Sciatica – Types, Causes, Symptoms, Diagnosis, Treatment

Sciatica is a disorder characterized by radiating leg pain that follows a dermatomal pattern, accompanied at times by sensory symptoms.^[rx] In about 90% of cases, it is caused by a herniated disc with nerve root compression and generally is considered to have a favorable prognosis.^[rx] However, most prognostic estimates of sciatica are based on data from individual studies, as systematic reviews on this topic are scarce. Moreover, evidence regarding specific prognostic factors for sciatic recovery, particularly in non-surgically treated patients, is conflicting.^[rx] For the chiropractor, communicating patient prognoses is nevertheless a routine part of proper informed consent procedure.³ Presented here in an ‘evidence-based’ format,^[rx] this case report will chronicle how research literature was used in estimating the clinical prognosis of a patient with a lumbar disc herniation and sciatica.

Sciatica is a debilitating condition in which the patient experiences pain and/or paresthesias in the distribution of the sciatic nerve or an associated lumbosacral nerve root. Often, a common mistake is referring to any low back pain or radicular leg pain as sciatica. Sciatica is specific to the pain that is a direct result of the sciatic nerve or sciatic nerve root pathology. The sciatic nerve is made up of the L4 through S2 nerve roots which coalesce at the pelvis to form the sciatic nerve. At up to 2 cm in diameter, the sciatic nerve is easily the largest nerve in the body.  Sciatica pain often is worsened with flexion of the lumbar spine, twisting, bending, or coughing. The sciatic nerve provides a direct motor function to the hamstrings, lower extremity adductors, and indirect motor function to the calf muscles, anterior lower leg muscles, and some intrinsic foot muscles. Also, indirectly through its terminal branches, the sciatic nerve provides sensation to the posterior and lateral lower leg as well as the plantar foot. It is an important distinction to know that most cases of sciatica result from an inflammatory condition leading to an irritation of the sciatic nerve. Conversely, direct compression of the nerve leads to more severe motor dysfunction which is often not seen, and if present, would warrant a more meticulous and expeditious workup.[rx][rx][rx]

Sciatica is a medical condition characterized by pain going down the leg from the lower back. The sciatic nerve is the largest nerve in the body. The sciatic nerve begins from nerve roots in the spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur.

Sciatica is defined as a severe pain in a leg along the course of the sciatic nerve. The pain is felt in the back of the leg running from the buttock down the back of the thigh into the calf and foot.

• The pain may begin abruptly or gradually and is characterized by a sharp, shooting, or electric shock-like quality.
• Movement of the extremity (ie, leg) often intensifies the pain.
• Pain may be uniformly distributed along the leg, but frequently there are certain spots where the pain is more intense.
• Pain is often associated with numbness and/or tingling in the distribution of the sciatic nerve.

Sciatica may result from any process which causes pressure or irritation of the nerve roots which compromise the sciatic nerve. This pressure may result from a variety of processes such as a ruptured intervertebral disc, narrowing of the bony spinal canal (called spinal stenosis), or rarely from infection or tumor.

The sciatic nerve is the longest and largest nerve in the body; it measures three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves in the low back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine and the sacrum combined. The sciatic nerve and its nerve branches enable movement and feeling (motor and sensory functions) in the thigh, knee, calf, ankle, foot, and toes.

About the Sciatic Nerve in the Low Back

The sciatic nerve starts in your low back, which is called your lumbar spine. The nerve roots are at the L4 and L5 vertebrae (the ‘L’ means lumbar, and the numbers indicate the level of the vertebra—where it is in your back). The sciatic nerve also travels through your pelvic region (sacrum).

In most people, the sciatic nerve runs under the piriformis muscle, which moves your thigh side to side. From there, the sciatic nerve descends through the buttocks and the back of the thighs. Behind your knee, smaller nerves branch out from the sciatic nerve and travel down to your feet.

• Your sciatic nerve is part of a complex structure – your body’s nervous system. That system is responsible for transmitting pain and sensation to other parts of your body. So, when something presses on a nerve, you’ll feel it, and it won’t feel good. With sciatica, something in your low back—a herniated disc, for example—compresses the sciatic nerve, which then transmits pain down your legs.
• The sciatic nerve exits the sacrum (pelvic area) – through a nerve passageway called the sciatic foramen. At the upper part of the sciatic nerve, two branches form; the articular and muscular branches. The particular branch goes to the hip joint. The muscular branch serves the leg flexor muscles (muscles that enable movement).
• Other complex nerve structures are involved—the peroneal nerves and tibial nerves. The peroneal nerves originate from the nerve roots at the fourth and fifth lumbar spine (L4-L5) and first and second levels of the sacrum (S1-2). After the peroneal nerves leave the pelvis, they travel down the front and side of the leg, and along the outer side of the knee, to the foot.
• The tibial nerves originate from the nerve roots at L4-5 and S1-3 – The tibial nerves pass in front of the knee and down into the foot (heel, sole, toes).

The pain might be worse when you sit, sneeze, or a cough. Sciatica can occur suddenly or it can develop gradually. You might also feel weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes. Less common symptoms might include the inability to bend your knee or move your foot and toes.

Types of Sciatica

According to the nerve root compression

Sciatica from L4 nerve root 

• Symptoms of sciatica stemming from this level, the L3-L4 level, in the lower spine may include: pain and/or numbness to the medial lower leg and foot; weakness may include the inability to bring the foot upwards (heel walk). The patient may have reduced knee-jerk reflex.

