Sciatica

By Spencer Schreckengaust
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Young man with back pain

SCIATICA

In our society, approximately 80% of adults will experience low back discomfort over their lifetime, resulting in considerable health costs as well as personal economic costs.  Out of those low back cases, individuals can experience sudden, intermittent or constant “sciatica” which typically can be describe symptoms in one leg such as intense, dull ache, burning, tingling, numbness, or weakness. 

The common risk factors associated with increasing the likelihood of sciatica are age (45-64 years old), increased height, obesity, smoking, diabetes, mental stress, prolonged sitting and strenuously physical occupations. Furthermore, activities such as prolonged sitting, prolonged standing, bending, turning and twisting aggravate sciatica. However, lying in a supine position (on the back) with the knees elevated could offer relief.

However, the term “sciatica” is a symptom or condition rather than the diagnosis. It is like a person with a cough since coughing is a symptom of an underlying illness. These symptoms stem from pressure on one or more roots of the sciatic nerve as it originates from your lumbosacral region to supply the leg for sensation and motor activity.

There are three main causes of sciatica:

  1. The disk between the vertebrae allows for combination of motion and stability while offering shock absorption during various low back activities. In ~90% of sciatica cases, a herniation of a lumbar or sacral disk will encroach upon and put pressure one of the roots of the sciatic nerve as it exits out of the lumbar or sacral region from the space created by the vertebra and disk called the foramen.
  2. Another cause can be attributed lumbar degenerative disk disease (lumbar DDD). As we age, the space between our vertebras diminish as the disk height also decreases. Such loss of disk height would cause the foramen to also shrink which could also put pressure on the nerve, resulting in various leg symptoms mentioned above.
  3. Spinal stenosis can also place pressure on the nerve root as the actual bony or anatomical space of the foramen decrease due to arthritic changes such as bone spurs.

Proper progress during a specific therapeutic activity would be defined if the intensity, frequency, or duration of the leg discomfort would diminish while moving up the leg toward the spine. This improvement would be called “centralization.”

If an activity creates more intense leg discomfort and greater symptoms further down the leg, that activity should be avoided. Such “peripheralization” of sciatica symptoms will not assist in your recovery.

Here are some home exercises for the acute phase of sciatica

  1. Supine position
  2. Positional traction
  3. Single knee to chest Stretch
  4. Lumbar AROM
  5. Hamstring stretches
  6. Use of ice or heat on the low back.

While core strengthening remains vital to return of function, it is recommended you seek a physical therapist or other health care practitioner to assist in the proper form and proper rehabilitation regimen as performing the incorrect exercise can actually exacerbate your condition.

If the following symptoms or “red flags” are present, please seek immediate medical attention: changes in bowel/bladder or sexual function, rapid unexplained weight loss, unchanging constant pain, drop foot in either leg, loss of balance, rapidly worsening condition, history of cancer, immunosuppression or osteoporosis.

Also, if conservative care does not offer relief after 6-8 weeks, you might require further medical consultation which can involve more aggressive medication, imaging, epidural injections and even surgical options.

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References:

  1. Ailianau A et al. Review of principal spinal pathologies causing sciatica and new MRI approaches. British Journal of Radiology. 2012 June; 85 (104): 672 – 681.
  1. Freburger JK et al. The Rising Prevalence of Chronic Low Back Pain. Arch Internal Med. 2009 Feb 9; 169 (3): 251 – 258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339077/pdf/nihms662073.pdf
  1. Koes B et al. Diagnosis and treatment of sciatica. BMJ 2007; 334: 1313 – 1317.
  1. Marin BI et al. Trends in health care expenditure, utilization and health status among US adults with spine problems, 1997 – 2006. Spine. 2009; 34: 2077-2084.
  1. Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Current Rev Musculoskeletal Med. 2009 June; 2 (2): 94 – 104.
  1. Snyder DL et al. Treatment of degenerative lumbar spinal stenosis. Am Family Physician. 2004; 70 (3): 517 – 20.
  1. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
  1. https://www.medbridgeeducation.com/patient-education-library/condition/10792-Low-Back-Pain-Handout
  1. https://www.medbridgeeducation.com/patient-education-library/condition/108-Lumbar-Disk-Herniation
  1. https://www.medbridgeeducation.com/patient-education-library/condition/109-Lumbar-Stenosis
  1. https://www.medbridgeeducation.com/patient-education-library/condition/106-Lumbar-Spondylosis

  

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