February 21, 2019 10 min read

A Guide to Sciatica

Do you have shooting pains starting from your lower back down to your calf, foot, or even toes? Then you may need sciatica treatment. The spectrum of sciatica pain is wide and can switch between constant to nonexistent. Sciatica also usually only occurs on one side of the body and is the result of the pinching of the sciatic nerve.
In general, people refer to sciatica as a condition or diagnosis, but it is a symptom that indicates lower spine complications. Most commonly, sciatica is caused by a disk problem, such as a herniated disk that is pressed against a nerve root. It can also occur when a disk degenerates which releases inflammatory proteins that irritate the adjacent nerve. 


The sciatic nerve is the largest nerve in your body with the width of a man’s thumb.
The entire nerve is actually made up of five separate nerves that come together on both sides of your spine.
The sciatic nerve controls the muscles in the back of your knee and lower leg. It provides feeling to the back part of your thighs, part of your lower leg, and the soles of your feet. Without the sciatic nerve, your legs would be like limp pasta.
The sciatic nerve can be pinched in the spinal canal and can cause a wave of pain as it passes through the leg. Lower back pain and sciatica are the second biggest reasons for days taken off work.
All leg pain does not qualify as sciatica, which is a widespread myth. Leg pain can be caused by a wide variety of conditions, but true sciatic pain runs from your buttock down into the back of your leg.
Though sciatic pain is quite severe, most cases of sciatica are resolved in a short amount of time. People in milder cases can even believe that sciatica is just a minor leg sprain. Mild sciatica symptoms usually go away over time. However, symptoms can get progressively worse if you don’t take care or seek medical help.
Up to 85% of Americans suffer from lower back pain at some point in their lives, but it’s important to note this may not always involve the sciatic nerve.
Normal back pain happens because of muscle overextension in your lower back. Sciatica pain radiates down your leg and into your foot instead of remaining in your back area. Most people refer to minor sciatica pain as “a bad leg cramp that lasts for days.”
You may need sciatica treatment if you suffer from any of the following:
◆ Constant pain in only one side of the buttock or leg
◆ Extreme pain while sitting
◆ Burning, tingling, searing leg pain
◆ Weakness, tingling, numbness and mobility issues with the leg, foot or toes
◆ Sharp pains that prevent you from standing up or walking
◆ Loss of bladder or bowel control


For a while, we believed we didn’t know the cause of sciatica. In your spine, there are hard bones that are stacked on top of each other to keep us upright called vertebral bodies. Between the vertebral bodies are a jelly-type substance called intervertebral discs. Sometimes the jelly squirts out of one of these discs, and it can irritate the nerve or cause a hard substance to rub up against the sciatic nerve.
Sciatica can be caused by a multitude of things that can irritate or compress your intervertebral discs and sciatic nerve:
◈ Piriformis Syndrome. The piriformis muscle that is located around the sciatic nerve can tighten or spasm causing compression on the nerve. Spasms and buttock pain can cause numbness and tingling along of the back of the leg and into the foot.
◈ Osteoarthritis. As discs deteriorate with age, they dry out and shrink. The wear-and-tear in the disc wall is painful and often bone spurs form. The joints here enlarge, thickening your ligaments and causing a lot of pressure on your nerves.
◈ Herniated Disc. A spinal disc has a gel-like center that can rupture through a weak area in the disc wall and severely compress your nerves. A disc that is herniated is usually in the early stages of degeneration. This can also be referred to as a “bulged”, “slipped”, or “ruptured” disc.
◈ Trauma. A sports injury, car crash, or fall can fracture your spine or tear a muscle that can damage your sciatic nerve.
◈ Spondylolisthesis. A weakness or stress fracture in your joints can allow a normally aligned vertebra to slip out of position and pinch your nerves.
◈ Stenosis. When the bony canals in your spine narrow, it compresses the spinal cord and can damage or pinch your sciatic nerve that runs down your spine. It occurs mostly in your lower back and neck.

Risk Factors for Developing Sciatica
Though sciatica can happen to anyone, most sufferers are between 30 and 50 years old. Women are more likely to develop sciatica during pregnancy because the fetus can press against the sciatic nerve. Herniated disks and degenerative diseases in your spine can also cause sciatica symptoms. T
Below are some of the factors that could cause you to be more at risk for developing sciatica:
● Age. Herniated disks and bone spurs are the most common causes of sciatica and they mainly occur at a later age.
● Obesity. Body mass increases the stress on your spine and can contribute to the spinal changes that catalyst sciatica.
● Height. Surprisingly in an observational study, scientists discovered that gender does not really make a difference for putting you at risk to have sciatica. However, body height did. Males that were taller were found to be more likely to have it. If you are over 5’8’’ your risk for developing sciatica is significantly higher.
● Occupation. A career that makes you twist your back, carry heavy loads, or drive for long periods of time may induce sciatica.
● Prolonged sitting. People who have a sedentary lifestyle are more likely to develop sciatica. Having a healthy lifestyle is essential to combat this symptom.
● Diabetes. Diabetes influences the way your body uses chemicals and sugar, which increases the risks of nerve damage.