Sciatica from L5 nerve root 

• If the L4-L5 segment is affected, the patient may have weakness in extension of the big toe and potentially in the ankle (called foot drop). Symptoms of sciatica originating at this level of the lower back may include: pain and/or numbness at the top of the foot, particularly in the web between the great toe (big toe) and the second toe.

Sciatica from S1 nerve root   

• Symptoms of sciatica originating at this L5-S1 level, which is at the bottom of the spine, may include: pain and/or numbness to the lateral, or outside, of the foot; a weakness that results in difficulty raising the heel off the ground or walking on the tiptoes. The patient may have reduced ankle-jerk reflex.

According to the severity

• Acute sciatica – Suddenly  onset of pain, that is continued for several time to few hours and gradually decrease the pain due to rest
• Chronic sciatica – It is a long time procedure & continues for a few months

Acute sciatica (short-term)

• Acute sciatica does not typically require professional treatment; OTC painkillers combined with hot and cold packs and exercise can significantly reduce symptoms.
• Acute sciatica normally lasts 4-8 weeks.

Chronic sciatica (long-term)Chronic sciatica

• Chronic sciatica (long-term)Chronic sciatica, on the other hand, may require physical therapy, which can include exercise, applied heat, and other techniques. In rare cases, surgery might be required. Chronic sciatica persists for 8 weeks or more.

Most often the undivided sciatic nerve exits the greater sciatic foramen inferior to the piriformis, but this is not always the case.[rx] In the most common anatomic variant, the sciatic nerve splits above the piriformis and one division exits through the piriformis while the other exits below. There are 6 anatomic variants described in the current literature:

• Type I – sciatic nerve exits inferior to piriformis, undivided
• Type II – sciatic nerve divides above piriformis, one portion exits through the piriformis, the other inferior to it
• Type III – sciatic nerve divides above piriformis, one portion courses anterior to piriformis, the other posterior to it
• Type IV – sciatic nerve exits through the piriformis, undivided
• Type V – sciatic nerve divides above piriformis, one portion exits through the piriformis, the other superior to it
• Type VI – sciatic nerve divides exists from the superior aspect of piriformis posteriorly, undivided

Causes of sciatica

Sciatica might be a symptom of a “pinched nerve” affecting one or more of the lower spinal nerves. The nerve might be pinched inside or outside of the spinal canal as it passes into the leg.

Causes of sciatica

Sciatica is a common symptom of several different medical conditions; however, an estimated 90 percent of cases are due to a herniated (slipped) disk.

The spinal column is made up of three parts:

• Vertebrae (individual bones in the spine that protect underlying nerves)
• Nerves
• Disks

Disks are made of cartilage, which is a strong and resilient material; the cartilage acts as a cushion between each vertebra and allows the spine to be flexible. A herniated or slipped disc that causes pressure on a nerve root — This is the most common cause of sciatica.

Others Causes of Sciatica

• Piriformis syndrome – This develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve.
• Spinal stenosis  – This condition results from the narrowing of the spinal canal with pressure on the nerves.
• Spondylolisthesis – This is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits.
• Cauda equina syndrome – A rare, but serious condition that affects the nerves in the lower part of the spinal cord; it requires immediate medical attention. Cauda equina syndrome may permanently damage the nervous system and even lead to paralysis.

• Bony growths (osteophytes)Bone spurs or osteophytes are bony outgrowths on the edges of joints. Bone spurs form where cartilage is worn away (for example in arthritis) and bone is rubbing on bone. In an effort to protect the body, new bone forms on the edge of joints. This is called a bone spur. Bone spurs are not painful in themselves, but unfortunately, the bone spurs can rub on nearby bone or nerves, causing problems. In the spine, bone spurs can intrude into space normally reserved for the nerves, thus causing sciatica.
• Sudden injury or accident – Some unexpected traumatic events, such as a car accident, can lead to sciatica. Injuries sustained and new scar tissue can place stress on the sciatic nerve.
• Pregnancy – During pregnancy, pain in the back of the thighs spurred by shifts in the pelvic region can be misdiagnosed as sciatica. However, there are situations in which the sciatic nerve is actually being pressed as a result of these changes. Speak to your doctor if you think you are suffering from sciatica or pelvic groin pain.
• Tumors within the spine – may compress the root of the sciatic nerve.
• Infection within the spine.
• Injury within the spine.
• Spinal Stenosis- narrowing of the spinal canal
• Development of bone spurs in the spine
• Herniated Disc
• Arthritis
• Compression of the nerve root
• Pregnancy
• Injuries to the spine
• Degenerative disc disease
• Spinal cancer

Associate causes

• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia

Degenerative

• lumbar disc herniation (most common, especially at L4/5 and L5/S1)
• lumbar spinal canal stenosis
• spondylolisthesis
• Tarlov cysts
• facet joint cysts

Trauma

• Traumatic events leading to fracture or partial dislocation (subluxation) of the low back (lumbar spine) result in compression of the sciatic nerve.
• Spinal fracture or dislocation
• Epidural hematoma (may also be spontaneous, post-operative, post-procedural or post-manipulation)
• A collection of blood surrounding the nerves following trauma (epidural hematoma) in the low back area can lead to compression of sciatica.
• Penetrating trauma (gunshot or stab wounds) can cause damage or compression of the sciatic nerve.
• A rare complication of spinal manipulation is partial dislocation (subluxation) of the low back (lumbar spine) that can cause sciatica syndrome.

