Dear Doctor: What causes sciatic pain and what can be done to alleviate it?

From oregonlive.com

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine. North America Syndicate

DEAR DR. ROACH: My husband has been totally disabled by sciatic pain for three months. His doctor prescribed 4 mg of methylprednisolone, but it hasn’t done anything to eliminate the pain. He uses a cane. Are there any other things he can do to stop this debilitating pain? -- H.B.

ANSWER: The sciatic nerve is the largest nerve in the body (about the size of your finger, only a little flatter). It comes off the spinal cord from the fourth lumbar vertebra through the third sacral vertebra, and provides sensation, motor and reflex innervation to the lower leg and foot region. The term “sciatica” is often used for pain in the foot or leg thought to be due to damage or compression of the sciatic nerve. Many conditions, including disk herniation, spinal stenosis and degenerative disk disease, can cause this.

Sometimes inflammation can exacerbate a chronic issue and cause acute back pain. A powerful anti-inflammatory like methylprednisolone, which is a glucocorticoid (steroid), can reduce inflammation and help the pain. I seldom use this treatment, but it is reasonable in some cases. If it is going to work, it will work within a few days. Long-term treatment with this medication is fraught, with the potential for many side effects including high blood sugar, bone loss, high blood pressure, weight gain and psychosis.

Persistent and disabling symptoms should prompt an evaluation for the underlying cause. Three months is too long to wait. An imaging study, such as an MRI, is indicated to see what could be causing his symptoms.

If his regular doctor is not doing anything more than continuing a treatment that has not helped and has high potential for harm, it is time for another doctor. Experts in sciatica include neurologists, rheumatologists, physical medicine and rehabilitation doctors and, when appropriate, surgeons such as orthopaedic surgeons and neurosurgeons.

https://www.oregonlive.com/advice/2023/08/dear-doctor-what-causes-sciatic-pain-and-what-can-be-done-to-alleviate-it.html

Buttock Pain When Sitting: Causes, Treatment, and Relief

From healthcentral.com

From sciatica to piriformis syndrome, there are common culprits to buttock pain from sitting, Here, experts recommend how to handle them 

Whether you’re dealing with a mega-commute, desk job, or just really loving your couch-time, if you’re like most people, you spend a lot of hours sitting down. One estimate in the International Journal of Behavioral Nutrition and Physical Activity looking at 54 countries found that adults spend nearly five hours every day sitting. As convenient as it may be, sitting is not doing your body any favours—particularly, your butt.

“Our bodies are not conditioned to be sitting for extended periods of time, and when we do, our gluteal muscles [the group that comprises the buttock area] begin to suffer,” says Ilan Danan, M.D., a sports neurologist and pain management specialist at the Centre for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. "With too much sitting, hip flexors begin to tighten over time, while gluteal muscles lengthen. Ultimately, this results in inefficient muscle activity with standing and walking.”

                                                                     GettyImages/fizkes

Even if you remember to take frequent breaks from sitting, you may still experience buttock weakness and pain from other issues. If you find that you're dealing with pain and difficulty whenever you've been sitting, here's a look at what may be going on.

Causes of Buttock Pain

To figure out what's causing your literal pain in the butt, you’ll want to consider your symptoms, as well as potential triggers and the intensity of your pain—for example, whether it's a dull ache or sharp and searing. With that in mind, here are four possible culprits, along with signs that may help with getting to the bottom of the issue.

Ischial Bursitis

Bursitis is the general medical term for painful swelling around joints and other tissues. Although it's most common in the shoulder, elbows, and knees, it can affect the hips and butt, too, according to Cleveland Clinic. Buttocks-specific painful swelling is called ischial bursitis, and symptoms include:

• Deep ache rather than shooting pain

• Pain that worsens with movement or stretching

• Tenderness and swelling in lower part of the buttocks

• Warmness (to the touch) in the swollen areas

Sciatica

There are several muscles in the hips and buttocks that allow you to extend your hip and turn your leg outward—these are called external rotator muscles, says George Eldayre, M.D., a specialist in primary care sports medicine at Orlando Health and Jewett Orthopaedic Institute in Orlando, FL. "These muscles are closely related to the sciatic nerve," Dr. Eldayrie says. "So if there are issues with these muscles or excessive pressure in the area, you can get radiating pain along that nerve—a condition called sciatica."

