Sciatica

 Sciatica Overview:

Sciatica is a term used to describe the symptoms of leg pain and sciatica_illustrationpossibly tingling, numbness or weakness that travels down the low back down via the sciatic nerve in the back of the leg. Sciatica (sometimes known as radiculopathy) is a description of symptoms, not a diagnosis. A herniated disc,spinal stenosis, degenerative disc disease, andspondylolisthesis can all cause sciatica, but it’s up to a patient and his or her doctor to determine the proper course of action.

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.

Common Sciatica Symptoms:lower_back_pain

Low back pain may be present along with the leg pain, but typically the leg pain is markedly more severe than the low back pain.

  • See Leg Pain and Numbness: What Might These Symptoms Mean?
  • Some combination of the following symptoms is common:
  • Lower back pain, if experienced at all, is not as severe as leg pain
  • Constant pain in only one side of the buttock or leg, but rarely both the right and left sides
  • Pain that originates in the low back or buttock and continues along the path of the sciatic nerve – down the back of the thigh and into the lower leg and foot
  • Pain that feels better when patients lie down or are walking, but worsens when standing or sitting
  • Pain that is typically described as sharp or searing, rather than dull
  • Some experience a “pins-and-needles” sensation, numbness or weakness, or a prickling sensation down the leg

Sciatica Causes:

 6 Most Common Causes of Sciatica:

There are 6 lower back problems that are the most common causes of sciatica:

  • Lumbar herniated disc
    A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) and irritates the contiguous nerve root.
  • Degenerative disc disease.

While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.

  • Isthmic spondylolisthesis
    This condition occurs when a small stress fracture allows one vertebral body to slip forward on another (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disc space collapse, the fracture, and the vertebral body slipping forward,      the nerve can get pinched and cause sciatica.
  • Lumbar spinal stenosis
    This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60.
  • Piriformis syndrome
    The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.
  • Sacroiliac joint dysfunction
    Irritation of the sacroiliac joint – located at the bottom of the spine – can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.

Sciatica Treatment:

For severe or ongoing flare-ups of sciatic nerve pain, the condition may need to be treated so that it does not get worse over time.For most, readily available nonsurgical remedies and regular exercise will go a long way to relieving their pain.

For others, when the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may offer the best approach to finding pain relief and preventing or minimizing future pain and/or dysfunction.

What is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

The piriformis muscle:

  • Starts at the lower spine and connects to the upper surface of each femur (thighbone)
  • Functions to assist in rotating the hip and turning the leg and foot outward
  • Runs diagonally, with the sciatic nerve running vertically directly beneath it (although in some people the nerve can run through the muscle).

Causes of Piriformis Syndrome

The exact causes of piriformis syndrome are unknown. Suspected causes include:

  • Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
  • Tightening of the muscle, in response to injury or spasm
  • Swelling of the piriformis muscle, due to injury or spasm
  • Bleeding in the area of the piriformis muscle.

Any one or combination of the above problems can affect the piriformis muscle (causing buttock pain) and may affect the adjacent sciatic nerve (causing pain, tingling, or numbness in the back of the thigh, calf, or foot).