Herniated Disk

• Most disk herniations will improve on their own (are self-limiting) and respond well to conservative treatment, including anti-inflammatory medications, physical therapy, and short periods of rest (one to two days).
• Sciatica syndrome can result from a herniated lumbar disk.
• Of lumbar disk herniations, most occur either at the vertebral levels L4-L5 or L5-S1.
• Seventy percent of cases of herniated disks leading to sciatica syndrome occur in people with a history of chronic low back pain, and some develop sciatica syndrome as the first symptom of lumbar disk herniation.
• Males in their 30s and 40s are most prone to cauda equina syndrome caused by disk herniation.
• Most cases of sciatica syndrome caused by disk herniation involve large particles of disk material that have completely separated from the normal disk and compress the nerves (extruded disk herniations). In most cases, the disk material takes up at least one-third of the canal diameter.

Spinal Stenosis

• Spinal stenosis is any narrowing of the normal front to back distance (diameter) of the spinal canal.
• Narrowing of the spinal canal can be caused by a developmental abnormality or degenerative process.
• The abnormal forward slip of one vertebral body on another is called spondylolisthesis. Severe cases can cause a narrowing of the spinal canal and lead to sciatica syndrome

Tumors (Neoplasms)

Sciatica syndrome can be caused by isolated tumors (primary neoplasms) or from tumors that have spread to the spine from other parts of the body (metastatic spinal neoplasms). Metastatic spine tumors are most commonly from the prostate or lung in males and from the lung and breast in females.

• Malignant – lymphoma ,metastases ,primary CNS malignancies(e.g. ependymoma, schwannoma, neurofibroma)
• The most common initial symptom of people with cauda equina syndrome caused by a tumor (spinal neoplasm) is severe low back and leg pain.
• Later findings include lower extremity weakness.
• Loss of feeling in the legs (sensory loss) and loss of bowel or bladder control (sphincter dysfunction) are also common.

Inflammatory Conditions

• Both acute and chronic form may be seen in long-standing ankylosing spondylitis (2nd-5th decades; average 35 years)
• Long-lasting inflammatory conditions of the spine, including Paget disease and ankylosing spondylitis, can cause a narrowing of the spinal canal and lead to sciatica syndrome.

Infectious Conditions

• Infections in the spinal canal (spinal epidural abscess) can cause deformity of the nerve roots and spinal column.
• Symptoms generally include severe back pain and a rapidly worsening muscle weakness.
• Infective – epidural abscess, tuberculosis (Pott disease)

Accidental Medical Causes (Iatrogenic Causes)

• Poorly positioned screws placed in the spine can compress and injure nerves and cause sciatica syndrome.
• Continuous spinal anesthesia has been linked to cases of sciatica syndrome.
• Lumbar puncture (spinal tap) can cause a collection of blood in the spinal canal (spontaneous spinal epidural hematoma) in patients receiving medication to thin the blood (anticoagulation therapy). This collection of blood can compress the nerves and cause sciatica syndrome.
• Aortic dissection
• Arteriovenous malformation

Symptoms of Sciatica

Basic symptoms are

• Bilateral neurogenic sciatica – Pain associated with the back and/ or unilateral/bilateral leg symptoms may be present.
• Reduced perineal sensation – Sensation loss in the perineum and saddle region is the most commonly reported symptom.
• Altered bladder function leading to painless retention – Bladder dysfunction is the most commonly reported symptom and can range from increased frequency, difficulty in micturition, change in the stream, incontinence, and retention.
• Loss of anal tone – loss or reduced anal tone may be evident if a patient reports bowel dysfunction. Bowel dysfunction may include incontinence, inability to control emotions, inability to feel when the bowel is full, and consequently overflow.
• Loss of sexual function – Sexual dysfunction is not widely mentioned in the literature but is an important aspect that should be discussed with patients.
• Weakness in the Legs – The weakness is oftentimes asymmetric.
• Loss of Sensation – Those affected may experience numbness or tingling in their perineum
• Loss of Reflexes – A person’s knee and ankle reflexes might be diminished, along with anal and bulbocavernosus abilities.
• Sensory Loss – Sensory loss may range from, ‘pins and needles,‘ to complete numbness. It might affect a person’s bowel, bladder and genitalia bladder, bowel and

The associate clinical feature is..

