What is Sciatica?
Sciatica is the pain that is as alleviating associated with the irritation or undue compression of the Sciatic Nerve. The Sciatic nerve is the longest nerve in the human body and it runs down from the lower back through hips and buttocks, to the toes. This nerve is situated at the back of both the legs and is very prominent, being 2cm thick.
Generally, the pain is felt only in one leg. The area of pain could be in the lower back, hip or buttocks. There could be a pain at the back of thigh and in some cases, the pain could be felt right from the lower back to the toe in the posterior part of the leg.
The Sciatic nerve pain can be mild, tingling, on one hand, and on the other hand, it could be very severe and unbearable. The severity of the pain may be so high, that it could immobilise the patient and may affect the bowel and/or bladder control too.
When mild/intermittent pain is felt, it is not considered to be very serious and can be managed by self-help/home remedy and over-the-counter medication. But the severe manifestation of the Sciatic pain warrants specialised medical attention and treatment.
Sciatica is a symptom and not a medical condition.
Symptoms of Sciatica pain
Whenever the Sciatic nerve fibre is irritated, it develops pain that can radiate anywhere from the lower back up to the toe, along the nerve.
Thе раіn thаt radiates frоm thе lower spine (lumbar) tо thе buttосkѕ аnd gоеѕ dоwn thе bасk оf thе lеg іѕ thе hаllmаrk оf ѕсіаtіса. Yоu mау еxреrіеnсе dіѕсоmfоrt аlmоѕt аnуwhеrе аlоng thе nerve раthwау, but іt іѕ еѕресіаllу lіkеlу tо fоllоw a раth frоm thе lоwеr bасk tо thе buttосk аnd thе bасk оf thе thіgh аnd саlf.
The pain is very typical of a burning sensation and can be easily identified. The pain can become worse in positions like sitting, or when lying down for a long time, squatting, climbing stairs or lifting any weight from the floor.
From being mild and intermittent, it could be persistent and severe too. At times it may feel like an electric shock, very sharp and intolerable. A feeling of numbness may also develop if the condition aggravates.
Causes
Sсіаtіса оссurѕ whеn thе ѕсіаtіс nеrvе become pinched, uѕuаllу bу a herniated dіѕс іn thе spine оr bу еxсеѕѕіvе bоnе grоwth (bоnе ѕрur) іn thе vertebrae.
Herniated Disc
In the spine, between the vertebras, there are soft discs consisting of jelly-like nucleus bound by the hard-annular ring. These soft tissues, facilitate flexible and smooth movement of the spinal cord.
But due to usage and age, sometimes these, annular rings develop cracks and the inner soft tissue projects out. As they project out, they tend to pinch the Sciatic nerve, resulting in the sharp typical pain.
Bone Spur
These are a kind of typical condition in which the vertebra bone develops extra, and creates spur-like structure. These spurs go and compress the sciatic nerve and irritate it to result in Sciatica pain.
Lumbar Spinal Stenosis
In this condition, the spinal canal starts narrowing down, generally after the age of 50 years. This narrowing of the spinal canal pressurises the Sciatic nerve and it gets inflamed and irritated to radiate sciatic pain.
Spondylolisthesis
Generally known as Slip Disk, here the disk slips out of its place between the vertebra. This may also result in the compression and irritation of the Sciatic nerve.
Degenerative Disk Disease
The disk itself starts breaking away and gets degenerated and this may also irritate the sciatic nerve.
Pregnancy
In some cases, the sciatic nerve may also come under pressure during pregnancy and the would-be mother may suffer from Sciatica, though temporarily.
The most common cause among all the above-listed ones is the HERNIATED DISC.
Long sitting hours coupled with bad sitting postures can lead to this condition. Lifting very heavy weights, without due consideration to the body posture can also be an invitation to Sciatica.
Overweight, lack of exercise, prolonged used of high heels, sleeping on a too soft or too hard mattress are some other reasons for the onset of Sciatica.
How to diagnose Sciatica?
If Sciatica is suspected, care should be taken immediately, otherwise the condition might aggravate. The onset of Sciatica can be checked in two ways
- By physical examination.
- By undergoing tests like X-ray, MRI, CT scan, Electromyography.
If the condition is very painful and diabolic, one should go for diagnostic testing, otherwise, the physical examination is good enough to diagnose Sciatica.
In the physical examination, the doctor would want to test your muscle strength, reflexes and flexibility.
At the onset, he may make you walk on toes/heels and look out for pain reaction. He may ask you to do a squat. If you experience pain, doing this, it could be Sciatica.
