Generality
Sciatica, or sciatica, is a medical condition characterized by a more or less intense painful sensation along the anatomical areas covered by the sciatic nerve (which, in short, are: lumbar area of the back, buttock, thigh, leg and foot).
The irritative compression of the sciatic nerve can determine: a spinal disc hernia, a vertebral or foraminal stenosis, located along the lumbo-sacral tract of the spine, a lumbosacral spinal tumor, piriformis syndrome, pregnancy advanced etc.
Often, where it can cause pain, sciatica is also responsible for other symptoms, such as: tingling, numbness, muscle weakness and difficulty moving.
For a correct diagnosis of sciatica, the physical examination associated with a careful medical history is often sufficient. However, doctors tend to resort to other more in-depth diagnostic tests to understand precisely what are the causes that trigger the painful condition.
Treatment varies according to the severity of the condition: for milder forms of sciatica, rest might be enough; for moderate and severe forms of sciatica, on the other hand, the intervention of the doctor is indispensable, who could prescribe drugs, targeted physiotherapy and, in extreme cases, even surgery.
Brief anatomical reference to the sciatic nerve
The sciatic nerve, or ischial nerve, is the largest and longest nerve in the human body. Equal anatomical element, it starts in the lower part of the back and covers the whole lower limb, ending at the level of the foot.
Belonging to the category of mixed nerves, the sciatic nerve is a derivation of the last two lumbar spinal nerves (L4 and L5) and of the first three sacral spinal nerves (S1, S2 and S3): these nerve structures give life to the ischial nerve, joining one another between them, about the height of the piriformis and gluteus muscles .
With origin therefore at the level of the piriformis and gluteus muscles, the sciatic nerve descends along the posterior part of the thigh and, after passing the knee, branches off into various branches.
The branches of the sciatic nerve are distributed between the back of the leg, the front of the leg, the back of the foot and the sole of the foot.
Thanks to its innumerable branches, the sciatic nerve guarantees the sensitivity and motility of the lower limbs, in particular of the legs. This explains why an injury to him could seriously affect the ability to walk.
What is sciatica?
Sciatica is the name of the peculiar painful sensation that can radiate along the entire course of the sciatic nerve, from the roots of the various spinal nerves of the latter to its extremities.
Although sciatica is the most widely used term, the most correct and appropriate term for the aforementioned painful condition is sciatica (where " sciat- " refers to the sciatic nerve and " pain ").
Causes
The most common cause of sciatica is the compression, with irritative effects, of one or more of the spinal nerves that make up the sciatic nerve or the sciatic nerve itself. This compression can be caused by:
- A spinal disc herniation . Responsible for a good 15% of sciatica cases, it is the main cause;
- A degenerative discopathy with a seat between the lumbar and sacral tracts of the spine . In medicine, the term discopathy indicates a generic alteration of the intervertebral disc;
- A vertebral stenosis with a seat between the lumbar and sacral tract of the spine (vertebral) . For vertebral stenosis, doctors intend the pathological narrowing of a portion of the vertebral canal; also known as spinal canal, the latter is the duct of the vertebral column within which the spinal cord resides, one of the fundamental components (the other is the encephalon) of the central nervous system;
- A foraminal stenosis with a seat between the lumbar and sacral tracts of the spine . For foraminal stenosis, doctors intend the narrowing of the small channels through which the spinal nerve roots flow.
- A spondylolisthesis with a seat between the lumbar and sacral tracts of the spine . Spondylolisthesis is a pathology of the spine, characterized by the sliding of one vertebra on the other.
- Piriformis syndrome . With piriformis syndrome, doctors identify the set of symptoms that arise from the compression and irritation of the sciatic nerve, by the piriformis muscle.
In general, the piriformis muscle causes the irritative compression of the sciatic nerve, after having suffered a trauma or a contracture;
- A spinal tumor located between the lumbar and sacral tracts of the spine . In these rare circumstances, the compression of the spinal nerves that form the sciatic nerve is the result of the mass effect of the tumor: by enlarging, the neoplasm can push on the roots of the spinal nerves or on the portions just after the roots, jeopardizing their function or normal anatomy .
To these causes of compression, it is necessary to add another, but separately, as it is of pure female interest. The further cause of compression to which reference is being made is the state of pregnancy at an advanced stage : in pregnant women almost at term, in fact, the uterus has such dimensions that it could press on the spinal nerves constituting the sciatic nerve and produce the typical symptoms of sciatica.
Other causes
Sciatica is an observable condition even where there has been a traumatic injury to the sciatic nerve .
In these circumstances the most common causes are: sciatic nerve excision, performed involuntarily by surgeons during hip replacement procedures, and displaced fractures of the thigh or leg bones .
