What is Sciatica?

Sciatica refers to pain along the Sciatic nerve. It can also be called Sciatic nerve pain. Sciatic nerve is the largest nerve in humans. It is formed by the union of nerves coming out of the lumbar spine and goes into the leg to supply the leg muscles and carry sensations from the leg.
From the lower back, it runs through the gluteal region, back of thigh, calf region and finally into the heel and sole of foot.
The Sciatica pain follows the same path from the gluteal region, down into the thigh, calf region and foot.
Sciatica is quite common and can cause very disabling pain. As per certain studies, 2-3% of the general population may get affected by Sciatica pain. Some persons are more prone to develop Sciatica than others.

Who can get Sciatica pain?

Sciatica is more seen in persons with certain risk factors.

• Age: People in their 30’s and 40’s are more commonly affected by Sciatica pain.
• Height: Taller individuals are more commonly affected by this pain. Men taller than 180 cms and women taller than 170 cms are more prone to Sciatica.
• Sex: Men are more prone to develop this pain.
• Smoking: Smokers are more prone than non-smokers.
• Obesity: Increased weight is another cause for Sciatica pain.
• Persons involved in strenuous activities like lifting weights, repeated twisting and bending movements.
• Persons involved in long driving.

Symptoms of Sciatic nerve pain

The most predominant symptom of Sciatica is pain. There are certain characteristic features of this kind of pain.

• Radiation of pain from the buttock region, down into the thigh and calf.
• Intensity of pain can vary from a mild ache, to excruciating pain.
• Pain worsens with walking, sneezing or coughing.
• In some patients Sciatica pain may be associated with numbness, or weakness in the foot or leg.

Causes of Sciatica

Sciatica pain is caused by pressure on the nerve roots forming the nerve. The pressure in most cases is the point of exit from the spinal column.
In majority of the cases the pressure on the nerves is caused by a herniated intervertebral disc. The herniated disc causes pressure and displacement of the adjacent nerve root.
In other patients, the pressure on the nerve may come from a small protruding bony overgrowth called an osteophyte. The pressure on the nerve causes swelling and inflammation. This leads to pain along the nerve path, radiating down the leg.

How is a Sciatic nerve pain diagnosed?

The diagnosis is mostly based on clinical findings. The history of patient, the characteristic pain in leg, aggravation of pain on walking point towards the diagnosis of Sciatica. A clinical examination will show if any weakness in muscles or numbness is associated with the pain. The clinical examination will also tell the doctor which nerve root is likely to be under pressure and causing the pain.
Straight leg raising test is an important clinical test in diagnosis of Sciatic nerve pain. In this the patient lies on a couch and lifts the leg in which pain is present. The pain becomes worse on raising the affected leg.
The most important investigation is Magnetic Resonance Imaging or MRI. This will clarify which nerve root is under pressure and what is the cause of pressure like a herniated disc.
Nerve conduction study is another test which can us in diagnosing this pain. In this study the nerve conduction velocity is studied along the path of the sciatic nerve to look for changes as compared to the normal side.

Treatment of Sciatica?

In most cases the pain subsides with time, rest, medicines and physical therapy. In some cases when pain is not responding to treatment or is associated with weakness or numbness in legs, surgery is required to relieve the symptoms. The type of surgery depends on the underlying cause of the pain. In case of prolapsed disc, Lumbar Microdiscectomy is done.

Disclaimer- This is for the general awareness of the patients and cannot replace expert medical advice. Patient treatments need to be individualised and that can be decided based on clinical examination and evaluation by a trained physician.

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