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Jun 09 2017
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The Pain In Your Lower Extremities Could Be Spine Related

What is sciatica?

The term ‘sciatica’ came from ‘sciatic nerve’ which is a long nerve traveling from our lower back through the hips and buttocks and down the legs.

Sciatic nerve image

Irritation or compression of the nerve causes pain along its distribution. Sciatic nerve originates in the lower spine (lumbar spine) and leaves the spine through small openings in the vertebra which is the commonest site of compression. You feel pain in the buttocks, thighs, back of the legs, and even toes although the problem is in the spine. There may be various other types of discomfort apart from pain like tingling, numbness, pin and needle sensation, etc.

 

What causes sciatica?

A collection of nerve fibers (nerve roots) emerging from the lower part of the spinal cord (a central nerve lying in the vertebral canal) unite to form sciatic nerve outside the spine. That thick nerve divides soon and supplies lower back, buttock and whole lower limbs. Compression or pinching of the nerve fibers can occur anywhere from the origin at spinal cord to branches of the nerve. This compression causes sciatic pain. However, the pain is felt in the areas where the affected nerve fibers supply. Commonest causes of sciatica include:

  • Prolapsed or herniated disc. There are soft structures in between bony vertebrae known as intervertebral discs. These discs may slip or become displaced putting pressure on nerve roots. It usually occurs on one side of the vertebra.
  • Spinal stenosis or narrowing of the spinal canal. It may compress nerve fibers at their origin. Usually, this affects nerve fibers of both sides of the spine.
  • Piriformis syndrome. It occurs when a small muscle (piriformis muscle) lying deep in the buttocks becomes taut due to spasms. The sciatic nerve is irritated due to the close proximity to the muscle.
  • Lumbar spondylolisthesis. It occurs when a vertebra slips backward and becomes misaligned putting pressure on nerve fibers at their exit.
  • Compression by a tumor in and around the spinal canal.
  • Long-standing diabetes. Sciatica occurs as part of peripheral neuropathy. There is no compression of nerve in this type of disease.

Risks of sciatica increase with age. Bone spurs are formed at the advanced age which may compress nerve fibers. Herniated discs are also more common in aged people. Obesity is another risk factor for sciatica. Excess body weight puts more stress on the spine leading to its structural changes. Jobs requiring prolonged sitting or carrying heavy loads may lead to changes in the spine causing sciatica.

 

What are the symptoms of Sciatica?

Pain in the lower back that radiates to the buttocks, back of the thighs and legs is the typical feature of sciatica. However, the pain can be felt anywhere along the course of the nerve. The nature of pain is variable. It can be sharp, shooting pain, dull aching, or burning sensation. It can be mild or severe and excruciating.

Sciatica pain

There may be tingling and numbness in the affected area, and weakness in the leg or foot. In most instances, one side of the body is affected. Pain is usually aggravated by coughing, sneezing, prolonged sitting, bending legs, and changing posture. Some people feel better during standing and walking. Taking rest sometimes relieves the discomfort. One may experience good days and bad days, but the duration of those spells is quite uncertain. Severe pain may hamper daily life and even lead to absence from work.

 

What are the non-surgical treatment options for sciatica?

Lifestyle and self-help measures

  • Take rest. It is the initial treatment of choice if your back pain is due to sudden disc prolapse. The Early movement will only cause more injury and delay in stabilization. Allow 2-3 days to cope with initial injury and start repair. However, you can go to the toilet, take a shower and sit on a chair briefly. Pass most of your time in a comfortable position.
  • Avoid bad postures. Some postures can displace the discs and put stress on them. Keep your body straight as much as possible. Identify the movements and postures that aggravate your pain and try to avoid them.
    • Keep pillows under your knees while lying on back.
    • Keep a pillow between your legs and lumbar roll to support lower back while lying on a side. Lumber roll is prepared by rolling a towel along its length with one-inch thickness.
    • Sitting position. Sit straight keeping your whole back in contact with the backrest of the chair. Put your buttock as much backward as possible while sitting on a chair.
    • Do not lift heavy object from the floor and avoid daily activities that need bending your back forward frequently.
    • While standing, keep your back straight.
    • Do not sit or stand for a prolonged period.
    • Do not climb stairs hurriedly.
  • Cold packs. It is soothing and works nicely in the first few days of acute pain. The best result is obtained by applying ice packs three times daily for 15-20 minutes each.
  • Hot packs. It is useful and becomes tolerable after two to three days. It helps improve blood circulation and hastens repair of the injured area. Application of hot and cold packs alternately can also be a good option.
  • Stretching exercises. These help to push the spinal discs forward and release compression on the nerve roots. Start with gentle movements and do not go beyond the point where you cannot tolerate, or the pain starts. Some specific exercises designed for sciatica include knee pull, sciatic mobilizing stretch, back extension, standing hamstring stretch, and lying deep gluteal stretch.
  • Painkillers and anti-inflammatory drugs are often helpful for alleviating pain. There are some over the counter medications like non-steroidal anti-inflammatory drugs, muscle relaxants, etc. It is advised to start with paracetamol. If the pain persists, you may take tablet aceclofenac, ibuprofen, or naproxen. Tolperisone, eperisone, tizanidine are some examples of muscle relaxants. Severe pain may require stronger painkillers that should be advised only by a physician. Sometimes steroid injections around the nerve root provide excellent pain relief.

 

What are the surgical treatment options for Sciatica?

Surgery is indicated for people who are non-responsive to lifestyle advice and medications, or who have increasing symptoms, or dangerous spinal cord compressions with a risk of paralysis.

  • Microdiscectomy

    A portion of herniated disc is removed to relieve compression on nerves. It dramatically improves pain, and post-surgical recovery is quite fast.

  • MicroInvasive Laminectomy

    It is done if there is compression of the spinal cord due to narrowing of the spinal canal. A portion of bone and the tissue that is putting pressure on the sciatic nerve are removed. However, factors leading to the decision of surgery include patient’s general condition, concomitant disease, and patient’s desire.

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