Other sciatica symptoms include: 

• Difficulty walking on your toes or bending your foot

• Loss of sensation or numbness

• Pain typically only on one side of the body

• Pain when lifting the leg straight up when lying down

• Shooting pain originating in the spine and radiating down the back of the leg

• Weak reflexes

Piriformis Syndrome

Your piriformis muscle is located at the centre of either side of your hips and stretches horizontally across to your legs. Because of its proximity to your sciatic nerve, tightness in this muscle can cause compression and inflammation, resulting in piriformis syndrome, with symptoms like:

• Burning sensation in the buttocks or hips

• Difficulty walking up stairs

• Inflammation in the front of the hips

• Muscle spasms in the hips and buttocks

• Numbness and tingling

• Pain that worsens after sitting for long periods of time

Gluteal Medius Tendinopathy

Known informally as "dead butt syndrome," or "gluteal amnesia," this condition happens when your gluteal muscles are unable to support your pelvis and spine, according to Jhankhana Jani, D.P.T., doctor of physical therapy at Providence Saint John's Health Centre's Performance Therapy in Santa Monica, CA. She says symptoms include:

• Feeling of poor lumbar spine and pelvis support, so your whole midsection feels unstable

• Imbalance while walking

• Tightness in the hips

• Weakness in the gluteal muscles

In addition to these difficulties, people who have tight hips, arthritis in the spine, or chronic lower back issues like herniated discs can have pain in the buttocks when sitting, Dr. Eldayrie notes. "With problems like those, posture changes may cause excessive pressure to the discs, and that can radiate pain into the buttocks and the legs," he says. "Even limited flexibility of the hips can cause some discomfort with sitting for long periods of time."

Treatment for Buttock Pain

Addressing pain while sitting depends largely on the cause. For example, with sciatica, treatment usually involves over-the-counter pain relievers as well as ice and heat therapy. Alleviating pain from piriformis syndrome can include medication that relaxes the muscles, steroid injections, and physical therapy that strengthens piriformis muscles specifically. One notable difference is that bed rest is not recommended for sciatica, while it does help with piriformis syndrome.

For "dead butt syndrome," Dr. Jani says the best treatment is taking breaks throughout the day from sitting, and performing exercises that strengthen the gluteal and hip muscles on a regular basis.

Because buttock pain can be brought on by several issues, getting the proper diagnosis is invaluable for the right treatment, says Dr. Eldayrie. "Particularly if pain doesn't resolve on its own with stretching, or you're experiencing hip or low back problems, getting an evaluation is helpful for restoring mobility and activity," he adds.

If you only have occasional buttock pain or it isn’t disruptive to your everyday life, treatment may be as easy as changing your chair, says Renee Urban, P.T., a physical therapist at Atlantic Rehab in Livingston, NJ. "Pain may be due to seating position and it can be fixed with postural correction," she adds. "If that's the cause, then the pain should be remedied right away."

When to See a Doctor About Buttock Pain

If your butt pain doesn't improve with postural changes like choosing a different chair, or it continues even after you've gotten up and moved around for a while, there may be a deeper issue going on, says Dr. Eldayrie.

Particularly if you’re experiencing other symptoms along with the pain such as numbness, tingling, or weakness in the legs, it’s worth an appointment with your doctor. "In general, if pain with sitting comes on quickly and frequently, and doesn't resolve on its own with a change in lifestyle habits, then the problem should be evaluated by a physician," Dr. Eldayrie says.

https://www.healthcentral.com/pain-management/buttock-pain-when-sitting

Top 15 Signs of Sciatica

From infoguidenigeria.com

Top 15 Signs of Sciatica – Sciatica is a condition characterized by pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. The pain is often caused by pressure or damage to the sciatic nerve. Sciatica can range from mild to debilitating for some people. Knowing the common signs and symptoms can help identify sciatica and guide treatment. Here are 15 of the top signs and symptoms of sciatica:15 Signs of Sciatica

The Top 15 Signs of Sciatica Are:

1. Pain in the Low Back, Buttocks, and Legs

One of the most common signs of sciatica is pain that radiates from the lower back and buttocks down one or both legs. The pain may feel like a mild tingling, dull ache, or a sharp, burning sensation depending on the underlying cause. Often, the pain follows the path of the sciatic nerve through the hip, buttocks, back of the thigh, and into the leg and feet. It tends to be unilateral, meaning it impacts just one side of the body.