When is sciatica called lumbo-sacral radiculopathy?
In medicine, the term radiculopathy indicates a group of pathologies, in which one or more spinal nerves function inadequately, due to an injury at the level of their roots (so as soon as they come out of the spinal cord).
Sciatica can be referred to as lumbosacral radiculopathy, when it is caused by irritative compression or damage to the spinal nerve roots L4, L5, S1, S2 or S3.
Risk factors and epidemiology
Typically, doctors and experts on the list of sciatica risk factors include:
- Advanced age . The aging of the human body involves a change in the shape of the spine. In some situations, this change is so profound that the spine is predisposed to the herniation of the disc;
- Obesity . An excessive body weight can represent an exaggerated stress for the vertebral column, which can change its anatomy and that of the connected spinal nerves;
- Work activities during which it is common to lift weights or twist your back . Several statistical studies have shown that those who carry out this kind of work are particularly subject to sciatica.
However, it is right to point out that, for the moment, there is no medical-scientific explanation to the consequential link between the aforementioned work activities and the appearance of sciatica;
- Diabetes . This metabolic disease can have various complications, including the so-called diabetic neuropathy. Diabetic neuropathy is a form of peripheral neuropathy, in which deterioration of peripheral nerves takes place, such as the sciatic nerve;
- A sedentary lifestyle . The comparison between those who lead a sedentary life and those who instead lead an active life, has shown that the former are more subject to sciatica than the latter;
- The traumas directed to the buttocks, thighs or legs . There is a risk that a strong trauma causes damage to the sciatic nerve; often, the traumas that cause damage to the sciatic nerve are also associated with bone fractures;
- Arthritis . Inflammation of the joints of the spine changes the anatomy of the latter. The anatomical changes of the spine predispose to the compression of the spinal nerve roots, including those nerves from which the sciatic nerve derives;
- Pathologies of the spine, such as vertebral stenosis, foraminal stenosis, spondylolisthesis, etc.
- Hip prosthesis operations . Fortunately, the involuntary injury of the sciatic nerve is included in the list of less common complications of the aforementioned operations.
Symptoms and complications
The intensity and persistence of this pain varies depending on the cause.
In some patients, sciatic pain can be searing, acute, penetrating and unstoppable; in others, on the other hand, it can be mild most of the time and only become more acute in certain circumstances, producing something very similar to annoying electric shocks.
In many sufferers, the painful sensation manifests itself with more ferocity after efforts, coughing or sneezing; according to some clinical testimonies, stress, anxiety and the stresses of daily or working life could also contribute to increasing painful intensity.
In general, the characteristic pain of sciatica tends to appear in only one half of the body ( unilateral sciatica ); however, there are also cases in which sciatica occurs on both sides ( bilateral sciatica ).
Other typical symptoms, in addition to pain
In the same lower limb where it causes pain, sciatica can also cause: tingling, muscle weakness, numbness comparable to an alteration of skin sensitivity and difficulty in motor control .
In general, it is rare for the pain and the aforementioned symptoms to all localize in the same place: more often, in fact, patients feel the painful sensation in one place (ex: buttock), the tingling in another (eg: thigh), the weakness muscle in yet another (ex: leg) and so on.
Complications
In the presence of severe compression or severe injury to the sciatic nerve and in the absence of adequate treatments, sciatica can lead to various complications, including:
- Lameness ;
- Loss of control of anal and visceral sphincters ;
- Total absence of sensitivity in the affected lower limb ;
- Intense sense of weakness along the lower limb involved .
When should I go to the doctor?
Sciatica deserves the doctor's attention when:
- The symptoms tend to worsen rather than improve;
- The patient felt a sudden worsening of the symptoms, with a sharpening of the back pain, of the formicular and / or of the sense of muscular weakness;
- The patient developed the symptoms after a violent impact, for example after a car accident;
- The patient has little control of intestinal functions (loss of control of the anal sphincter) and bladder functions (loss of control of the bladder sphincter).
Summary of the typical clinical picture of the patient with sciatica:
- Impairment of the natural ability to move;
- Sharp, burning, penetrating and unstoppable pain;
- "Electric" pain;
- Circumscribed pain in a specific area of the lower limb (eg calf, buttock or knee) or pain radiated from the lumbar area to the foot;
- Muscular weakening of the involved lower limb;
- Numbness / tingling in the leg of the affected lower limb;
- Progressive sharpening of pain;
- Sensation of needles that prick the skin of the affected lower limb.
Diagnosis
Very often, to formulate a correct diagnosis of sciatica, a physical examination (or physical examination ), associated with a scrupulous medical history (or examination of the clinical history ) of the patient, is sufficient. In fact, the clinical picture typical of sciatica episodes emerges very easily from these analyzes: pain, numbness, tingling, muscle weakness, etc.
