SCIATICA -
What is the cause of that “shooting” leg pain?

Sciatica is a medical term used to describe the symtoms caused by low back pain disorder which causes mild to “intense” leg pain. When the sciatic nerve or related nerve roots in the low back are compressed it causes “sciatica”.

Some doctors refer to sciatica as radiculopathy, which is a medical term used to describe pain, numbness, tingling and weakness in the arms or legs. This is due to a compression of the nerve roots in the low back. If the nerve problem is in the cervical (neck) region of the spine , it is then called cervical radiculopathy. When sciatica affects the lumbar (low back) region, it is called lumbar (low back) radiculopathy. Symptoms of Sciatica:

Pain that travels from low back, through the buttocks, downward into the leg and sometimes into the foot
Shooting pain down your leg- sometimes described as like electricity.
Burning and tingling sensations in your leg
Partial leg numbness or weakness
Symptoms usually affect one side of the lower body
Pain and other symptoms may be constant and vary from “mild” to “severe”
In severe cases, sitting , standing and walking becomes difficult
Coughing, sneezing and other sudden movements can intensify the pain

Patients should treat their back pain properly. Discuss your symptoms with your physician to get a proper assessment and diagnosis.

Signs you Need to see your Physician:

Leg pain is getting worse
Pain has intensified
Pain affects every day activities
You are unable to walk or sit without experiencing pain
Leg numbness or weakness
Loss of bowel or bladder control

Understanding the Causes of Sciatica

Sciatica can develop when the sciatic nerve is compressed, pinched or irritated. Symptoms and the severity of pain depend on what part of the sciatic nerve is affected. The following are some of the common causes of Sciatica:

Lumbar herniated disc: When a disc in the lumbar spine herniates or “bulges”, it causes the sciatic nerve to become compressed or irritated. This is the most common cause of Sciatica.

Lumbar Spinal Stenosis: When the space in which your nerves travel through become narrow (stenosis), it puts pressure on the nerves in the low back. This pressure and nerve compression may also cause sciatica.

Degenerative Disc Disease (DDD): This is an age-related spinal disorder. DDD is a change in the disc shape and function. DDD is the normal wear and tear process of aging, and it can also result in a herniated disc (bulging) and pain. This can also cause sciatica.

Isthmic Spondylolisthesis: A stress fracture –usually in the fifth lumbar vertebrae – and disc-related changes in your spine allow the vertebra to “slip” forward over the vertebra below it. This slip can pinch the nerve root and cause sciatica and low back pain.

Piriformis Syndrome: The piriformis muscle which is located in the lower part of the spine can have spasms that compress the sciatic nerve and causes low back pain.

Spinal Tumors and infections: Tumors and spine infections can compress the sciatic nerve and cause sciatica and back pain.

Pregnancy: During pregnancy, women often carry extra weight which puts pressure on the spine. This extra pressure can cause compression of the sciatic nerve and can cause low back pain. They symptoms usually go away after childbirth.

What tests are effective in diagnosing Sciatica?

The most important this to do when you suspect that you have sciatica and persistent back pain is to call your primary care doctor or your spine specialist. During your visit, your physician will ask you questions, perform some exams to diagnose the cause of your sciatica and develop a treatment plan that will help you manage your pain and alleviate your symptoms.

Types of Questions your doctor may ask you to diagnose Sciatica:

When did the pain start?
Where do you feel pain?
On a scale of 1 to 10, with 10 being worst pain imaginable, rate your pain
What activities did you recently do?
Does walking uphill or downhill increase your back pain?
What have you done so far to treat your pain?
What reduces your pain?
What makes your pain worse?

Physical Exam to Diagnose Sciatica:

Your doctor will do a physical examination to diagnose Sciatica. Your doctor will observe the following:

Your Posture
Range of Motion
Your Physical Condition

Movements that cause pain will be noted. During your physical examination, your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasms.

The Neurological Examination entails testing your reflexes, muscle strength, other nerve changes , and pain spread.

Other Tests to Diagnose Sciatica:

CT Scan or CAT SCAN (Computerized Axial Tomography Scan) MRI (Magnetic Resonance Imagign Test) will help to diagnose a herniated disc or spinal stenosis which both cause sciatica

Non-Surgical Treatments of Sciatica:

Once a diagnosis is made, your doctor will prepare and discuss your treatment options with you to treat the pain you are experiencing. A large percentage of patients who have sciatica respond well to non-surgical treatments which include:

NSAIDS (non-steroidal anti-inflammatory drugs) and Analgesics both reduce swelling and inflammation and therefore alleviate back pain
Muscle Relaxants : relax the muscles that are spasming and therefore alleviate the pain and sciatica
Epidural Steroid Injections place corticosteroid medications near spinal nerve roots to alleviate back pain and sciatica. For some patients, the corticosteroid injections reduce nerve inflammation and pain for months.
Physical Therapy : includes passive treatments such as cold or heat, deep tissue massage, electrical stimulation, and ultrasound. These treatments help to prepare the patient for therapeutic exercises. Additionally, physical therapy will help you to correct your posture, and will also make your stronger and more flexible.
Alternative Therapies: include Yoga, Acupuncture, acupressure, and biofeedback.

Surgical Treatments of Sciatica: In most cases, Sciatica can be treated with Non-surgical Treatment Methods. However, there are a few situations when spine surgery may be considered as an option to treat Sciatica:

When you have no control of your bladder or bowel movements , which could be a result of spinal cord compression
You have Lumbar Spinal Stenosis
Your are experiencing neurologic dysfunctions such as severe leg weakness
Your symptoms become severe
Your non-surgical treatments are not effective to alleviate your symptoms

There are many types of surgical procedures that can be used. Your spine surgeon will recommend the best procedure to treat your spine problem.

Two common surgeries are:

Discectomy: A procedure that involves removinig part or all of a bulging or ruptured disc to relieve nerve compression.

Laminectomy or Laminotomy: Both these procedures involve a part of the spine called the lamina- a bony plate that protects the spinal canal and spinal cord. A laminectomy is the removal of the entire lamina; a laminotomy removes only a part of the lamina. These procedures create “more space” for the nerves, therefore, reducing the chance of the nerves being compressed or pinched.

Simple Steps to Prevent Recurrence of Sciatica:

Consider these simple suggestions to help reduce sciatica and reduce the chances of recurrence:

Regular exercise helps to build and preserve a strong muscular core; specifically, target the muscles in the abdomen and low back. A strong core is essential for good posture and spinal alignment. Proper posture relieves pressure on the low back that contributes to sciatica.
To reduce the risk of lumbar disc herniation that can lead to sciatica, avoid movements that involve extreme body rotation.
Try to keep body weight close to ideal.
Choose seating that supports the spine's natural curve and allows the feet to rest flat on the floor. Avoid sitting for prolonged periods of time. Make it a point to get up and walk around often.
Do not sit cross-legged. This places pressure on the sciatic nerve
Lifting and carrying things that are heavy, bulky or awkward in shape can contribute to sciatica. Remember to hold the item close to the body, lift with the back straight using the strong leg muscles.
Select a mattress and box spring that offers good support. Slip a pillow under the knees to help relieve low back pressure. People who prefer to sleep on their side should place a pillow between their knees to help reduce hip and low back pain.

Dr. Emmanuel - Providing services in orthopedic surgery to the area of Culver City, Los Angeles and Beveraly Hills, California (CA).