Sciatica
Sciatica is pain going down the leg from the lower back. This pain is often described as shooting and may extend down the front of the leg, the back of the leg or the outside. It often comes suddenly after activities such as heavy lifting, though gradual onset does also occur. The term Sciatica can also be used as a diagnosis for nerve dysfunction caused by compression of one or more of the lumbar or sacral nerve roots form a spinal disc herniation. Pain often goes from below the knee to the foot. It may also be associated with neurological dysfunction, such as weakness and numbness
Causes
It has been estimated that 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots. Other possible causes may be
- Spinal stenosis
- Spondylolisthesis
- Piriformis syndrome
- Pelvic tumors
- pregnancy
Symptoms
Sciatica is associated with pain radiating down the leg from below the knee to the foot. Symptoms often occur on only one side of the body. However, certain causes may result in pain on both sides. Lower back pain is sometimes present. Weaknesses and numbness may occur in various places of the affected leg and foot. Disc herniation most often occurs during heavy lifting. Pain typically increases by bending forward or sitting and often reduces when lying down or walking.
Diagnosis
The straight-leg-raising test is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. Imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumor or infections. Sciatica is most common in men between the ages of 40 and 59. Men are more frequently affected than women. Some risk factors for sciatica include smoking, obesity and occupation and physical activities where back muscles and heavy weights are involved.
Treatment
Pain medications are typically recommended for initial treatment. In many cases symptoms are resolved in less than six weeks. If pain is severe and lasts longer than this, surgery may be an option. Complications such as loss of normal bowel or bladder function may require surgery. Other treatments such as corticosteroids, acupuncture, heat or ice may be tried but have only limited evidence of supporting their use.