By Kyle Barth OMS-II
Sciatica is a very commonly used term among doctors and patients alike, but often what the term implies can become blurred or even misunderstood. The term sciatica is derived from the Sciatic nerve, a major nerve in the leg that gives rise to many smaller nerves that branch off further down. The sciatic nerve is large nerve created from many smaller nerves that come together after exiting the spine in the lumbar and sacral regions (lower back). The sciatic nerve carries information to and from the brain involved in sensation, pain, and muscle function for the lower extremity.
Patients who are diagnosed with sciatica typically experience pain that can be felt radiating down the leg, often described as a burning or tingling pain. Patients may also experience numbness, tingling or weakness in the same leg, feet or toes. Sciatica rarely presents in both legs simultaneously, and rarely presents as symptoms in the feet or toes alone without similar symptoms also being felt in the same leg. Certain activities such as leg or back exercises as well as sitting for prolonged periods of time may make these symptoms worse in patients with sciatica.
Sciatica itself is a diagnosis based on symptoms that can originate from several problems, all of which cause irritation of the sciatic nerve or the nerves that make up the sciatic nerve. These problems can originate in the spine, the leg itself, or elsewhere. Sciatica can be seen in patients with a lumbar disc herniation, in which the discs between the vertebrae of the spine begin to bulge and give out over time, causing irritation to the nerves as they exit the spinal cord. Stenosis is another commonly used term that refers to a narrowing of the space in which nerves pass through, putting pressure on the nerves either within the spinal canal or as they exit the spine. A common cause of sciatica that originates in the leg rather than the spine is known as piriformis syndrome. The piriformis is one of several muscles in the hip that act to move the leg. It is found in the gluteal (buttock) region and runs directly next to, and sometimes surrounds the sciatic nerve. Because of this, irritation, injury, spasm, and overuse of this muscle can also cause irritation to the sciatic nerve itself, reproducing some or all of the symptoms of sciatica. Other less common causes of sciatica include spinal tumors, pregnancy, and trauma.
Sciatica treatment can be best approached when identifying the underlying cause of the symptoms, as described above. Sciatica treatment is most often approached conservatively, with the use of physical therapy, spinal manipulation, and anti-inflammatory medications such as NSAIDs or corticosteroid injections. Surgery may be considered in certain cases such as disc herniation, spinal tumors, and trauma. If the underlying cause is not an urgent one, the goal of treatment is to eliminate the symptoms causing the patient distress, which is often accomplished with conservative methods. While sciatica is a common diagnosis based on symptoms that many patients will encounter at some point in their lives, it is important to understand the causes and treatment options, so these patients can continue to lead healthy and active lifestyles.
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