Sciatica

Sciatica is one of the most common forms of lower back pain among men and women.

Learn about Sciatica, tips to prevent it, and how to maintain a healthy back.

Sciatica 

Sciatica or Sciatic pain is related to the impingement or compression of the Sciatic nerve between the lumbar bones or vertebras. There are five lumbar bones, known as lumbar vertebrates.  In addition, the nerve impingement occurs most of time between Lumbar 4-5 (L4-L5), Lumbar 5- and Sacral 6 (L5-S1) and Lumbar 3-4 (L3-L4) segments.

Lower back pain is a very common debilitating condition affecting 50-80% of the general population globally and 5%-10% of people with lower back pain end up with Sciatica pain.

Sciatica Nerve

The Sciatic nerve is considered the longest and the widest nerve in the body according to recent research. The nerve is two centimeters in diameter. It originates in the lumbosacral junction (the lowest part of the back). The Sciatic nerve has four roots from L4 to S2. The roots go all way down and innervate the lower leg.

Sciatica Nerve Function

The Sciatic nerve provides motor function that controls several muscles in the leg (hamstrings), inner thigh (adductors), calf muscles (gastrocnemius), and muscles localized in the anterior part of the lower leg.

The Sciatic nerve provides sensation to the skin of the back of the leg (hamstrings), lateral lower leg (peroneal muscles), and bottom of the foot (plantar fascia).

Sciatica Symptoms

• Shooting and burning pain in the rear, back of the thigh, calf, foot, or toes.
• Tingling, pins, and needles down the leg.
• Lack of sensation in the affected leg.
• Burning sensation deep in the rear.
• Heaviness in the affected leg.
• Discomfort that comes and goes.
• Tenderness and pain over one side of the lower back, or muscles of the buttock.
• Leg muscle spasms and cramping muscles.

Sciatica Signs

• Pain gets worse with sitting with the affected leg straight.
• Less pain with lying down.
• Muscle tightness in one side of the lower back down to the affected leg.
• Reduce flexibility in lower back and legs. (Worse in the affected leg).
• Pain is aggravated with sneezing, and coughing.
• Pain is aggravated with leaning forward.
• Unable to walk with a normal speed.
• Difficulty with prolonged standing or sitting.

Sciatica Causes

• Bulged herniated disc between L3-L4, L4-L5, or/and L5-S1.
• Degenerative aging process between the spine’s vertebrae, and intervertebral discs.
• Repetitive lifting, and twisting.
• Poor Posture.
• Weak abdominal muscles.
• Instability of the pelvis.
• Traumatic events in the lower back such as car accident or gunshot wounds.
• Inflammation of the Piriformis muscle.
• Pregnancy may compress the Sciatic nerve.

Risk Factors

• Age older than 40 or 50 years due to aging degenerative process.
• Job-related factors such as lifting, bending, and twisting movements of the back.
• Repeated lifting of heavy loads combined with side-bending and twisting.
• Driving long distances
• Vibration (truck drivers, bulldozers, helicopters, forklift, etc).
• Smoking impairs the blood flow to the vertebral body and the nutrition to the disc. Smoking accelerates the degenerative process of these structures.
• Obesity produces excessive stress on the spine and adjacent structures.
• Very uncommon before age 20, unless a traumatic event occurs.
• Depression

Sciatica and Piriformis Muscle

The Sciatic nerve runs adjacent to the Piriformis muscle. The Piriformis muscle is responsible to rotate the hip out. Remember Chaplin’s feet? The piriformis muscle was in charge on keeping his feet out. Also, the piriformis moves the leg back (kicking back).

Piriformis Syndrome

Any trauma or injury to the piriformis muscle can produce Sciatic symptoms. The piriformis can be injured or irritated due to overuse in activities such as:

• Weightlifting squat.
• Cycling
• Running
• Prolonged sitting (office workers, commuter drivers).
• Climbing stairs
• Direct trauma (falling on the rear).

Piriformis Symptoms

• Pain with direct pressure on the piriformis muscle.
• Worse pain with going upstairs
• Worse pain with walking uphill.

Sciatica Recovery Time

Usually takes 4 to 6 weeks to recover, and a little bit longer in some cases when the neurological symptoms are all way down to the affected leg.

Treatment

• Ice for 15 to 20 minutes. Always wrap the ice pack in a towel or pillowcase to avoid burning the skin. Ice reduces edema, inflammation, and pain.

Keep in mind not to put ice if the sensation is reduced, or the person has poor circulation, or a wound is healing slowly.

• Heat for only 20 minutes. Heat decreases the intensity of the pain, reduces lower back pain, increases tissue flexibility, and relaxes the muscle.
• Proper Sitting: Sit up straight and avoid a slumped posture.
• Bed rest is not recommended and can contribute to increase lower back pain, muscle weakness, and adaptive shortened back muscles, due to inactivity.
• Strengthening Transversus Abdominis and Hip Extensors.