Having said this, it should be pointed out that doctors, even when the diagnosis is obvious, still tend to prescribe more in-depth diagnostic tests, with the intention of tracing back to the precise causes. Moreover, as previously analyzed, sciatica is a condition that can derive from the presence of different pathologies: knowing which of these pathologies is the causal factor responsible is fundamental for planning a proper cure.
Exams for the discovery of the causes unleashed: what are they?
Among the tests that can help the doctor in identifying the causative factors of sciatica, are:
- Blood tests (although rarely, these could include ESR and test of C-reactive protein);
- X-rays to the spine . They represent the preliminary radiological examination to understand the general state of health of the spine. In glaring situations, this examination may suffice to discover the causal factors.
By exposing the patient to a small dose of ionizing radiation, X-rays are among the minimally invasive tests;
- Lumbosacral magnetic resonance . It is a safe and completely harmless test for the patient. It allows to easily identify triggering factors such as: spinal tumors, vertebral stenoses, foraminal stenoses, spondylolisthesis, etc.
- CT on the spine . It provides even more detailed images of X-rays and low-back magnetic resonance, but has its price: it exposes the patient to a non-negligible dose of ionizing radiation (it is therefore invasive);
- Electromyography . By analyzing the flow of nerve impulses along the sciatic nerve, it allows us to assess the motor activity of the latter (ie the quality of muscle control).
It is among the most important tests in identifying compression due to a herniated disc and that induced by a vertebral or foraminal stenosis.
Therapy
The treatment of sciatica depends on the severity of the symptoms and the causative factor.
If sciatica is mild and at its origin there are no worrying causes, doctors believe it is useless to resort to medicines or other types of treatment, since, in these situations, healing is very often spontaneous. The only recommendation is rest and, if necessary, modification of some incorrect postural habits.
If, on the other hand, sciatica is severe or does not improve at all with rest, and at its origin there are important causal factors, doctors consider the adoption of pharmacological treatments, physiotherapy treatments or, in extreme cases, even surgical treatment justified.
drugs
Possible drugs administered in the case of sciatica include:
- Anti- inflammatories of the NSAID type (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen.
- Muscle relaxants, such as Muscoril.
- Tricyclic antidepressants or, alternatively, anticonvulsants . Usually indicated for other purposes (depression, epilepsy, respectively), these medicines have also been shown to be effective on pain from peripheral neuropathy (or neuropathic pain)
- Corticosteroids given intravenously. They are very powerful anti-inflammatories, which doctors prefer to use only in extreme cases, due to their serious side effects.
Physiotherapy
The physiotherapy treatment for sciatica consists of a rehabilitation program of exercises, which help the patient correct and improve his posture, reinforce the back muscles and increase the flexibility of the trunk and spine.
Surgery
Surgery is reserved for the most severe cases of sciatica and does not improve with the aforementioned treatments or which cannot benefit you (eg spinal tumors)
The sciatica surgical operations are very delicate - this is why the doctors use them only if strictly necessary - and they consist in freeing the spinal nerves that make up the sciatic nerve from what causes its compression.
The causes that most often require the use of surgery are the herniated spinal disc and the alterations of the lumbo-sacral tract of the vertebral column (vertebral stenosis); among the less frequent causes, on the other hand, there are spinal tumors.
Tips and home remedies
The experts in the field of sciatica advise to observe a short period of rest from all the "heavier" activities and from the sporting ones, but not to exaggerate, because the protracted physical inactivity is often associated with a worsening of the symptoms.
Furthermore, they consider it particularly useful:
- The application of cold packs, alternative to hot packs, at the level of the painful area (s).
- Daily muscle stretching, or so-called stretching . There are exercises for stretching the back, able to effectively alleviate the compression of the sciatic nerve.
Alternative therapies
For the treatment of sciatica, alternative therapies such as osteopathy, chiropractic and ultrasound therapy are also available.
Prognosis
Prominent factors affecting the prognosis of sciatica are: in the presence of treatable causes, sciatica will recover with good results in a short time; on the contrary, in the presence of causes that are difficult to treat or require a highly articulated therapeutic plan, sciatica can have very long healing times (even several months).
Prevention
At the moment, there is no remedy or a series of remedies that prevent sciatica with a probability close to or equal to 100%. However, there are various precautionary measures that greatly reduce the risk:
- Use your body properly, while lifting weights, and avoid excessive back torsions. There are numerous online guides that teach how to lift a weight without burdening the spine.
- Maintain a correct posture, especially in a sitting position, so as not to alter the normal anatomy of the spine.
- Exercise regularly, because inactivity is an important and established factor predisposing to sciatica.