2. Numbness or Tingling Sensations

Many people with sciatica experience numbness or a tingling “pins and needles” sensation along the path of the sciatic nerve. This is often accompanied by pain and can occur in the low back, buttocks, thigh, calves, and even the feet. Numbness indicates the sciatic nerve is being compressed or irritated.

3. Pain that Worsens with Prolonged Sitting

Sitting for extended periods can worsen sciatic pain for many patients. The seated position adds pressure on the sciatic nerve at the buttocks and lower back. People with sciatica often find relief when standing up, stretching, or walking. Prolonged sitting in cars, at work, or even on the toilet can aggravate symptoms.

4. Leg Pain Worse than Back Pain

In many cases, the leg pain from sciatica is more severe than the back pain. The shooting peripheral pain radiating down the leg is a hallmark of sciatic nerve compression. Patients may describe the leg pain with words like burning, searing, or electric. This occurs because a pinched nerve leads to inflammation.

5. Difficulty Standing up from a Seated Position

The act of standing up from sitting can be very painful for some sciatica patients. The transition from flexion to extension (sitting to standing) compounds pressure on the spinal discs and irritated nerve roots. Some people may use their hands to “crawl” up their thigh when rising from a seated position.

6. Pain that Disrupts Sleep

For some patients, the leg and low back pain from sciatica prevents restful sleep at night. The constant nerve irritation makes it difficult to get comfortable and may wake someone from sleep. Tossing and turning and difficulty finding pain relief keeps the body from the restorative sleep it requires. portal

7. Muscle Weakness

Sciatica can lead to weakness, numbness or difficulty moving the leg and foot. This occurs from the compressed or inflamed sciatic nerve’s reduced ability to stimulate the muscles. People may have trouble with activities requiring strength like climbing stairs, standing on their toes, or squatting down. The foot on the affected side may drag. morning My Love Message

8. Stabbing Pain with Certain Movements

Coughing, sneezing or straining can trigger bursts of stabbing pain in some sciatica patients. This results from a “pinched” nerve root struggling to transmit signals. Sudden movements compress the nerve and surrounding muscles, ligaments and discs. Changing positions or using proper body mechanics may help.

9. Burning or Tingling Pain in the Feet

A distinct burning or tingling sensation in the feet or toes is a tell-tale sign of sciatica for some patients. A pinched sciatic nerve in the lower back has trouble transmitting signals the full length of the nerve down the leg. Feet and toes tingling or “falling asleep” easily can indicate sciatic nerve irritation.

10. Difficulty Moving or Controlling the Leg

Sciatica can make it difficult to move or control the affected leg. Patients may have trouble bending the knee or pointing the toes. Loss of reflexes in the ankle and knee can occur from sciatic nerve compression. One leg may feel weaker than the other or trouble with coordination and balance is possible.

11. Pain from Extended Periods of Standing

Prolonged standing can also aggravate sciatica pain for some patients. Gravity and upright postures put tension on spinal discs and nerve roots. Jobs that require extended standing like retail, construction, manufacturing or even cooking, can be problematic. Some relief comes from shifting positions, stretching, or sitting down.

12. Pain that Radiates Below the Knee

Sciatic nerve pain frequently radiates below the knee and down the calf and shin. The sciatic nerve actually splits below the knee to form the tibial and common fibular nerves. Irritation of these nerve branches causes burning, tingling or numbness sensations below the knee and into the feet.

13. Low Back Pain with Leg Pain

Most patients with sciatica experience low back pain (lumbago) in tandem with the radiating leg pain. The lumbar spine houses the spinal cord and sciatic nerve roots, so inflammation or compression here commonly leads to sciatic symptoms down the legs. Determining whether the back pain or leg pain predominates can help diagnosis.

