What is Sciatica?
Sciatica is pain that originates in a personâ€™s lower, or lumbar back and shoots down the buttock and down the leg when the sciatic nerve is compressed, or pinched.
There are two sciatic nerves, and they are the largest nerves in the body. They run down the base of a personâ€™s spine to their feet.
Pain occurs when a disc in the lower vertebra ruptures and its contents press against one of the sciatic nerves.
The discs are made out of a spongy substance that cushions the bones of the vertebrae from each other.
Pressure is put on the spine when a person bends over and tries to lift a heavy object the wrong way or when they try and lift weights without properly warming up.
A bone spur can also irritate the nerve, and people with uncontrolled diabetes may contract sciatica due to nerve damage caused by the disease.
Another cause of sciatica is piriformis syndrome. This happens when the piriformis muscle compresses the nerve, as can be seen in this video fromÂ Spine-Health.
The piriformis muscle helps a personâ€™s hip rotate outward and helps the thigh move away from the body. However, piriformis syndrome is a rarer cause of sciatica than a herniated disc.
Sciatica is a symptom of leg pain, including weakness, tingling, and numbness. These sensations begin in your lower back and travel through your buttocks and down the large sciatic nerve in the back of your leg- which can have an effect on your knee, causing pain.
The pain of sciatica is usually felt on only one side of the personâ€™s body. It can range from mild to excruciating, and some patients claim it feels like being electrocuted down their leg. Sitting down for a long time makes the pain worse, as does sneezing or coughing.
The good news about sciatica is that usually goes away after a few weeks as the ruptured disc shrinks.
However, there are some patients whose sciatica is so severe the numbness or weakness it causes in their leg or foot interferes with normal movement.
A very severe case of sciatica can even cause the patient to become incontinent, according toÂ Mayo Clinic. These people need more aggressive treatment.
While many people believe that sciatica is a condition in and of itself, the truth is, it is not a diagnosis itself, but just a symptom of an underlying condition such as spinal stenosis, lumbar herniated disc, or degenerative disc disease.
Nerve Pain and Sciatica
In most cases, this symptom of a back problem is characterized by one or more of the following symptoms:
- Constant pain in one leg or on one side of your buttocks
- Leg pain that can be described as searing, burning, or tingling- instead of a dull ache
- Pain that is made worse by sitting for a long period of time
- Sharp pain that makes it difficult to walk or stand
- Difficulty moving the leg/foot
- Weakness or numbness in legs/feet
The pain of sciatica can be infrequent and a minor irritation to an incapacitating and constant one. Specific symptoms of sciatica can differ in severity and location depending on the condition that is causing your sciatica.
While it is true that the symptoms of sciatica can be extremely painful and even possibly debilitating, it is very rare that permanent nerve or tissue damage will occur.
Sciatica and the Sciatic Nerve
Symptoms of sciatica manifest when the large sciatic nerve is compressed in the lumbar spine or becomes irritated for some reason.
Your sciatic nerve is the biggest single nerve in your body and is made up of individual roots of nerves that branch out from your spine in your lower back and then come together to form your sciatic nerve.
Following are a few important points that you should know about the sciatic nerve:
- Your sciatic nerve begins in your lower back at the lumbar segment #3, referred to as L3.
- At each level of your lower spine, a nerve root comes out from inside of your spine, and each of these comes together to create what we know as the large sciatic nerve.
- Once formed from the combination of all the other nerves, your sciatic nerve runs from your lower back, through your buttocks, and then down the back of each one of your legs.
- Then, once in your legs, portions of this large nerve branch out to various parts of your leg: calves, thighs, toes, and feet.
The specific symptoms of sciatica– numbness, leg pain, weakness, and even symptoms that radiate into your foot- are dependent upon what portion of the sciatic nerve is irritated or pinched.
For example, if it is pinched or irritated along lumbar segment #5, or L5, you may notice that you have weakness in extending your big toe and possibly your ankle.
The Course of Sciatic Pain
Research has shown that the chances of developing sciatica increase around middle age. It rarely occurs in anyone under the age of 20 and often peaks somewhere around age 50, declining after that.
In most cases, it is something that develops over time instead of being caused by a particular injury or event.
Most people who have sciatica pain will see an improvement within a few weeks to a few months and are able to obtain relief with non-surgical treatments.
However, for some others, leg/knee pain due to a pinched nerve can be extremely debilitating and severe.
There are a few of the symptoms related to sciatica that may require immediate medical intervention- including surgery.
These symptoms include dysfunction of the bowels and/or bladder, leg weakness, and other progressive neurological symptoms.
Since sciatica is due to an underlying medical condition- such as a herniated disc or spinal stenosis, instead of a condition of its own, treatment is most often more focused on treating these underlying causes.
In most cases, treatment is primarily self-care, non-surgical techniques. On the other hand, if you do have severe pain that does not improve over time or some severe dysfunction related to your sciatica, you may want to consider surgery as an option.