• Severe back pain
• Saddle anesthesia i.e., anesthesia or paraesthesia involving S3 to S5 dermatomes, including the perineum, external genitalia, and anus; or more descriptively, numbness or “pins-and-needles” sensations of the groin and inner thighs which would contact a saddle when riding a horse.
• Bladder and bowel dysfunction, caused by the decreased tone of the urinary and anal sphincters.
• Sciatica type pain on one side or both sides, although pain may be wholly absent
• The weakness of the muscles of the lower legs (often paraplegia)
• Pain in one leg (unilateral) or both legs (bilateral) that starts in the buttocks and travels down the back of the thighs and legs (sciatica)
• Numbness in the groin or area of contact if sitting on a saddle (perineal or saddle paresthesia)
• Bowel and bladder disturbances
• Lower extremity muscle weakness and loss of sensations
• Inability to urinate (urinary retention)
• Inability to stop or control urination (incontinence)
• Reduced or absent lower extremity reflexes
• Local pain is generally a deep, aching pain resulting from soft tissue and vertebral body irritation.
• Leg pain (radicular pain) is generally a sharp, stabbing pain resulting from compression of the nerve roots.
• Radicular pain projects along the specific areas controlled by the compressed nerve (known as a dermatomal distribution).
• Inability to stop or feel a bowel movement (incontinence)
• Constipation
• Loss of anal tone and sensation
• Achilles (ankle) reflex absent on both sides.
• Sexual dysfunction
• Absent anal reflex and bulbocavernosus reflex
• Gait disturbance

Additional symptoms

• Sharp, shooting or searing pain in the leg
• Numbness or pins and needles in leg and foot
• Weakness when moving the leg or foot ,
• Electric shock sensation in back or legs
• Burning or prickling sensations
• Inability to bring the foot upwards (walk on heels)
• Weakness in lifting the big toe or ankle up
• Pain and/or numbness on top of the foot, particularly between the big toe and second toe.
• Pain and/or numbness to the lateral, or outside, of the foot;
• Difficulty raising the heels off the ground

Diagnosis of Sciatica

A doctor can diagnose cauda equina syndrome. Here’s what you may need to confirm a diagnosis

• A medical history – in which you answer questions about your health, symptoms, and activity.
• A physical exam to assess your strength – reflexes, sensation, stability, alignment, and motion. You may also need blood tests.
• Magnetic resonance imaging (MRI) scan – which uses magnetic fields and computers to produce three-dimensional images of your spine.
• A myelogram – an X-ray of the spinal canal after injection of contrast material — which can pinpoint pressure on the spinal cord or nerves.

• A computed tomography (CT) scan.
• Urodynamic studies – may be required to monitor recovery of bladder function following decompression surgery.

Treatment of Sciatica

Patient Education

Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)

• Use of hot or cold packs for comfort and to decreased inflammation
• Avoidance of inciting activities or prolonged sitting/standing
• Practicing good, erect posture
• Engaging in exercises to increase core strength
• Gentle stretching of the lumbar spine and hamstrings
• Regular light exercises such as walking, swimming, or aromatherapy
• Use of proper lifting techniques

Non-surgical

• Rest – It is important that patient take proper rest and sleep and avoid any activities which will further aggravate the disc bulge and its symptoms. Many minor disc bulges can heal on their own with rest and other conservative treatment.
• Ice & Moist Heat Application – Ice application where the ice is wrapped in a towel or an ice pack for about 20 minutes to the affected region, thrice a day, helps in relieving the symptoms of a disc bulge. Heat application in the later stages of treatment also provides the same benefit.
• Heat therapy/Cryotherapy – In the initial stages of Sciatica, the application of heat or ice packs may be recommended to alleviate pain. The patient can wrap ice cubes in a clean towel for application to prevent ice burns. The patient may be advised to apply the pack every 2-3 hours for not more than 10 minutes each. Some patients may find relief by alternating between hot and cold therapy.
• Exercising – Long walks, stretching the piriformis muscle (runs parallel to the sciatic nerve in the leg), water aerobics, lower abdominal crunches and strengthening muscles of the abdomen and back help may provide additional support to the sciatic nerve
• Orthotics – Use of external support devices such as a back brace, crutches, and a walking cane can help relieve pressure on the nerve
• Physical Therapy – Consulting a physical therapist may enable the patient to deal with his/her daily activities and shorten the recovery period.
• Cervical Pillow – It is important to use the right pillow to give your neck the right type of support for healing from a cervical disc bulge and also to improve the quality of sleep.
• Hot Bath – Taking a hot bath or shower also helps in dulling the pain from a disc bulge. Epsom salts or essential oils can be added to a hot bath. They will help in soothing the inflamed region.
• Over the Door Traction – This is a very effective treatment for a disc bulge. It helps in relieving muscle spasms and pain. Typically a 5 to 10-pound weight is used and it is important that patients do this under medical guidance.
• Support or brace – A pelvic belt can be used to stabilize a joint that is too loose until the inflammation and pain subside.
• Deep tissue massage may be helpful
• Physical therapy, which may include ultrasound, massage, conditioning, and exercise
• Weight control
• Use of a lumbosacral back support

Medications

• Analgesics – Prescription-strength drugs that relieve pain but not inflammation.
• Antidepressants – A Drug that blocks pain messages from your brain and boosts the effects of endorphins (your body’s natural painkillers).
• Medication – Common pain remedies such as aspirin, acetaminophen, ibuprofen, and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenoses, such as muscle spasms and damaged nerves.
• Corticosteroid injections – Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make the inflammation go down. However, because of side effects, they are used sparingly.
• Anesthetics – Used with precision, an injection of a “nerve block” can stop the pain for a time.
• Muscle Relaxants – These medications provide relief from spinal muscle spasms.
• Neuropathic Agents: Drugs(pregabalin & gabapentin) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling.
• Antibiotic –  to the management of bowel & bladders control and protect further infection. Infection causes should be treated with appropriate antibiotic therapy
• Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin.
• Calcium & vitamin D3 – to improve bone health and healing fracture.
• Glucosamine & diacerein – can be used to tightening the loose tension and regenerate cartilage or inhabit the further degeneration of cartilage.
• Corticosteroid oral tablets– to healing the nerve inflammation and clotted blood in the joints.
• Dietary supplement -to remove general weakness & improved health.
• Joint injections – Numbing injections into the sacroiliac joint are used diagnostically to help identify the cause of them but are also useful in providing immediate pain relief. Typically, an anesthetic is injected along with anti-inflammatory medication.

