What is Sciatica?
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Sciatica is a medical condition that is characterized by back pain coupled with pain that radiates from the back to the lower extremities. This type of back pain is caused by a form of peripheral neuropathy called radiculopathy. The pain in the legs and feet is caused by an impingement on the sciatic nerve on the back of the body.
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When the sciatic nerve is impinged, there is damage caused to the nerve as a result. The severity of the damage to the nerve will impact what kinds of symptoms a person has. Also, the longer the condition is left untreated, the higher the likelihood that the symptoms will get worse.
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Symptoms of Sciatica
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Signs and symptoms of sciatic are a result of the nerve impingement. Depending on where the impingement is located, the symptoms may vary slightly. Some of the symptoms include:
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Back pain
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Burning sensations in the legs or feet
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Tingling sensations in the legs or feet
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Shocking (or electricity-like) sensations in the legs or feet
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Shooting pains down the back of the legs
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Numbness in the feet
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Ankle pain
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Legs or feet feel heavy or dead
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Difficulty walking
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Difficulty maintaining balance
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Legs or feet feel tired or weak
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Many of these symptoms are non-specific, meaning that even though they are symptoms of sciatica, the symptoms could be caused by some other condition. For example, patients with diabetic neuropathy could have the exact same symptoms, but the symptoms may be caused by diabetic neuropathy and not sciatic nerve damage.
Causes of Sciatica
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Sciatica is always caused by some other medical condition, typically conditions that "pinch" or put pressure on nerves as they exit the spinal cord. In order to treat the symptoms of sciatica, the underlying cause must also be treated.
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Disk Herniation
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Disk herniation is a condition in which there is damage to one of the disks in the spine. The disks in the spine provide two primary functions - they maintain a space for the nerves to exit the spine and they serve as a cushion between the individual bones that make up the spine. In turn, the disks enable movement of the bones, which is what allows you to bend your back. Sometimes the disks become injured, causing the cushion to "leak" or herniate out. As a result, the disks put pressure on the nerves that are exiting the spine, causing injury to the nerves.
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Spinal Stenosis
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Spinal​ stenosis is a medical condition that is characterized by a narrowing of the bony space where the spinal cord is located. This narrowing is typically result of age, but can be the result of other underlying issues, such as osteoarthritis. When the space becomes more narrow, the bone may put pressure on one or more nerve before they exit the spinal canal. The pressure on the nerves can cause numbness, tingling, pain, burning or other neurological symptoms in the back, legs, or feet.
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Piriformis Syndrome
Piriformis syndrome is a medical condition caused by inflammation of the piriformis muscle. The piriformis muscle is a muscle located deep to the muscles of the buttocks. The piriformis muscle helps in maintaining balance while walking.
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The piriformis muscle is located right next to the sciatic nerve. When the piriformis muscle becomes inflamed, it can press down on the sciatic nerve, causing the symptoms of sciatica. In addition, piriformis syndrome can occur more easily in individuals with an accessory piriformis muscle, when the sciatic nerve runs partially or completely through the piriformis muscle.
Many patients with piriformis syndrome may have no idea that there is inflammation in the muscle. A simple examination can help diagnose sciatica caused by piriformis syndrome.
Diagnosing Sciatica
Diagnosing sciatica can be tricky. The signs and symptoms are too non-specific to reach a diagnosis easily. Instead, a thorough and comprehensive assessment of several factors are required to make an accurate diagnosis. Factors to be considered in reaching a diagnosis of sciatica include medical history, medications, lifestyle, previous injuries, length of symptoms, to name a few.
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Physical Exam
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The physical exam provides important diagnostic information for a doctor when determining whether or not an individual is diagnosed with sciatica.
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Diagnostic Imaging
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Whether to perform diagnostic imaging should be determined based on the individual case.
Many doctors may order a lumbar x-ray to rule out some specific causes. X-rays are primarily used to determine whether or not there are bony abnormalities that may be the underlying cause of symptoms. Often times, an insurance company may require less invasive (and cheaper) imaging (such as an x-ray) before they will pay for more expensive imaging tests such as an MRI.
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EMG/NCS
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Treatment for Sciatica
There are a number of treatments available for the treatment of sciatica. The treatment should be targeted for the underlying cause of the condition. For example, if disk herniation is the underlying cause of sciatica symptoms, treating piriformis syndrome will not likely alleviate the symptoms.
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FDA-Approved Treatments
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There are technically no "FDA-approved" treatments for sciatica. However, the FDA has approved quite a few treatments or medications that involve the management of symptoms.
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Alternative Treatments
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Alternative treatments may be an option for those individuals who do not require surgery.
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PRP for Sciatica
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Platelet rich plasma, or PRP, is an effective treatment for sciatica for some individuals.
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Prolotherapy for Sciatica
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Prolotherapy has also been used to treat sciatica.
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Electrical Stimulation
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Electrical stimulation may be effective for some patients in treating the neurological pain caused by sciatic nerve impingement.
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Osteopathic Manipulation
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Osteopathic manipulation, or OMT, can often times be an effective, non-invasive treatment for sciatica.
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