14. Relief from Moving Around

Light exercise and moving tends to help relieve pain for some sciatica patients. The increased blood flow reduces inflammation and may take pressure off pinched nerves. Stretches, walking, swimming or yoga might offer pain relief. However, overexertion may make symptoms worse. Finding the right balance is key.

15. Pain Triggered by Sneezing, Laughing or Straining

An increase in abdominal pressure from laughing, coughing or sneezing can intensify sciatica pain. This occurs when the sudden tensing of abdominal muscles squeezes the lower spinal discs and nearby sciatic nerve roots. Using sciatica-friendly body mechanics, and proper posture may provide relief.

Conclusion

In conclusion, the hallmark signs of sciatica include pain radiating from the lower back down the back of the thigh and leg, numbness or tingling along the sciatic nerve pathway, and pain that is exacerbated by prolonged sitting and standing. Difficulty moving the leg, diminished reflexes, and leg weakness may also occur. Seeking a medical diagnosis is important to identify the underlying cause and appropriate treatments. Being aware of the common symptoms can help people identify when they should seek medical care for possible sciatica.

https://infoguidenigeria.com/signs-of-sciatica/SC 

Lower Back Pain on the Left Area Above the Buttocks: What Are the Causes

From healththoroughfare.com

We spoke in a previous article about having sharp and stabbing pain in the lower side of the back, as well as about the possible causes. If you’re dealing with pain originating in the lower back’s left area above the buttocks, you need to know that the condition can arise from multiple sources. Possibilities include muscle strain, sciatica, musculoskeletal imbalances, spinal stenosis, issues with the sacroiliac joint, kidney stones, herniated discs, injuries, arthritis, and conditions like fibromyalgia.

Thanks to newyorkpaincare.com, we can learn more about the possible causes that trigger lower back pain in the left area above the buttocks.

• Fibroids: Benign tumours within uterine walls can cause symptoms such as lower abdominal bloating, heavy menstrual bleeding, pain, and discomfort during sex or urination.
• Osteoarthritis: Cartilage deterioration between vertebrae leads to osteoarthritis, especially for the lower back due to walking stress. Standard wear, tear, as well as previous injuries contribute, resulting in stiffness, pain, and discomfort during bending or twisting.
• Sacroiliitis: Inflammation affecting the sacroiliac joints linking the pelvis and spine prompts lower back and buttock pain, exacerbated by specific movements and weight-bearing activities.
• Kidney Stone or Infection: Kidney stones appear because of fluid imbalance or waste build-up. Symptoms include vomiting, radiating lower back pain, painful urination, as well as fever. Kidney infections stem from urinary tract infections and need medical attention to prevent kidney damage.
• Sciatica: Compression of the sciatic nerve triggers sciatica, often due to herniated discs, bone spurs, or spinal stenosis. Pain radiates to the leg’s back, intensifying while coughing, sneezing, or prolonged sitting.
• Muscle Strain or Sprain: Twisting or improper lifting can cause muscle or tendon strains and ligament sprains. Overstretching can induce back muscle spasms and limited movement.
• Herniated Disc: Vertebrae-disc squeezing prompts bulging into the spinal canal, adding pressure on nerves. Numbness, pain, and weakness may follow, often causing sciatica. Degeneration and injury can trigger this, with risk rising as age advances.
• Endometriosis: Uterine lining cells growing outside cause endometriosis. Swelling and bleeding during periods result in lower back pain, alongside severe menstrual cramps, pelvic discomfort, painful urination, and digestive issues.

While such factors contribute to lower left back pain, individual circumstances vary. This means that you should always seek medical evaluation for accurate diagnosis and appropriate treatment.

Lower back pain can affect your life in numerous ways

Lower back pain situated on the left area above the buttocks can disrupt numerous aspects of life, which means that you definitely shouldn’t take the condition lightly! Physically, such pain will restrict mobility, making routine movements arduous and uncomfortable. This can extend to the workplace as well, affecting productivity and engagement when it comes to certain tasks requiring physical effort or extended sitting.

