You’ve got some nerve: How and why sciatica causes pain

From veronews.com

Sciatica refers to irritations – sometimes severe – of the sciatic nerve, the body’s largest nerve. According to the Harvard Health newsletter, as many as 40 percent of the population will suffer from sciatica during their lifetime.

Dr. Shivam Upadhyaya, an orthopaedic surgeon at South Florida Orthopaedics, says nature and nurture both come into play for those dealing with sciatica. “Genetics can definitely play a role,” he says. “Add to that our American lifestyle that includes lack of core strength and flexibility, being overweight and sitting a lot for work, and it’s a challenging combination.”

He adds that even the type of shoes we wear can contribute to the development or worsening of sciatic pain. Flip flops and high heels both offer little or no support and many popular styles force your body and feet into unnatural positions.

According to PennMedicine, the University of Pennsylvania’s website, the most common causes of sciatica involve trauma to the nerves higher in the spine that combine to form the sciatic nerve. The correct treatment depends on the cause, which may include a slipped or herniated disc, spinal stenosis, piriformis syndrome (a pain disorder involving the muscles in the buttocks), pelvic injury or fracture, pinched nerve or late stages of pregnancy.

Upadhyaya says age probably affects the cause of your sciatica. “When someone in their teens or 20s experiences sciatica, it’s usually because of sports, exercise or workplace injuries.” Active people who lift a lot or twist their lower body may experience herniated discs that lead to sciatic pain.

For older patients, he says, “decades of wear and tear cause your discs to flatten out, which leads to a different set of issues.” Mayo Clinic concurs, advising that age-related changes in the spine, including bone spurs and herniated discs, cause sciatica. If you are over 50, chances are good your sciatica is due to nerves, muscles and bones degenerating. The inflammation of your nerves leads to sciatica as you advance in age.

Generally, symptoms include a dull, aching, shooting or “burning” pain that starts in your lower back and/or buttock and radiates down one of your legs. Back pain accompanied by leg pain is the key symptom that suggests you have sciatica rather than another type of back pain. You may also feel neuropathies such as numbness, a “pins and needles” tingling sensation, muscle weakness or altered reflexes.

Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.

MedicineNet says that, depending on symptoms and the extent of the condition, sciatica can be categorized into four types: acute, chronic, bilateral and alternative.

• Acute – caused by sudden irritation to the nerves due to pinching, compression or a combination of both. Symptoms as outlined above may also include difficulty sitting as symptoms get worse. Pain can last one to two weeks.
• Chronic sciatica – can last months or years and may occur intermittently. Conditions that can worsen the pain include inflammatory conditions, injuries, infections and spinal misalignment issues. May resolve temporarily but can recur without treatment or lifestyle and activity adjustments.
• Bilateral sciatica – a rare type of sciatica that affects both legs. May be caused due to multiple herniated discs or disc degeneration. Pain may be felt in both legs and buttocks at the same time or be more severe in one leg.
• Alternative sciatica – a rare type of sciatica that can cause pain in both legs alternatively. Can result from degenerative problems in the sacroiliac joint or sacroiliac arthritis.
  Sciatica usually heals on its own with rest and time. To help relieve the pain, treatment may include:
• Nonsteroidal anti-inflammatory (NSAIDS), medicines such as ibuprofen.
• Heat or cold applied to the sore muscles.
• Movement (keeping your body in motion minimizes inflammation).
• Osteopathic manipulation.
• Surgery (to repair a herniated disc if the condition persists).
  “If your pain isn’t responding, by all means see an orthopaedist if you can’t meet with your PCP,” he says. You’ll definitely want to consider a doctor’s visit if:
• You are under age 20 or older than 55 and having sciatica for the first time.
• Your symptoms are severe.
• You have weakness in a leg or foot.
• You have a fever in addition to your pain.
• You have a history of cancer.

Dr. Shivam Upadhyaya has a BA in Medical Sciences from Boston University and a medical degree from Boston University School of Medicine. He completed his internship at Massachusetts General Hospital and his orthopaedic surgery residency at Harvard Medical School. He also completed a fellowship at Norton Leatherman Spine Centre in Louisville, Kentucky, and is a member of American Academy of Orthopaedic Surgery. South Florida Orthopaedics is located at 9401 SW Discovery Way, Port St. Lucie: 772-288-2400.

https://veronews.com/2023/11/10/youve-got-some-nerve-how-and-why-sciatica-causes-pain/