Treatments for Sciatica
If you experience ongoing or severe sciatica flare-ups, you may need to treat your condition so that it does not progress over time.
For most individuals suffering from sciatica, non-surgical and/or self-care techniques along with adequate exercise will do wonders for treating the pain.
On the other hand, some individuals find that these techniques do not work and their pain does not improve on its own over time.
Therefore, these individuals require a more structured approach to their treatment- possibly including surgery to minimize pain and dysfunction in the future.
The primary goals of the non-surgical treatments for sciatica are to relieve neurological symptoms and pain related to the nerve root being compressed.
Of course, there is a wide range of options that are available for treating sciatica. You can use one- or a combination of- the following treatments when you experience a sciatica flare-up.
Heat and Ice
According toÂ Dr. Axe, When you are experiencing an acute case of sciatica pain, heat packs along with ice packs are available to help to relieve the leg pain associated with this condition, especially in the beginning.
You should apply ice or heat for about 20 minutes at a time and then repeat this process every two hours. In most cases, people choose to use the ice first- but there are some that find they get greater relief from theÂ heat.
You should alternate the two- use heat first and ice second, or vice-versa. The best way to apply the ice is by placing a towel or cloth between the ice pack and your skin. This will help you avoid getting an ice burn.
There are lots of OTC and prescription medications that are effective for relieving or reducing the pain associated with sciatica.
The best options are the NSAIDs, such as naproxen or ibuprofen, and even oral steroids to reduce the inflammation associated with sciatica.
There are lots of other treatments for sciatica, but these are the two most common. If you do not obtain relief from self-care treatments, please contact your physician so that you can gain medical treatment if required.
Home Remedies for Sciatica
Peppermint oil is used as a pain reliever. It has analgesic properties, and it can help reduce pain and inflammation caused by sciatica. According toÂ stylecrazeÂ Website, using peppermint oil will speed up your recovery.
First, mix four to five drops of peppermint oil and one tablespoon of a carrier oil. Next, apply the mixture to the affected areas. You must do this one to two times each day to see results.
Ginger Essential Oil
Ginger essential oil has many benefits. Ginger oil is known to be soothing, and it can help relieve pain from sciatica. Ginger contains an ingredient that has anesthetic effects.
First, mix four to five drops of ginger essential oil and one tablespoon of a carrier oil. Next, apply the mixture to the affected areas. You must do this two times a day to see results.
Garlic is a therapeutic herb that has many health benefits. Garlic can relieve inflammation and pain that sciatica causes.
Place two cups of milk, one cup of water and 10 crushed garlic cloves in a saucepan. You’ll want to let it heat up until it begins to boil. Simmer for five minutes.
Next, strain the milk. You can add honey to the mixture if you want. Allow the mixture to cool before you drink it. Drink a cup of garlic milk twice a day.
Ginger essential oil will help sciatica externally, and ginger tea will help sciatica nerve pain internally. As discussed previously, ginger contains an ingredient that has anesthetic effects. Ginger can help reduce pain and inflammation caused by sciatica.
Add one inch of ginger in a cup of hot water. Allow it to steep between 10 to 15 minutes. Next, strain the ginger tea. Let it cool down before you drink it. When the tea cools down, you can add honey to it if you want. Drink the ginger tea three times each day to see results.
Celery juice is another home remedy for treating sciatica. It can help reduce pain and inflammation.
You’ll want to cut a cup of celery into small pieces. Next, add water to the cut celery and blend it using a blender. You can use between one cup to 11 cups of water. Add honey to the mixture before you consume it. Drink a cup of celery juice twice a day.
According toÂ top10homeremediesÂ Website, turmeric contains curcumin, and it helps reduce the pain and inflammation caused by sciatica.
Add one teaspoon of turmeric to one cup of milk. Add a small cinnamon stick to the mixture if you want. Next, boil the mixture. You can sweeten the drink by adding honey to the mixture. Drink the mixture one to two times a day to see results.
Another option is to take turmeric supplements. You should consume turmeric supplements three times a day. You’ll want to talk to your doctor before you begin taking supplements.
You should avoid consuming turmeric if you suffer from gallstones. Turmeric may not be suitable for you if you take blood thinners or diabetes medications.
Capsaicin contains cayenne pepper. The active ingredient works as a natural pain reliever. Cayenne pepper lowers the levels of a neurotransmitter that transports pain signals.
Capsaicin should be applied to the affected areas four times a day. You should use it for at least one week to see results. Don’t apply the cream on skin that’s broken. You may feel a burning sensation the first time you apply the cream or ointment on your skin.
It’s important that you get plenty of rest while maintaining normal activity. It’s beneficial if you have sciatica. You’ll want to start a regular exercise program.
This YouTube videoÂ shows you what exercises you need to be doing. The video teaches you how to do the exercises, and if you need help comprehending what the video says, you can read the description to determine what you need to do.
