What is Sciatica?
Your spine is made up of a column of bones called the vertebrae. Between each vertebra is a gel-filled disc that acts as a shock absorber, keeping your vertebrae from rubbing together. These disks are made up of about 80% water that slowly lose water with age, and with it their ability to act as shock absorbers.
Degenerative disc disease, also known as spondylosis, is a spinal condition caused by the breakdown of your intervertebral discs. As you age, your spine begins to show signs of wear and tear as your discs dry out and shrink. When your discs “degenerate”, they lose their flexibility and ability to cushion your spine. These discs do not have a good blood supply, so once injured, they cannot repair themselves.
Causes of Sciatica
Sciatica can be caused by a number of conditions that irritate or compress the sciatic nerve:
- Piriformis syndrome – tightening or spasm of the piriformis muscle can compress the nerve.
- Trauma – a sports injury or fall can fracture the spine or tear a muscle and damage nerves.
- Herniated disc – the gel-like center of a spinal disk can bulge or rupture through a weak area in the disc wall and compress nerves.
- Stenosis – narrowing of the bony canals in the spine can compress the spinal cord and nerves.
- Osteoarthritis – as discs naturally age, they dry out and shrink. Small tears in the disc wall can be painful, bone spurs can form, and the facet joints enlarge, and ligaments thicken.
- Spondylolisthesis – a weakness of stress fracture in the facet joints can allow a vertebra to slip out of position and pinch the nerves.
Symptoms of Sciatica
Classic sciatic pain starts in the low back and buttocks. It affects one leg traveling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling can occur in your leg and foot. This is usually not a concern unless you have weakness in your leg muscles or foot drop.
Sitting is the most common cause of pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may feel better than sitting or standing for too long.
Diagnosis and Treatment of Sciatica
A careful medical exam will determine the type and the cause of your spine problem and the treatment options. A diagnostic evaluation includes a medical history and physical exam. Your provider may need imaging scans, like X-ray or MRI to check muscle strength and reflexes.
Your provider may explore noninvasive treatments before considering surgery. These can include:
- Self-care – rest, ice, heat, massage, or pain relievers.
- Medication
- Steroid injection
- Physical therapy
Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or a severe pain that has not resolved after a reasonable course of nonsurgical treatment. Surgery for a herniated disc, called a discectomy, removes a portion of the disc that is compressing the spinal nerve. People with stenosis may benefit from a decompression of the nerves.
It is important to follow instructions provided by your provider for continued recovery. If you have questions or would like to schedule with one our Spine Center specialists, please call 515-875-9888.