Acute vs. Chronic Sciatica Treatment

Acute Sciatica Treatment
Acute Sciatica treatments are well resolved with simple self-care solutions like:
● Over the counter NSAIDs like ibuprofen. Though it is important to note excessive use can cause liver failure and other long-term side effects.
● Daily exercises such as walking, stretching, or light sports. Avoiding excessive rest has helped more sciatica patients, and numerous studies have found that there is little to no benefit in bed compared to being active for people with sciatica.
● Hot or cold treatments. The most cost-effective way to treat sciatica symptoms is through heating and cooling treatments. Heat treatments relax tense muscles and cause more movement in deteriorating nerves. Applying cold elements to chronic pain reduces joint inflammation, pain, and swelling that can develop through everyday activity in sciatica sufferers.
●A personal TENS / EMS Device used for sciatica pain.
● Massage therapies. Aligning and decreasing tense muscles around your nerves can reduce sciatica symptoms.
You can receive massage treatment that will assist with sciatica symptoms in a cleansing day spa, treatment room at a physical therapy clinic, or even in the comfort of your own home using massage tools that help with sciatica.
Massage therapies help soothe sore and inflamed joints and muscles in ways that medication often cannot. Sciatica patients have reported lessened stress levels and better sleep when staying on a continuous massage schedule.
Massage therapies are the most popular secondary therapies used by Americans (9% as reported by the NCCAM). Research suggests that massage affects your internal body balance by promoting beneficial blood pressure, heart rate, hormones, and other vital and immune system signals.
A decrease in the stress hormone cortisol, a boost of serotonin production, and general mood improvement are just a few of the results of massage therapy in sciatica patients.
Seeing as a large percentage of pain is emotional, and the stress hormone cortisol is reduced, pain levels in these patients were lowered. You can receive massage chronic pain relief at a day spa, a therapeutic massage clinic, or at home massage.


Chronic Sciatica Treatment
● Physical therapy. Continued stretching and working of your body can allow bones and nerves to align to their proper places naturally. Strengthening your core muscles will take the pressure off a disrupted disc.
● Cognitive behavioral therapy (CBT) can help manage chronic pain. Pain is mainly a psychological driven feeling and developing skills to react differently to pain can reduce sciatic nerve damage.
● Prescribed pain killers. In more cases of severe sciatica, your doctor may put you on a pain killer regimen to assist you in managing pain. To facilitate the healing process neuropathic pain medications, anti-inflammatory medicines, or oral steroids may be prescribed by your doctor.
● Surgeries like a lumbar laminectomy, (widening the spinal cord to reduce pressure on nerves), or discectomy, (removal of a herniated disk), can assist in reducing inflammation and irritation on your sciatic nerve.
● Steroid Injections. For severe sciatica pain, a doctor may recommend an epidural steroid injection, where a corticosteroid medicine is injected near the base of your spine. The relief from an epidural shot such as this can last for a few months or even longer.
● A personal TENS / EMS Device used for sciatica pain. You can discretely use a TENS / EMS device to gently stimulate your nerves throughout the day to minimize nerve pain.
TENS / EMS devices used for sciatica pain apply gentle electric pulses to your nerves that stop your brain from sending pain signals to your spine and back. It causes your muscles to contract and is often used with people that have sciatica to strengthen muscles that are surrounding the affected nerves. Other benefits than shutting down pain signals can occur when using your TENS / EMS device.
“The electrical current also stimulates the nervous system, possibly stimulating the brain to release endorphins and enkephalins, opiate-like substances that relieve pain.” Said Tirish Padmanabhan, the clinical director at The George Washing University Hospital.
This technology assists in both long- and short-term pain and has been proven to relieve osteoarthritis pain and reduce the need for addictive pain medications. “TENS is effective in treating any kind of arthritis pain – and in treating pain, period,” Padmanabhan emphasizes.
TENS / EMS technology is a new breakthrough in the sciatica pain market. Sciatica pain relief has gone mobile, easy to access, and proven to work. A TENS / EMS device may just be the solution to solve your sciatica pain in a 100% drug-free way.
Please consult your doctor when considering any sciatica treatment so you can best take care of your needs.