Though most cases of sciatica pain disappear after a few weeks for most patients, some patients with intractable pain or other problems caused by their sciatica opt for surgery.
Because sciatic pain often does go away on its own, the timing of the surgery is important according to a paper from theÂ Acta Neurochirurgica.
Most surgeons with sciatic patients put off the surgery anywhere from a month and a half to six months as the patient is treated with more conservative techniques.
One exception to this is patients who could not even sit down without experiencing excruciating shooting pains down their leg.
Other exceptions were patients who were incontinent, had spinal stenosis, or a narrowing of the spinal canal or had such weakness that they could not stand on the affected leg, accordingÂ toÂ SpineUniverse. These patients were candidates for early surgery.
One type of surgery to treat sciatica is called a discectomy or a microdiscectomy. In this procedure, the surgeon removes all or part of the disc that compressing the sciatic nerve.
The difference between discectomy and microdiscectomy is that discectomy is an open procedure while microdiscectomy is initially invasive.
The surgeon uses a surgical microscope to perform this operation. The incisions are only about 2 inches long and may need only one or two sutures to close.
It is believed that patients who have microdiscectomy recover a bit faster from this surgery than a regular discectomy, but this is disputed.
Both patients spend about three days in the hospital, and both recover after about two weeks.
In laminectomy or laminotomy, the lamina is removed. This is the â€œroofâ€ of the vertebra, saysÂ Cedar SinaiÂ that protects the spinal cord.
The theory behind this is that removing the lamina creates more room for the nerves and lowers the risk of nerve compression.
Watch this video fromÂ Dr. Jaydev PanchwaghÂ to see the finer points of sciatica surgery.
The Patient and the Surgery
Most patients are given general anesthesia during spinal surgery, according to theÂ Houston Methodist Hospital, though some are given spinal anesthesia with sedation.
The patient does not lie their stomach as might be expectedÂ but kneels in a frame to take the pressure off of their abdomen and prevent a large loss of blood.
After the surgery, the patient is taken to a recovery room but is encouraged to start walking a few hours after the operation.
If there is a drainage tube in the surgical wound, it is removed before the patient goes home.
Patients should have someone drive them home, and stay with them for a few days. They need to avoid strenuous activity for at least a monthÂ and start physical therapy about two weeks after the surgery.
The physical therapy that the doctor recommends is meant to ease the pain and inflammation of the surgery.
Sometimes the physical therapist helps the healing with electrical stimulation and massage.
The patient also does exercises to support their cardiovascular and respiratory systems and to build up the muscles of their lumbar, or lower back.
How long does sciatica last?
Sciatica, pain and other complications such as numbness caused by irritation of the sciatic nerve, can last for quite some time depending on the exact cause of the condition.
Acute sciaticaÂ or sciatica with a sudden onset that goes away on its own without intensive medical treatment usually lasts for several weeks.
This video, made by the Illinois Back Institute, explains more about sciatica and how long to expect the symptoms to last.
According toÂ Harvard Medical School, researchers have found that in many patients sciatica pain improves within one month.
In order to address the pain from acute sciatica, both time and symptomatic relief are necessary.
While the irritation causing the pain needs time to heal â€“ anywhere from two to four weeks being common â€“ various simple strategies people can do at home will help to relieve the pain and can speed healing.
If theÂ pain is severe, rest is recommended while the symptoms subside. However, being physically active in general is thought to help reduce the risk of getting sciatica pain.
Alternating ice and heat in the painful area can help reduce the pain of sciatica. Taking over the counter pain medication is also helpful in the short term to relieve the pain.
Specifically, non-steroidal anti-inflammatory drugs (NSAIDs) will help the most. This is why it is better to take Motrin for sciatica than to take Tylenol.
If the pain does not improve within a few weeks of rest and treatment of the symptoms at home, it is recommended to talk to a doctor.
Physical therapy can help to treat sciatica pain as well as make it less likely to reoccur.
The main goal of physical therapy for sciatica is to move the body in ways that relieve pressure on the sciatic nerve.
Exercises used might include stretching, aerobic activity like walking, or exercises to increase the strength of a patientâ€™s core, leg, and back muscles.
According toÂ the National Institute of Health, while the majority of people report that their sciatica has resolved within a month, as many as thirty percents of patients with sciatica can have pain for one year or longer.
This is chronic sciatica, and while the pain from flares of the condition can be managed and will subside, most sufferers of chronic sciatica continue to experience episodes of sciatica pain until the underlying cause of the irritation of their sciatic nerve is treated.
TheÂ Cleveland ClinicÂ reports that the typical cause of sciatica is a slipped disc which moved out of place and put pressure on the sciatic nerve.
In order to treat chronic sciatica caused by a disc problem, surgery might be necessary if a patientâ€™s sciatica is not resolved in other ways.
There are two main options for surgery to treat sciatica, depending on a physicianâ€™s assessment of the specific type of disc problem that is causing the condition.