What is Sciatica?
It is pain that radiates from your back down your leg. You can have numbness and weakness associated with it. Sometimes, people will have pain and numbness at the same time. The pain can be sharp, stabbing, shocking, and can be excruciating. Some of our patients will describe it as taking their breath away.
Sciatica is often worsened by coughing, sneezing, prolonged sitting, prolonged standing, or walking. It can start upon awakening in the morning or sometimes after a trauma. Some patients are unable to recall any inciting event.
Why does it occur?
The pain is from nerve compression in the back (lumbar spine). In between the lumbar vertebral bones there are discs. The discs act as shock absorbers for the bones and also maintain the space where the nerves exit out to supply your legs. In the case of sciatica, either the disc bulges back to compress the nerve, the disc leaks chemicals onto the nerve that irritate it, the bone develops some spurs from arthritis that compress the nerve, or rarely, a tumor can press on the nerve. Whatever the cause the nerve is either compressed or irritated and it responds by causing low back, buttock, thigh, and leg pain.
Are there risk factors?
One of the main risk factors for this condition is age. As we age, we are more likely to develop arthritis. Our discs also lose quite a bit of water out of them leading to degenerative disc disease causing disc bulges and herniations.
Another risk factor is smoking. Smoking robs the discs of oxygen and they wear out faster leading to disc degeneration.
Repetitive lifting, especially with poor body mechanics, meaning bending at the waist instead of the knees can cause this condition.
Diabetes increases risk of all different types of nerve damage.
Obesity because the heavier you are, the more weight on the spine.
Trauma such as falls, car accidents or high impact sports put you at risk of this condition.
Genetic factors may also play a role. If other people in your family develop disc problems early in life, you may develop them also.
Certain occupations can put you at risk. Everyone knows that jobs that require a lot of constant lifting of heavy objects are not good for your back, but would it surprise you to know that desks jobs are equally bad for your back? It has to do with the mechanics of sitting. When you stand 100% of your body weight is placed on the spine, but when you sit, it could be as much as 140% your body weight even with proper posture. If you sit leaning forward as in working on a low computer or reaching, it could be closer to 200%. If you work at a desk job, it is important to stretch regularly, strengthen your core muscles and get up and walk when you can.
How can I prevent it?
By changing the risk factors of which you have control.
- Maintain a healthy weight.
- Don’t smoke.
- Maintain tight blood sugar control if you are diabetic.
Exercise regularly, especially exercises that strengthen your core muscles. Core muscles are the muscles around your midsection that support your spine while you are standing, walking, and sitting. If these muscles are weak, all of the support for these activities falls to your spine. We were not designed to work that way. Unfortunately, as human beings in this era, we do not usually strengthen them during daily activities, so you have to be very intentional about it.
You can also reduce your chance of developing sciatica by lifting with proper body mechanics (lift with your legs) and get help if an item is too heavy – try not to rush.
How Sciatica Treated?
Most people who have sciatic will never go to the doctor. For most people, it resolves in 1-2 weeks. If it does not though, you should seek medical attention.
Initial treatment is supportive only with anti-inflammatories like steroids, muscle relaxers, heat/ice, or possibly stronger pain medication.
If it fails to improve after a couple of weeks or is accompanied with extreme weakness of the legs, urinary incontinence (wetting yourself) or bowel incontinence (soiling yourself), you should see a specialist to order testing like an MRI, EMG, or CT and provide further treatment.
More advanced treatments range from physical therapy to spinal injections to acupuncture, or as a last resort surgery. We at Comprehensive Rehabilitation and Pain Specialists, P.C. are here to help you.
Where can I get additional help?
If you battle with sciatica that is uncontrolled, discuss it with your family doctor or ask for a referral to see a spine specialist at our practice. There are a lot of treatments and education that we can prescribe to get you on the right path.