How is Sciatica Diagnosed?
In most acute sciatica cases, the symptoms are mild and do not last longer than 4 weeks. If it is under this amount of time, you probably have acute sciatica and medical attention is not usually necessary.
To determine if you have sciatica, your doctor will begin asking you how your pain began and its exact location. You will probably be asked to walk on your heels, squat, or raise your leg without bending the knee. Muscle tests like this help your doctor determine if it is, in fact, the sciatic nerve that is irritated.
If pain persists for more than 4 weeks, there are medical exams that have been developed to determine if someone has sciatica. Imaging scans like x-rays and MRIs check muscle strength and reflexes in your spine for sciatica indicators like spine compression and pinched nerves. A CT scan using contrast dye can also give a picture of your spinal cord and nerves to pinpoint the exact spot of pain.

Sciatica Prevention
It is important to note that not all cases of sciatica can be prevented but staying active can greatly reduce the probability of lower back pain. A strong core in your abdomen and back lessen sciatica symptoms significantly. Exercising good posture, minimizing sitting, managing your weight, maintaining flexibility, and attempting to have good spinal alignment can be beneficial your sciatica symptoms.

Pregnancy and Sciatica
Sciatica symptoms can be felt during pregnancy; however, a large percentage of women have been diagnosed with back pain and not sciatica during pregnancy.
Hormones produced during pregnancy cause ligaments to stretch, which is the primary cause of back pain in women. Only 1% of women develop sciatica during pregnancy.
If you have had a history of pelvic trauma, chronic lower back pain, or lower back pain during a previous pregnancy then you are at more of a risk for sciatica while pregnant. 

Sciatica or Sacroiliac Pain?
At times during pregnancy, women can believe that their symptoms are sciatica related. In reality, the pain is coming from the area of the sacroiliac (SI) joint. This is the joint where the base of your spine connects to the wing-like bones of your pelvis.
SI pain is much more common in pregnancy than sciatica. Pregnant women produce a unique hormone called relaxin, that loosens the woman’s body through her ligaments and tendons in preparation for labor.
The increase of these hormones leads to more motion than normal in the SI joint, which can cause a painful ache that can replicate sciatica symptoms. SI pain radiates from the buttock, hip, groin, and the back of the thigh. SI pain is like sciatica pain, but SI pain does not extend all the way to the feet.

The Best Back Exercises for Sciatica
Stretching and strengthening your muscles daily may help to prevent sciatic episodes. Below are a few exercises that can help enhance the condition of your lower back and spine.
⫸ Knees to Chest. Lie on your back with both knees bent. Pull your left knee to your chest and hold this position for 5-10 seconds. Repeat this stretch on the opposite side. 5 sets of this exercise will help give optimum flexibility.
⫸ Modified Knees to Chest. Lie on your back with your knees bent. Pull both knees to your chest and hold this position for 5-10 seconds. Rest and repeat 10 sets.
⫸ Cobra or modified Cobra. Lie on your stomach, legs together and extended fully, elbows bent with your palms resting on the floor below your chest. Push on your palms, and partially straighten your elbows to lift your chest off the floor 45 degrees. Hold 5 seconds and return to starting position.
⫸ Seated hip stretch. Sit in a chair with your feet planted on the floor, knees bent at a 90-degree angle. Raise the affected leg and cross that ankle over your opposite knee. Gently bend forward over your crossed leg, breathe deeply, and hold for 15-30 seconds. Release and repeat.
⫸ Standing hamstring stretch. Start by standing with feet directly together. Lift the affected leg directly out in front of you and rest the heel on a ledge that is about the height of your hip. Keeping your knee straight, bend forward at the waist and keep your spine straight until you feel a stretch in the back of your leg. Hold 15-30 seconds. Release and repeat on the opposite side.
⫸ Seated spinal twist. Sit on the floor with your legs together, straight out in front of you. Bend one leg at the knee and place the foot of that leg on the floor outside of your opposite knee. Twist towards the bent knee, placing the opposite elbow on the outside of the bent knee for a deeper stretch. Hold 15-30 seconds. Return to the starting position, then repeat on the opposite side.
⫸ Relaxed release. Lie with your knees bent, and cup your hands behind your head. Flatten your back completely to the floor. Hold this position for 5-10 seconds. Rest and repeat 10 sets.

When diagnosing or treating your sciatica it is always wise to consult your physician for advice about a specific medical condition.
Sciatica is a painful, chronic disease that can be difficult to relieve. If you are suffering from sciatica, you are not alone. Approximately 80%-90% of patients with sciatica get better over time without surgery, typically within a few weeks.
Rehabilitation exercises may be assigned by your doctor to help you strengthen your back. Following treatment with sciatica, you will probably be able to resume your lifestyle and keep your pain in check.

Shabir Aminzada
Shabir Aminzada

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