Other Treatment Options

Other treatment options –  may be useful in certain patients, depending on the underlying cause of the CES

• Anti-inflammatory agents – including steroids, can be effective in patients with inflammatory causes – eg, ankylosing spondylitis.
• Chemotherapy – Patients with spinal neoplasms should be evaluated for chemotherapy and radiation therapy.
• Weakness – Physiotherapy may be helpful if there is no inflammatory component such as that found in arachnoiditis where exercise might exacerbate the condition and cause flare-ups.
• Vitamin B complex – Sensory Loss little conventional treatment exists for sensory loss in cauda equina syndrome, although in conditions such as Multiple Sclerosis use of vitamin B complex is considered to have potentially beneficial effects.
• Sore Feet – Loss of muscle tone and control over the movement of the foot may lead to foot pain. If foot drop is a notable issue, a brace to hold it in the position may help. It is important; however, to attempt to maintain as much muscle tone as possible as well as the range of movement (ROM). Exercises might help.
• Sexual Dysfunction – Sexual dysfunction is very hard for people to talk about at times. It might be best to pursue advice from specialists. If no physical treatment is feasible for improving function, the person and their sexual partner might pursue counseling which might help to lessen the impact of this disability on not only the person affected but their partner.
• Depression – Depression is an understandable reaction to a form of debilitating illness. Antidepressant medication should be reserved for severe depression. Counseling and support are the preferred methods of managing depression. Sharing experiences may help people with cauda equina syndrome to come to terms with the disabilities associated with Cauda equina syndrome.
• Postoperative care – includes addressing lifestyle issues (eg, obesity), and also physiotherapy and occupational therapy, depending on residual lower limb dysfunction. Muscle relaxants, such as cyclobenzaprine might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment.
• Spinal injections — An injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility.

Surgery

Surgery might be needed for people who do not respond to conservative treatment, who have progressing symptoms and are experiencing severe pain.

Common minimally invasive surgeries are

• Discectomies – During a discectomy, an expert removes herniated disc material that is pressing on the sciatic nerve.
• Microdiscectomies – A microdiscectomy or microdecompression involves removing fragments of intervertebral discs that have broken away and are pressing on the sciatic nerve or spinal cord. Microdiscectomies may also extract bulging or protruding disc material that is causing sciatica.
• Laminectomies – Sometimes, a portion of the vertebral bone called the lamina can be ousted to curtail sciatica

Other Rx

Chiropractic Care

Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”

Acupuncture

“You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.

Yoga

A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates sciatica,” says James W. Carson, Ph.D., a psychologist at the Comprehensive Pain Center at Oregon Health & Science University. For extra grip and stability, try these grip socks from Natural Fitness.

Massage

Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.

Topical Preparations

St. John’s wort oil, a liniment, is “one of my favorites for nerve pain,” says Tieraona Low Dog, MD, director of the fellowship at the Arizona Center for Integrative Medicine. Apply the anti-inflammatory oil two or three times a day where there’s a pain. Another option: an OTC cayenne pepper plaster or cream; capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.

Ice or Heat

Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But the time-honored treatments can act as counterirritants—that is, “they give your body other input in the painful area, and that brings the pain down a notch,” says Ruppert. Apply an ice pack or a heating pad as needed for 15 minutes.

Devil’s Claw

The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. She generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications.

Epidural Steroid Injections

People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.

Exercise and Physical Therapy for Sciatica

Some simple exercises and stretches you can do at home can help ease pain from sciatica (pain in your buttocks, legs and feet) and improve your strength and flexibility.Aim to do these exercises every day, along with other activities like walking, swimming or yoga.

Your pain should start to ease within 2 weeks and will usually pass in about 4 to 6 weeks.

See a GP if:

• your pain doesn’t improve within a few weeks
• you experience severe pain while trying any of these exercises

Knee to chest stretch

Start position: Lie on your back on a mat or the carpet. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.Action: Bend one knee up towards your chest and hold it with both hands. Hold for 20 to 30 seconds with controlled deep breaths.

Repeat 3 times, alternating legs.

Tips:

• Don’t tense your neck, chest or shoulders.
• Only stretch as far as is comfortable.

Variation: Grasp both knees and press into your chest.

Sciatic mobilizing stretch

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.Action: Bend one knee up towards your chest. Hold the back of your upper leg with both hands, then slowly straighten the knee. Hold for 20 to 30 seconds, taking deep breaths. Bend the knee and return to the starting position.

Repeat 2 or 3 times, alternating legs.

Tips:

• Don’t press your lower back down into the floor as you stretch.
• Only stretch as far as is comfortable.

Back extensions

Start position: Lie on your front and rest on your forearms with your elbows bent at your sides. Look towards the floor and keep your neck straight.Action: Keeping your neck straight, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles. Breathe and hold for 5 to 10 seconds. Return to the starting position.

