions is relatively the same. It follows a process that begins with physical tests and extends to imaging scans.
In sciatica, the muscles and the area of skin supplied by the nerve are also checked. Anomalies in these areas indicate an underlying sciatic nerve injury.
Some imaging tests may also be conducted to investigate the condition further. They are also useful to identify the underlying causes. MRIs and CT scans can detect causes like tumours and disc hernias, bringing the condition one step closer to treatment
Several sciatica occurrences resolve on their own with a bit of rest and self-care. Research shows that 9 out of every 10 cases of sciatica are resolved without any surgical interventions. For the cases that don’t resolve on their own, other interventions may be effective in treating them.
Medications that are prescribed for managing sciatica include
Physiotherapy is useful for treating sciatica in all its stages. In the acute stage, stretching can loosen up tight muscles and relieve pain. It can also help strengthen the muscles of the back and improve flexibility. In chronic conditions, it can help manage the pain and prevent sedentary behaviour.
In cases where the sciatica has been resolved, exercises and other physiotherapy interventions can help prevent a reoccurrence by correcting posture and strengthening the muscles around the lumbar and sacral region.
Since most sciatica conditions resolve on their own, this option is usually reserved for extreme cases like situation s where the nerve compression causes significant muscle weakness, loss of bowel control. It is also considered when other methods of intervention have failed.
“sciatic nerve (anatomy)”. Britannica Online Encyclopedia. Retrieved 23 April 2012.
Describing its part of the lumbosacral plexus: Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray’s anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0.