The sciatic nerve is composed of individual spinal nerve roots that start by branching out from the lower back region of the spine specifically from L3-S1. When the sciatic nerve gets pinched or irritated at any point in its course, it will give rise to symptoms of sciatica. Sciatica pain may start from the back and radiate behind the thigh and may go down the leg. Depending on the region and intensity of impingement on the sciatic nerve root, the symptoms experienced may vary.
Sciatica Causes
The most common cause of sciatica is disc herniation which causes compression of the nerve root level. Other common causes are stenosis,spondylolisthesis. The lesser common causes are infection, injury to the surrounding muscles and ligaments, tumour, cauda equine etc.
- Degenerative disc disease: Discs are the soft cushions between the bones of the back. Degeneration of the disc and bones or herniation (slipped disc) may cause compression of the sciatic nerve and lead to the symptoms of sciatica.
- Piriformis Syndrome: The sciatic nerve runs alongside or through the Piriformis muscle in the buttock. Tightness or spasm of the Piriformis muscle may irritate the nerve and give rise to Sciatica pain.
- Lumbar Spinal Stenosis: Narrowing of the spinal canal in the lower back that puts pressure on spinal nerve roots leading to Sciatica pain.
Other causes of Sciatica include
- Spondylolisthesis: Shifting of one vertebrae over the other due to degenerative changes or trauma may also impinge the nerve roots forming the sciatic nerve.
- Pregnancy: Weight gain, hormonal changes and shift of centre of gravity may produce sciatica like symptoms.
- Sacro - Iliac joint Dysfunction: Mal-alignment of the Sacro-Iliac joint impinging Sciatic nerve.
Sciatica Symptoms
Symptoms of Sciatica or Radiculopathy include:
- Pain in the buttocks, back of the thigh and legs more than the back.
- Mild ache or sharp shooting pain like an electric shock.
- Burning sensation or pins and needles in the leg
- Tingling or numbness in leg.
- Occasionally muscle weakness of leg or feet.
- More common on one side of the body.
- Pain can be experienced mostly in sitting for longer hours or running.
Sciatica Diagnosis
Diagnosis of sciatica is done by history of the symptoms and a physical examination which includes assessing the sensory status of the lower limbs, strength of the muscles, neurological tests done commonly involve the straight leg raise test and the Lasegue test.
Medical history
A complete medical background check is done to know the detailed history of the condition, aggravating and relieving factors.
Physical Examination
A thorough physical examination to understand spine alignment and spinal movement. Any loss in muscle strength and sensation along the course of the nerve is also assessed. Straight leg raise test or other neurodynamic test is done to rule out any dural signs.
Diagnostic tests
After forming an opinion on the cause of the patient's pain, a diagnostic test may be indicated to confirm the disc problem and/or to gain additional information, such as the location of a herniated disc and impinged nerve roots. Diagnostic tests may include:
- Digital Spine Analysis: Digital spinal analysis test is done to get a complete objective evaluation of spine mobility and strength of various spine muscles of the Back which could be the main causative factor of sciatic pain.
- X- Ray: A spinal X-ray can reveal degenerative changes in the bone which may be irritating the nerve.
- MRI: An MRI will reveal any problems with the disc or any compression of nerve roots.
Treatment Protocol
The treatment for Sciatica is directed towards reducing the compression on the nerve through specific movements (McKenzie Technique) and Sciatica treatment also focuses on neural mobility exercises, muscle activation, motor control, neuro-muscular coordination of spinal muscles with bio feedback devices to improve the stabilization of the spine. Hereby gradually the load bearing capacity of the spine is increased and progress to a stage to match with patients normal functional activities along with reducing the chance of recurrence of an episode.
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