Repeat 8 to 10 times.

Tips:

• Don’t bend your neck backwards.
• Keep your hips on the floor.

Standing hamstring stretch

Start position: Stand upright and raise one leg on to a stable object, such as a step. Keep that leg straight and your toes pointing up.Action: Lean forward while keeping your back straight. Hold for 20 to 30 seconds while taking deep breaths.

Repeat 2 or 3 times with each leg.

Tips:

• Only stretch as far as is comfortable.
• Your lower back shouldn’t arch at any time.

Lying deep gluteal stretch

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your left leg and rest your right foot on your left thigh.Action: Grasp your left thigh and pull it towards you. Keep the base of your spine on the floor throughout and your hips straight. You should feel the stretch in your right buttock. Hold for 20 to 30 seconds while taking deep breaths.

Repeat 2 or 3 times with each leg.

Tip:

• Use a towel around your thigh if you can’t hold it.

Pigeon Pose

Knee to opposite shoulder

Sitting spinal stretch

Exercise with care

 Home Remedies For Sciatica Pain

Suffering from sciatica, you may feel a pain that goes along the path of the sciatic nerve that branches from your lower back, your hips, and buttocks to each leg. However, sciatica pain can influence in one side of your body. Sciatica will happen when a herniated spine compresses part of your nerve. As a result, it will cause pain, inflammation and numbness in your affected legs and even in your toes. Factors, including age, obesity, occupation, prolonged sitting, diabetes may increase the risk of developing sciatica pain.

Hot Or Cold Compress

It is said that using hot or cold compress is the first tip on how to treat sciatica pain and inflammation. Tense muscles may compress the sciatic nerve; as a result, it can cause sciatica pain. Heat temperature may help you to find the significant relief because it will relax the tense muscles. Cold treatment is also effective in easing swelling around the nerve and numbing the pain. You can alternate heat and cold treatment. Specifically, start the hot compress and then apply the cold compress. If you want to use heat treatment, it will be a great idea to use moist heat like taking a steamed towel. You should apply a cold or hot pack on your affected areas and hold it for 15 to 20 minutes.

Turmeric

Turmeric contains anti-inflammatory properties; therefore, it should be considered as one of the effective home remedies for sciatica. Moreover, it contains curcumin, a compound that helps to reduce inflammation and nerve pain. In order to treat sciatica with turmeric, you should add one teaspoon of turmeric into one cup of milk. If you want, you can put a small cinnamon stick into it. After that, boil the solution. When it finishes, turn off the heat and add a little of honey to make it sweet. It is recommended drinking this solution once or twice daily for a few weeks in order to see a significant improvement.

Massage

Asking for home remedies for sciatica pain, you should not ignore massage treatment. Massage therapy will be effective in relieving the pain caused by muscle spasm. Moreover, it will help your body to relax, release tension, boost blood circulation, and stimulate the range of motion.

You should massage your affected lower back and legs with St John’s wort oil twice or three times daily until you get a significant result. St John’s wort contains anti-inflammatory properties; therefore, it can help you to relieve inflammation and sciatica pain.

Valerian

Using valerian as one of the effective home remedies for sciatica will help you to relieve the pain and relax your muscles. Valerian is effective in treating sciatica pain associated with a muscle spasm. The possible reason may be that this herb contains a volatile oil which is effective in relaxing your muscles and easing the tension. Moreover, patients with sleep deprivation also use valerian as their excellent solution.

Capsaicin Cream

Capsaicin which is the active ingredient in cayenne peppers can work as effective pain relief. Capsaicin plays the important role in weakening the levels of a neurotransmitter known as substance P that transmits pain signals.

Therefore, patients who get diagnosed with sciatica can buy an ointment or cream containing 0.025% to 0.075% capsaicin.

Fenugreek Seeds

A poultice made from fenugreek seeds may help you to ease sciatica pain. The possible reason may be that fenugreek seeks to contain anti-inflammatory properties. Moreover, fenugreek seeds are also considered as an effective treatment for gout pain and rheumatoid arthritis.

White Willow Bark

White Willow Bark can be used for sciatica pain and this remedy has a long-lasting result. This is because white willow bark contains salicin and phenolic glycosides, which can give you analgesic and anti-inflammatory benefits. Patients with sciatica pain should take a white willow bark containing 120 or 240 mg salicin every day for a few weeks. However, you should consult a doctor first before using white willow bark as one of the home remedies for sciatica pain. Ask your doctor about possible side effects.

Spinal Manipulation

Chiropractic care is increasingly considered as a natural treatment for back and neck pain. Chiropractic spinal manipulation with different techniques such as rapid, short thrusts is effective in alleviating nerve irritation, inflammation and other symptoms related to sciatica. According to a study published in 2015 in the Journal of Manipulative and Physiological Therapeutics, 60 percent of the study participants who suffer from sciatica recover well to the same degree as patients with sciatica take a surgical intervention. Because the techniques and methods used in chiropractic spinal manipulation vary from individual to individual and depend on the exact cause of sciatica pain, you should consult the doctor first and ask him for proper treatment.

Tennis Ball Therapy

Tennis ball therapy involves different techniques of acupressure, massage, and reflexology which can help you to relieve muscle tension and sore muscles. As one of the home remedies for sciatica pain, a tennis ball is effective in treating the piriformis muscle located close to the sciatica nerve. This muscle can make the sciatica nerve press against the tendons, which causes buttock and leg pain. The tennis ball therapy will treat certain points in the piriformis muscle; as a result, it helps to ease the muscle tension and rigidity. Moreover, the tennis ball will improve the blood circulation to this area and boost mobility.