Sleep quality suffers as well, as finding a comfortable position becomes a struggle, leading to disrupted rest patterns. Emotionally, the persistent discomfort from the back pain triggers frustration, irritability, and possibly even depression in some cases. Social activities, hobbies, as well as exercise regimens often bear the brunt of this pain, reducing enjoyment and participation.

Daily tasks such as personal care, household chores, and even traveling become challenging, influencing overall quality of life.

Precise identification of your problem causing lower back pain always demands medical evaluation. If the pain is persistent or severe, you must seek medical attention as fast as possible to pinpoint the root cause and receive suitable treatment.

https://www.healththoroughfare.com/medicine/lower-back-pain-on-the-left-area-above-the-buttocks-what-are-the-causes/65270 

Sciatica: Causes and treatment

From utphysicians.com

Anyone who suffers from sciatica is regrettably familiar with the discomfort – described as “shooting” nerve pain along the lower back and down the leg. The severity can be variable, ranging from manageably mild to nearly immobilizing. Understanding how sciatica is treated and effective ways to avoid it can help people lead improved, healthier lifestyles.

UT Physicians orthopaedic surgeon Eric O. Klineberg, MD, explained that sciatica pertains specifically to an irritation of the nerve roots that become the sciatic nerve. These roots originate from the spinal cord, and then exit out of the lower spinal column, and travel underneath the buttocks, and down the back side of the leg. He added that the irritation can stem from multiple different spinal issues, the most common being a disc herniation or bulge that presses on the nerve root in the spinal column. Other causes include direct injury to the sciatic nerve, including physical injury or trauma to the nerve, as well as cysts, tumours, osteoarthritis, or pregnancy. Causes from spinal disorders include conditions such as stenosis, scoliosis, or spondylolisthesis that compress the nerve roots.

“Sciatica can occur when the nerve is directly pinched or when stretched — for example, during pregnancy when there is relaxation along the spinopelvic ligaments,” said Klineberg, professor and chief of orthopaedic spine surgery with McGovern Medical School at UTHealth Houston. “People feel pain as the first symptom, which can be followed by sensory deficits or numbness. If untreated, the condition can lead to motor function weakness.”

Diagnosis, pain management, and treatment

According to Klineberg, sciatic irritation can occur at various locations along the nerve bundle. A proper patient diagnosis will include a combination of methods and technologies to determine the appropriate treatment.

“Understanding the pathway of the nerve and localizing discomfort are essential. Hence, a physical exam should be conducted to determine where pain is occurring, including any movement which intensify or lessen a patient’s sciatic pain,” Klineberg said. “Diagnostic tests such as X-rays, CT scans, or MRIs can also be used to understand patient anatomy and the pressure being experienced. Once the diagnosis is understood, we need to think of things to decrease irritation.”

Klineberg said the first step in mitigating sciatic pain begins with activity modification. This can be as simple as reducing stressors to the body such as high-impact or excessively strenuous activity. Also, nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen can be prescribed to help with discomfort. Steroid injections and gabapentin can also be used to reduce symptoms and achieve nerve stabilization.

“Treatment will often depend on the patient’s symptoms. If conditions are relatively mild and can be controlled with medication, that can be enough. “The human body has a tremendous capacity to heal itself,” Klineberg said. “If the identified problem is severe and an exact location where the nerve is being compressed can be determined, pressure can directly be removed through surgery. An operation can be curative, taking someone from excruciating pain to no pain at all, walking out of a hospital within the same day.”

“Treatment will often depend on the patient’s symptoms. If conditions are relatively mild and can be controlled with medication, that can be enough. The human body has a tremendous capacity to heal itself,” Klineberg said. “If the identified problem is severe and an exact location where the nerve is being compressed can be determined, pressure can directly be removed through surgery. An operation can be curative, taking someone from excruciating pain to no pain at all, walking out of a hospital within the same day.”

Healthy living; preventive measures

Maintaining a fit lifestyle can be key to protect against issues of lower back and leg pain.

Klineberg recommends these useful practices for health and wellness:

• Smoking cessation. Nicotine increases risks to disc herniation and should be avoided.
• Weight loss. For each pound on the body, the spine sees 10 times this amount in pressure to sustain an upright frame. Even losing a few pounds can make a huge difference.
• Exercise and stretching. Core-strengthening exercise can help increase spine health, as well as programs like yoga and Pilates which improve balance and flexibility.
• Walking. This remains a simple, useful way to reduce and keep off excess weight.

