Dr. Kaixuan Liu discusses Sciatica, its causes, treatments, and preventative measures.
Sciatica is a term used to refer to nerve pain that originates in the lower back and is felt through the buttock, down the back of the thigh, and into the calf. Sciatic pain radiates along the path of the sciatic nerve, the longest single nerve in the body. This nerve is responsible for the movements of the lower body. There are two sciatic nerves, the right and the left, each supplying the corresponding leg, and sciatic pain is typically felt just on the side with the affected nerve. “Sciatica is not itself a medical diagnosis,” says Dr. Kaixuan Liu, Founder of Atlantic Spine Center. “It describes a set of symptoms caused by an underlying medical condition - sciatica, which is responsible for compressing the sciatic nerve where it emerges from the spine. Sciatic pain can be mild or excruciating and often resolves with self-care, but there may be indications that call for medical attention.”
Sciatica is characterized by unpleasant sensations such as moderate to severe pain in the back, legs, and other lower body areas, as well as numbness and weakness.
Sciatic pain radiates from the sciatic nerve and may be felt anywhere along its path. It is commonly felt on one side from the lower back or buttock all the way down the leg, usually down the back of the leg. The pain may be a mild ache, a sharp burning sensation, or an excruciating pain that feels like an electric shock. Pain is sometimes accompanied by tingling, numbness, or weakness. There might be pain in one part of the leg and numbness in another. Symptoms might be better or worse in different positions -- sitting, bending, standing – and may be alleviated by walking. Medical attention should be sought immediately if there is progressive neurological deterioration, such as leg weakness or bowel and/or bladder dysfunction.
Sciatica is triggered when the sciatic nerve is compressed or pinched in the lumbar spine, often by a herniated disc. Discs are shock-absorbing cushions between the vertebrae in the spine. Each disc has a strong, fibrous outer ring and a soft, gel-like center. A herniated disc occurs when a tear in the tough outer layer of cartilage allows some of the soft inner material to protrude out of the disc. Other causes of sciatica include spinal stenosis, a narrowing of the space through which the nerves pass in the spinal canal; general degenerative changes in the vertebrae or discs; and spasms of the lumbar or pelvic muscles. Spondylolisthesis is a spinal condition where a disk slips forward over the vertebra below it; spine tumors and infections can also cause sciatica pain.
Many causes of sciatica are due to age-related spinal degeneration, making advancing age the most common risk factor. Usually, people in their 30-s and 40-s have a higher risk of this condition. Others include obesity, which increases the pressure on the spine; occupations that require frequent twisting, carrying heavy loads, or sitting for prolonged periods; and diabetes, which increases the risk of nerve damage. A sedentary lifestyle is also among the sciatica risks.
To determine the correct sciatica diagnosis, a doctor needs a complete medical history of the patient, a list of symptoms, and their evaluation. A physical exam might be required to see how the body reacts to basic exercises. If the pain lasts for a while, longer than 4-8 weeks, a doctor can recommend imaging tests such as X-rays or MRI to see if the sciatic nerve is compressed.
Most cases of sciatica improve with four to six weeks of non-surgical care, generally including some combination of physical therapy, medication, and therapeutic injections. Sciatica is considered chronic if it lasts longer than eight weeks, and the length of treatment may depend on the underlying cause.
Some activities, such as lying in bed for long periods, can worsen your pain, so try to avoid them. There are several at-home remedies to ease the pain. Among them is using heat or cold and applying it to the affected areas. Gentle stretching can also be helpful to ease the pain. However, it is essential to learn proper stretching techniques; otherwise, you can worsen your state.
You can also join physical therapy. The goal of physical treatment for sciatica is to strengthen the muscles of the spine, abdomen, buttocks, and hips; stretch tight muscles like the hamstrings; increase core strength, and improve aerobic conditioning with gentle exercises like walking and water therapy. Some forms of massage therapy can help relax tight muscles and improve circulation. Medication might include prescription drugs like oral steroids or – for short periods – opioid analgesics and muscle relaxers; over-the-counter remedies such as non-steroidal anti-inflammation drugs (NSAIDs) like naproxen and ibuprofen; and steroidal injections to control inflammation around the nerve. Surgery may be indicated in severe cases or the presence of progressive neurological symptoms. For example, if the patient has developed bowel and bladder control issues. Two types of surgery are usually recommended for people with sciatica: discectomy and microdiscectomy. The first involves removing a part of a disc that is pressing on nerves. The second surgery targets the same, using a microscope through a small cut.
“It may not be possible to prevent all age-related degeneration of the spine,” says Dr. Liu, “but general good health habits go a long way to preventing back problems like sciatica. These include regular exercise, particularly a core-strengthening regimen targeting the back and abdomen muscles, proper sitting pasture with good lower back support, and proper lifting technique that lets the legs rather than the back do the work. Your back is designed to support your whole body. Take good care of it, and it will carry you far!”
Exercises for sciatica
Some sciatica exercises can help reduce the pressure on the sciatic nerve, which eases back pain symptoms. It happens due to endorphins released by the body during physical activity that act as natural pain relievers. You don’t need to choose high-impact workouts to get these benefits, and you can swim or do yoga. You can pay attention to gentle stretches to prevent strains, sprains, and spasms. Later, you can opt for aerobics and strength training. Regular training is essential here. But it is also crucial to discuss your training routine with your doctor, as some exercises can only seem beneficial, but in fact, they can worsen your state.
Your doctor can recommend a physical therapist who will show proper sciatica exercises to improve your posture and flexibility.