 Epsom Salt Bath

Asking for home remedies for sciatica pain, you should not ignore Epsom salt bath. Epsom salt which is available in any local drug store is effective in relaxing the nervous system and flush toxins out of your body. In order to use Epsom salt to treat sciatica, you just need to add 2 cups of Epsom salt into a bath filled with hot water. Patients with sciatica are recommended soaking the Epsom salt bath for about 15 – 20 minutes. Heat temperature of this bath will help you increase blood circulation and ease inflammation.

Sleep

Sleep is an important thing for the recovery process. For patients with sciatica, they need extra good quality sleep in order to restore the balance of their body. Sleep will help to relax your muscle, rebuild your nerve, balance the temperature and make sure that your body parts perform their optimal roles. It is recommended sleeping in a dark room with no artificial light in order to provide your body the purest relax.

Hydration

When you suffer from sciatica, you should drink enough water to lubricate and hydrate your body. Water is a great choice if you want to reduce inflammation and nourish the nerves. However, tea made from these herbs such as linden flower, milky oat tops, lemon balm, and licorice root and so on will also nourish your body and help you to find the significant relief from sciatica pain. It is recommended to drink enough 8 glasses of water per day.

Breath

It is said that deep breathing can help you to bring oxygen to every cell in your body. Deep belly breathing is considered a powerful and simple tool that will help you ease sciatica pain.

Jamaican Dogwood

Jamaican dogwood, which comes from the bark of the dogwood tree is a curative powerful substance for nerve pain. In order to treat sciatica, you can take Jamaican dogwood supplements or apply Jamaican dogwood tincture on your affected areas. Before taking its supplement, you should consult a doctor before and ask them about possible unwanted side effects. Pregnant women or breastfeeding moms should avoid using Jamaican dogwood to treat sciatica pain.

Garlic

Like turmeric, garlic contains anti-inflammatory properties; therefore, it should be considered as one of the effective home remedies for sciatica pain. You can take garlic supplement or include garlic in your dietary dishes. It is recommended to chew four raw cloves every morning in order to get significant relief from pain.

Grapes

Grapes are the common citrus fruit that can be used for various health purposes. Because grapes have anti-inflammatory properties, it can be considered as one of the effective home remedies for sciatica pain. It is recommended to consume anti-inflammatory fruits like grapes to reduce inflammation.

Lemon

Lemon is an available ingredient in every kitchen. More importantly, lemon is amazingly effective in treating the problem of sciatica. The possible reason may be that lemon has a great source of vitamin C, an anti-inflammatory vitamin, which can ease soreness, swelling, and pain. You should increase vitamin C intake by consuming lemon juice on a regular basis. Vitamin C can work well for inflammation as well as sciatica pain subsides.

Take Devil’s Claw

Devil’s claw, an herbal supplement, can help patients with sciatica find relief. This herb can work as anti-inflammatory drugs such as ibuprofen. It is recommended taking a dose of around 1,500 mg daily. No side effects are shown in most cases. However, people who are taking blood-thinning drugs such as warfarin should avoid this treatment because using the devil’s claw together with blood-thinning drugs may cause problems. Therefore, it is still needed to talk to your doctor before making your choice.

Diet For Sciatica

For patients with sciatica, it is important to have a healthy and well-balanced diet which includes complex carbohydrates, fresh vegetables, whole grains, and organic animal protein. It is recommended to eat healthy foods that are rich in potassium such as oranges, potatoes, bananas, spirulina, oranges, and chlorella. Moreover, a patient with sciatica should also eat more saltwater fish like salmon, flounder, and sardines.

Infrared Light

Infrared mats will help you to ease any form of back pain. All things you need to do are plugging in the infrared mats to an electric resource and lying down on your mat. The infrared light will be effective in treating nerve pain and making you relax.

Nutmeg Powder

Mix roasted nutmeg powder with a tablespoon of ginger oil. Wait for a few minutes until the mixture cools down. After that, you can apply it on your affected skin areas. Leave for 20 minutes and then rinse it off with lukewarm water. It is said that if you want to get a more satisfactory result, you should repeat this treatment several times a week for a few weeks.

Mustard Oil

Talking about home remedies for sciatica pain, I would like to mention mustard oil treatment. You should mix 3 tablespoons of mustard oil, carom seeds with three crushed cloves of garlic. Heat this mixture for a few minutes and then allow it to cool down. Use your fingertips to massage the affected areas with this mixture gently. Repeat this process until you find the significant relief.

Elderberry

All the parts of elderberry such as leaves, fruits or flowers can be used for many uses. Thanks to their muscle-relaxing properties, elderberry can help to reduce pressure on the ends of affected nerves. If you want to get a better result, you should drink a glass of elderberry juice twice a day.

Black Snakeroot

You should add ½ tablespoon of dried black snakeroots into a cup of boiling water. Cover it and let it steep for about 15 minutes. It is recommended to drink 2 tablespoons of this solution three times daily.