“If you do develop sciatic symptoms, non-operative methods can be very successful,” Klineberg said. “But if pain persists or worsens, seeing a health care professional is important so timely treatment can be implemented that leads to relief and recovery.”

https://www.utphysicians.com/sciatica-causes-and-treatment/ 

Common Reasons Why Your Lower Back is Hurting So Much; Tips For Care & Treatment

From healththoroughfare.com

Did you know that roughly 84 percent of individuals report at some time in their life experiencing lower back pain? If the pain does not minimize within a reasonable amount of time, you should seek the immediate assistance of a medical professional. For instance, there are many different things that might be causing pain on the left side of your lower back. There are some that are localized to one region, while others might potentially produce discomfort in any section of the back. 

The Most Common Sources of Pain on the Left Side of the Lower Back

There are five vertebrae that make up your lower back. The vertebrae are held in place by ligaments and tendons, and cushioning discs are located in between them to prevent the bones from rubbing against one another. And speaking of muscles, the lower back has 31 nerves! Impressive!

In addition, organs such as the uterus, pancreas, kidneys, and colon are situated close to the lower back region of your body. All of these things have the potential to be the cause of discomfort on the lower left side of your back. Let’s go deeper into the topic and find out which of the following is the most typical cause:

1) The pain from sciatica

Sciatica is a condition that often is limited to one side of the body. It creates discomfort in the low back that is either electric or burning and extends down the leg. When you cough, sneeze, or sit for an extended period of time, the discomfort may become more intense. This ailment can also be brought on by a bone spur, a herniated disc, or even spinal stenosis, all of which put pressure on a portion of the sciatic nerve.

2) The onset of osteoarthritis

Osteoarthritis is characterized by a wide range of symptoms, the most frequent of which are pain and stiffness. Particularly uncomfortable movements for your back include twisting it and bending it. Osteoarthritis is a dangerous condition that manifests itself when the cartilage that normally cushions your vertebrae begins to deteriorate.

3) Sprain or strain the muscle

The majority of cases of low back pain are brought on by a strained or sprained muscle. Sprains and strains are common injuries that can be caused by inappropriately twisting or lifting an object, lifting something heavy, or overextending your back muscles.

4) A bulging or herniated disc

An injury is one of the potential causes of a herniated disc. Because of the normal degeneration that occurs in the discs with age, they also grow more prevalent. These herniated discs frequently press on nerves, which can result in discomfort, numbness, and weakening. Sciatica can also be brought on by a herniated disc, which is another prevalent reason.

5) Stones in the kidney or an infection

Kidney stones that are too small to cause symptoms may dissolve on their own if they are passed naturally. Bigger stones, which might call for treatment, can produce symptoms such as discomfort during urination, vomiting, fever, or severe pain on one side of your lower back. Other symptoms include having to urinate frequently or straining to urinate.

6) Uterine fibroids

Uterine fibroids are also referred to as benign tumors that develop in the muscular layer of the uterine wall. Painful periods, a sense of fullness in the lower abdomen, excessive bleeding during periods, discomfort during sex, or low back pain are some of the symptoms that may be associated with these conditions, which are often harmless.

Managing the lower back pain on the left side

If you do not have any warning indications of a dangerous ailment or you have not been injured recently, you may be able to try some home treatments first and then go see a doctor if the pain continues after that. You might want to give the following methods a shot:

• Lotion or cream that is used topically to relieve discomfort
• Avoiding or cutting out on activities that are painful
• Ice packs/hot packs
• NSAIDs, which stands for nonsteroidal anti-inflammatory medications.

Call a doctor if you have recently had an accident if you are experiencing a feeling of weakness in your legs, if you are exhibiting indications of an infection, or if you are experiencing discomfort that seems to be tied to your menstrual cycle.

https://www.healththoroughfare.com/disease-medicine/common-reasons-why-your-lower-back-is-hurting-so-much-tips-for-care-treatment/64714