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Sciatica 101: Understanding Your Back Pain

What is sciatica?

Sciatica presents with pain in one side of the lower back, buttock, hip or leg. The classic example of sciatica begins at your lower spine and then travels down the back of your leg. However, this is not always the case. Pain may remain in a single area. Weakness, tingling or numbness in the leg may also occur.

The degree of pain varies in a case-by-case basis. For some people, the pain is a mild, irritating ache. Others experience sciatica pain as a sharp jolt. Severe cases can be debilitating. Minor cases, if untreated, run the risk of becoming more serious over time.

Pain from sciatica can be constant or it may come and go. Certain sudden movements, like sneezes or coughs, may worsen your symptoms. Leg pain from sciatica worsens when sitting for prolonged periods of time. The location of the pain is more important than the frequency or duration when diagnosing sciatica.

It is rare, although not unheard of, for sciatica pain to happen on both sides of a patient’s body. Each of your legs has a different sciatic nerve running through it so it would be an unfortunate coincidence for someone to develop sciatica on both sides of their body.

Other possible sciatica symptoms include hip pain, a burning sensation in the leg, and difficulty standing up. Seek medical attention immediately if your sciatica is severe enough to cause bowel or bladder dysfunction, numbness in the upper thighs, or extreme progressive muscle weakness.

What causes sciatica?

The sciatic nerve is the largest nerve in the human body. It starts in the lower back, goes through the buttocks, and runs down the back of the leg. This, in turn, branches out into the thigh, calf, foot and toes. Given the huge reach of this nerve, it’s easy to understand how pressure or damage on the sciatic nerve can require pain treatment.

In the past, sciatica was assumed to be caused by compression or damage of the sciatic nerve, hence the name “sciatica.” As medical technology has progressed, medical professionals have used tools like MRIs to determine that this is not the case. In very rare cases, the sciatic nerve can be compressed or “pinched” by the piriformis muscle in the sciatic notch. This is called piriformis syndrome.

Sciatica is much more common than piriformis syndrome, occurring in an estimated 43% of people at some point in their lives. Almost 85% of sciatica cases are associated with a disk disorder.

The symptoms of sciatica can be severe, even debilitating in some cases. Fortunately, very rarely does sciatica stem from a permanent injury.

Who is at risk of developing sciatica?

There are a wide variety of situations that put people at risk for developing sciatica, some of which can be controlled while others simply have to be dealt with gracefully. Some of the risk factors include:

  • Occupation: Jobs that require long periods of sitting can increase your likelihood of developing sciatica.
  • Weight: Extra weight puts stress on your spine and, over time, cause changes that result in sciatica.
  • Diabetes: As a whole, diabetics are more prone to nerve damage than non-diabetics.
  • Pregnancy: Unfortunately, a bouncing bundle of joy can wreak havoc on more than a few systems in your body. Weight gain and increased fluid retention can put the sciatic nerve under pressure where it passes through your pelvis. Further into your pregnancy, changes to your body will change your center of gravity and cause tension in the muscles of your butt and pelvis. A more developed fetus can also directly put pressure on nerves in the pelvis.
  • Age: As the body ages, it naturally loses some of the cushioning tissues in your spine, known as discs. Without these natural “shock absorbers,” your body can wear down and suffer damage in several different ways. Sciatica is simply one of several issues associated with this natural degradation.
  • Activity level: Ironically, while a sedentary increases the likelihood of developing sciatica, so too does being a runner. During extended periods of running, the piriformis muscle tightens and can cause irritation over time.

Wearing high heels, lacking regular exercise and sleeping on a mattress that is too soft may also contribute to the back pain associated with sciatica.

Often, sciatica is temporary. Pregnancy, for example, is not a permanent state and other issues, like activity level and weight, can be changed. However, there are rare cases where the sciatic nerve has been more seriously damaged. These cases will require more intense pain treatment and potentially surgery.

How is sciatica treated?

Your doctor will need to assess how severe your sciatica is and what the root cause is prior to determining how to treat your pain. These factors play a large role in safely, effectively providing spine treatment. Pregnancy-induced sciatica, for instance, requires a different approach than someone who suffered a trauma that damaged the sciatic nerve.

Some cases of sciatica can be managed with pain medication. Anti-inflammatories, muscle relaxants, narcotics, tricyclic antidepressants, and anti-seizure medications are all potential options for managing sciatica pain.

Steroid injections around the sciatic nerve root can relieve your pain by decreasing the inflammation that is putting pressure on the nerve. It’s important to note that these injections wear off in a few months and the frequency of shots you can receive is limited. If you receive steroid shots too frequently, there are serious side effects.

If and when your back pain doctor feels you are ready, physical therapy is an excellent option for treating sciatica. Strengthening your back muscles, improving your posture and improving your flexibly can provide long term relief for many people.

In the most severe cases, where an individual’s daily life is completely hindered and they are not responding to alternate options, surgery is available. Depending on what is causing your pain, surgeons may remove a bone spur or address a herniated disk that’s putting pressure on a nerve. While meeting with a spine surgeon is a last resort, in debilitating cases of sciatica, this can relieve patients’ pain and return them to health.

Who can help with my sciatica pain?

The clinical team at the South Texas Spinal Clinic in San Antonio, Texas can help assess your situation and then put you in the care of medical professionals, from orthopedic surgeons to physical therapists, who are trained to resolve your pain. Reach out to us at (210) 614-6432.

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