Celery

Coumarin, a compound present in celery, contains anti-inflammatory and antioxidant properties which are effective in treating sciatica pain. All things you need to do are adding celery leaves and stems into a glass of boiling water. Continue to boil until the water turns green. To get rid of sciatica pain, you should drink 3 cups of celery tea every day.

Dong Quai

As one of the effective home remedies for sciatica, drinking a mixture of dong Quai and water will cure the pain in a natural way.

Potato Juice

Firstly, you should grate one potato and then extract its juice. Make potato juice with sufficient carrot juice. Drinking this solution twice a day will help you to reduce irritation and ease the pain in your foot and leg.

Chamomile

Thanks to anti-inflammatory properties, you should massage your affected area with chamomile oil. For better results, you should repeat this treatment several times a week for a few weeks.

Wintergreen oil

Besides chamomile oil, massaging your affected areas gently with wintergreen oil is also effective in treating sciatica pain. You can find wintergreen oil available in herbal shops.

 Horseradish

Horseradish is also one of the effective home remedies for sciatica pain. You just need to mince some horseradish until it becomes a fine past. Warm it a little bit and then massage the affected areas with this paste. Use a clean cloth over the treated area and then wait for 2 hours.

Homeopathic Remedies for Sciatica

Specific treatment for sciatic will depend on the cause of the nerve damage, so professional help is recommended. Most people rely on pain medication that will provide temporary relief. Surgery is often only needed when bowel or bladder function becomes disturbed, of if chronic nerve pressure and persistent pain fail to be relieved.

Homeopathy can complement your sciatica treatment plan. A study published in the journal Homeopathy in 2012 found that the homeopathic treatment hypericum improved the functional recovery of peripheral nerve regeneration in rats with sciatic nerve damage. For the study, the rats received three oral drops of hypericum 30c twice daily for a week.

For sciatic pain, 30c is the appropriate potency per hour or as needed. In chronic cases, one to three doses should be sufficient. The following are eight other popular sciatica homeopathic remedies often used for sciatic pain relief.

Ammonium Muriaticum

Ammonium muriaticum is often used for chronic sciatica with tearing and shooting into the tips of the toes. The sufferer may also have difficulty straightening the affected leg due to contractions of the hamstring. Heel pain, hip pain, and a lopsided walking style are also common. Symptoms improve from walking stooped, limbering up, lying down, and rubbing the affected area; however, symptoms worsen from sitting, walking erect, resting in bed, or at night.

Magnesia Phosphorica

Magnesia phosphorica will benefit a person showing the traditional sciatica pattern of nerve pain that extends from the low back to the back of the leg and buttocks. The pain can feel cramping, sudden, violent, or neuralgic with sharp, shooting, cutting, or lightning-like pains. Warmth and pressure will often improve symptoms.

Colocynthis

Colocynthis is another classic sciatica remedy, especially when sciatica is left-sided, and pain improves from hard pressure and warmth. No position will relieve pain, and yet symptoms worsen from movement, dampness, and at night. What’s interesting is that lying on the painful side actually improves symptoms.

Arsenicum

Arsenicum is deemed necessary when sciatica results from the cold. Primary symptoms will include restlessness, weakness, exhaustion, chilliness, aching heels, and burning pain that may travel to the toes. Symptoms improve from gentle walking, warmth, or hot compress. Symptoms may worsen after exertion, dampness, and while on the right side.

Chamomilla

Chamomilla is often required when it is extremely intense and tearing pain from the buttocks to the heel with numbness. The pain is often so intense, it will drive the person out of bed at night. Other symptoms include restless legs, stiffness, irritability, heavy limbs, spasms, hot sweats, burning feet, and cramps in the calves. Symptoms may worsen from lying on the painless side, warmth, stretching, at night, and after being angry.

Gnaphalium

Gnaphalium is recommended when intense numbness with tingling followed the sciatica pain that can be described as intense cutting and shooting pains experienced along the whole length of the nerve. There may also be cramps in the calves, neuralgia in the front of the leg, and the joints may feel creaky and dry. Symptoms often improve from sitting and worsen from movement and dampness.

Rhus Toxicodendron

Consider Rhus Toxicodendron for sciatica with intense attacks of burning and tearing pain. The person’s legs may also feel dead, stiff, or wooden. Leg cramps and pain down the back of the thighs are also common. Symptoms may improve from continued motion, rubbing, stretching, or heat; however, they seem to worsen from overexertion, initial motion, dampness, after resting, and at night.

Phytolacca

Phytolacca is needed when sciatica produces aching pain and sudden shooting down the leg or outside of the thighs. Other symptoms may include weakness, stiffness, aching heels, and contracted hamstrings. Restlessness usually worsens from motion, and cramps and knotting come and go. Warmth and lying down often improve symptoms, while pressure and dampness make it worse.

Support your spine

Use good posture when sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back.
Avoid sitting for long periods.

What is the outlook for people with sciatica?

Sciatic pain usually goes away with time and rest. Most people with sciatica (80 percent to 90 percent) will get better without surgery. About half of affected individuals recover from an episode within six weeks.

Can sciatica be prevented

Some sources of sciatica are not preventable, such as degenerative disc disease, back strain due to pregnancy, and accidental falls.

Although it might not be possible to prevent all cases of sciatica, you can take steps to protect your back and reduce your risk.

Practice proper lifting techniques. Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.
Avoid/ stop cigarette smoking, which promotes disc degeneration.

References

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