What it is

Sciatica is the name people give to a pain in the buttock, leg
or foot brought on as a direct result of some form of irritation
to the sciatic nerve. The sciatic nerve is the longest nerve in
the body. It runs all the way from the lower back splitting at
the base of the spine and terminating in the foot.

The discs which cushion the vertebrae in the lower back become
progressively thinner and harder as we get older. This stresses
the lower back and often causes a variety of lower back pain
disorders, including sciatica.

Sciatica is usually caused by a prolapsed or ’slipped’ disc
bulging and pressing on to a nerve. It doesn’t usually cause
permanent nerve damage since the spinal cord is not present in
the lower part of the spine and a prolapsed or herniated disc in
this area does not pose a risk of paralysis.

The cause

The most common cause of sciatica is a prolapsed (slipped) disc,
pinched nerves or some form of arthritis. It usually starts with
back pain which sometimes improves only to be followed by
hamstring or calf pain. It may also include numbness in the toes
depending on which branch of the sciatic nerve is irritated.

Piriformis syndrome is a condition in which the piriformis
muscle irritates the sciatic nerve. The piriformis muscle is a
small muscle behind the gluteus maximus. Piriformis syndrome is
most common among women, runners and walkers.

Spinal stenosis is the name given to the narrowing of the nerve
channel (vertebral canal) of the spine. This narrowing causes
compression of either the spinal cord within the vertebral
canal, or the nerve roots that exit the spinal cord. People with
spinal stenosis experience sciatic pain symptoms in the legs and
feet. It usually results from degenerative arthritis causing a
narrowing of the spaces in the vertebral canal. Manual workers
are more prone to developing symptoms of spinal stenosis but it
seldom affects people under 30 years of age – unless it is due
to traumatic injury to the vertebrae.

The spine is made up of a series of connected bones called
“vertebrae.” Spondylolisthesis or isthmic spondylolisthesis
occurs when a cracked vertebra slips over the vertebra below it.
Poor posture and curvature of the back or weak abdominal muscles
can contribute to this slippage, which can press on the nerve.
The presence of this spondylolysis usually does not represent a
dangerous condition in the adult and most treatments concentrate
on pain relief and increasing the patient’s ability to function.

The Cure

Some cases of sciatica which result from inflammation get better
with time and heal themselves perhaps within six weeks to three
months.

Recent studies have shown that bed rest is not necessarily the
best way to treat sciatica. It is better to remain active,
starting off with some gentle stretching and exercise. Swimming
is particularly useful, as it is not a weight bearing exercise.
The good news is that herniated spinal discs usually do heal on
their own, given time.

There are many different treatments for sciatica and it is
important to discuss these with your health practitioner.
Accurate diagnosis to determine the exact cause of sciatic pain
is also equally important. The most conclusive diagnosis is
usually gained by a having an MRI scan. However having said that
skilled medical practitioners, and I include Osteopaths and
Chiropractors, are often able to determine the suspected cause
by carrying out a physical examination

Stretching and exercising are a must if you really want to
progress along the road to rehabilitation and if you are in
extreme pain this is probably the last thing you will
contemplate doing.

Since getting mobile and becoming flexible is extremely
important you might require some pain management to help you get
going. For mild cases of sciatica your doctor may start off by
recommending non prescription medications like aspirin,
ibuprofen, or naproxen, known as non steroidal anti-inflammatory
drugs, or NSAIDs. A downside of these drugs is that they may
cause stomach upsets or bleeding.

If your pain is not relieved by analgesics or NSAIDs, your
doctor might prescribe narcotic analgesics (such as codeine) for
a short time. Side effects of these include nausea,
constipation, dizziness and drowsiness, and continued use may
result in dependency.

Sciatic pain is usually nerve related and responds well to
treatment with low doses of tricyclic anti-depressant drugs like
amitriptyline, dothiepin, nortriptyline, lofepramine,
desipramine, clomipramine or imipramine combined with
acupuncture or the use of TENs machines. The low dosage of the
tricyclic drug acts by closing “a pain gate” blocking the
message to the brain.

Other medications like Corticosteroids taken orally or by
injection are sometimes prescribed for more severe back and leg
pain because of their very powerful anti-inflammatory effect.
Corticosteroids also have side effects and the pros and cons of
taking them should be fully discussed with your doctor.

In extreme cases spinal injections of corticosteroid into the
epidural space (the area around the spinal nerves) or facet
joint (between vertebrae) may be given. This is usually carried
out by a specialist with follow up injections at a later date.

Other treatments to manage sciatica include traction;
manipulation by a skilled osteopath, physio therapist or
chiropractor; Chemonucleolysis (injection of a special enzyme
into the disk).

There is a fairly new procedure called IDET which stands for
Iintro Discal Electrothermy). When a disc is herniated the water
content of the inflamed disc causes it to bulge and press
against the nerve. IDET dries up the disc very quickly, in less
than 20 minutes, a process which might take weeks or months if
left to dry up naturally

As a last resort you may consider surgery to remove fragments of
the prolapsed disc are then removed.

As I mentioned earlier it is important to stay active and
continue with an exercise and stretching program. Especially do
exercises to develop your back and stomach muscles. This will
help stabilize your spine and support your body.

It is also important to maintain a reasonable body weight,
ensure you have a good posture, sleep on a mattress that is
neither too soft nor too hard, be careful when bending or
lifting heavy weights.

This information in this article should not be used to diagnose,
treat, or prevent any disease. You should always consult with
your health care professional especially relating to the
suitability of supplements or drugs and on all health matters
that may require diagnosis or medical attention. If you suffer
from progressive weakness in the leg or bladder or bowel
incontinence this constitutes a medical emergency and you should
seek immediate medical attention – you may have cauda equina
syndrome a serious condition due to compression of the nerve
roots in the lower end of the spinal canal.