Sciatica

Is Sciatica a Symptom or a Spinal Disorder?

Sciatica is a general term for pain originating from the sciatic nerve. Sciatica is a symptom of a disorder that causes mild to sharp and sometimes excruciating pain. Patients have described sciatic pain as mildly disturbing to burning, aching, deep, and similar to a sudden bolt of lightning. Sciatic nerve pain travels from the buttock, down the back of the thigh, and into the leg. Leg pain is the classic hallmark of sciatica. Low back pain may accompany sciatica, and some patients experience sciatic pain extending into the foot. Another characteristic of sciatica is it usually affects either the lower left or right side of the body.

Sciatic pain can make life miserable. Walking, standing, bending over, driving a car, working at a computer, catching up on household chores, sneezing or coughing, and many other activities of daily living can cause sudden and intense pain. Patients who suffer sciatica, especially of a more acute nature, find the symptoms disrupt many aspects of their life.

How can one nerve cause so much pain?

One reason the sciatic nerve causes so much pain is because it is the longest nerve in the body! The nerve starts at the back of the pelvis and runs downward through the hip area and buttocks into each leg. Near the knee, the sciatic nerve divides into two nerves—the tibial and peroneal nerves. The tibial nerve runs behind the knee and the peroneal nerve runs along the side of the calf and ankle. Through the tibial and peroneal nerves, the sciatic nerve innervates ('stimulates') the action of many muscles in the lower legs and enables feeling in the thighs, legs, and feet.

Other Symptoms

Besides pain, other symptoms may accompany sciatica. These symptoms include sensations such as tingling, pins and needles, burning, numbness or muscle weakness. Such symptoms may be felt in the buttock, thigh, behind the knee, calf, ankle, and sometimes the foot.

Common Cause of Sciatica

The most common cause of sciatica is a bulging or herniated disc in the low back (lumbar spine). A disc may bulge or rupture due to normal aging and/or events involving spinal wear and tear or poor body mechanics when lifting. When a disc herniates, the gel-like interior (nucleus pulposus) may protrude into or through the disc's tire-like outer ring (annulus fibrosus).

The damaged disc may press on adjacent spinal nerve roots creating nerve compression leading to nerve inflammation and pain. If the nucleus breaks through the annulus (herniates), chemicals are released from the nucleus causing nerve irritation, inflammation, and pain. Other symptoms such as tingling and weakness may affect the leg.

Non-Surgical Treatments

There are several non-surgical sciatica treatments and most patients do not require spine surgery. The type of treatment depends on the diagnosis— what is causing the sciatica. Common non-surgical treatments include over-the-counter pain relievers, prescription non-steroidal anti-inflammatory drugs (NSAIDs), hot and cold packs, spinal injections, chiropractic care, and physical therapy.

When is spine surgery a treatment option?

Surgery may become an immediate consideration if the patient loses control of their bowel or bladder. However, this is a rare occurrence and if it happens, the patient should seek immediate medical attention.

The good news is the majority of patients with sciatica get better with time without spine surgery. Only a small percent of patients will require spine surgery to treat sciatica. There are many types of surgical procedures to treat spinal disorders known to cause sciatica. Fortunately, most patients will not need to follow a surgical path to find relief from sciatic nerve pain.

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