Physical examination of Sciatica
Straight Leg Raising
The patient lies supine (lying horizontally with the face and torso facing up) and then lifts one leg, straight from the hip, gradually, till it makes an angle of 90 degrees with the ground. Repeat with the second leg. If pain is experienced below the knee, Sciatica is diagnosed
Crossed straight leg raising
The patient is made to lie supine and the unaffected leg is raised straight from the hip. If the patient suffers pain in the other leg, because of this, it means Sciatica tested positive.
Bragard
Do as in Straight Leg raising test and as soon as the patient feels pain in the raised leg, lower that leg a bit and flex the ankle. If the pain reoccurs, the test is positive for Sciatica.
Fajersztajn
This is very similar to the Bragard, except that the flexing of the ankle is vertical.
Bechterew
The Patient sits on an examination couch with legs down and hanging. Then he lifts one of the legs to project it straight from the hip. Pain may occur. If not make him flex ankle vertically. Pain may occur. If not make him lower his head. Pain may occur. If pain occurs at any stage, it is a positive test for Sciatica.
Slump
This is similar to Bechterew. Just a confirmation test. Where the straight leg is bent a little and the ankle is flexed to test pain.
Bow String
Make the patient lie down supine and raise his leg up straight. As soon as the pain shoots bend the leg inward at knee and press with thumb in the well of the knee. Sharp shooting pain is indicative of Sciatica.
All the above are some specialised positions and postures which a trained Physiotherapist or Doctor would ask a patient to do. He would observe the body movements and the corresponding pain if any, that the patient develops in these positions and would conclude the existence/non-existence of Sciatica.
How to treat sciatica pain?
Self Help / Home Treatment
The Milder form of sciatica can be self-treated but the severe ones definitely need to be looked after by the Doctor.
Some of the remedies that can be tried before consulting a doctor are
- Rest for a day or two, (not more) and check if there is a relief.
- Apply cold packs 3-4 times a day for 2 to 3 days.
- Then after 2/3 days of cold pack, apply hot packs, starting with just warm temperatures of the pack.
- Alternate cold and hot packs, 4 to 5 times in a day if the pain persists.
- Over the counter, non-steroidal, painkillers like ibuprofen (Advil, Motrin IB,) or Naproxen Sodium might help. ( take physicians advice)
- Gentle slow stretching exercises should be down, to stretch legs, hips and abdomen.
Some of the exercises suggested are:
Knee To Chest Stretch
Lie down supine on the floor and bend your legs at knees.
Then hold one of the knees and pull it up as high as possible to touch your chest.
Repeat with the other leg. Repeat the whole sequence 6-8 times.
The sciatic mobilising stretches
As in the previous exercise, lie down on your back and bend your knees to fold your legs.
With your hands hold the back of the thigh of one leg and stretch it up straight.
Hold for 10-15 seconds. Lower the extended leg and then rest it next to the other leg.
Repeat with the other leg. Repeat the whole sequence 6-8 times.
Back Extensions
Lie on your chest with your arms legs held.
Slowly lift your chest and hold for a few seconds in the position shown below.
Go back to the starting position and repeat it 6-8 times.
Standing Hamstring Stretch
Stand comfortably with a step or a stool, not more than knee height, in front of you.
Place your leg straight on step/stool and the toes pointing towards the ceiling.
Bend forward from your hips as far as you can comfortably.
Repeat 6-8 times.
Deep Gluteal Stretch
Lie on your back and fold your legs at the knees and rest the heel on the ground.
Lift one leg to place its heel on the knee of the other leg.
Pull up the other leg to stretch the first leg at the hip.
Hold for a few seconds and go back slowly to the original position.
Repeat with other leg and repeat the whole sequence 6-8 times.
Initially you can do the exercises under the guidance of a physical therapist, if you are not comfortable doing it alone.
Alternatively, you could also try some very simple yoga poses for Sciatica Pain Relief.
More yoga poses can be found here.
Some alternative form of treatment like the below-listed ones may also help:
Acupressure
This ancient Chinese method of relieving pain by pressing predetermined points on the body is effective according to some patients. It is also helpful in chronic cases.
This therapy may be self-administered with knowledge of the pressure points.
Press the acupressure points as shown in the chart with your thumb for 30-45 seconds and then release it.
Do this press-release technique for every point 3-6 times.
Acupuncture
This is also a Chinese method of alternative medicine, where instead of pressing points in the body, needles are pricked at certain locations and this relieves pain. This therapy would need a knowledgeable practitioner. This is said to cure chronic pain too
Chiropractic
A Chiropractor would attempt to realign the spinal cord by manually manipulating the spinal externally.
For this, you definitely need an experienced professional.
This is useful if the underlying cause is herniated disc or spinal stenosis.
Massage
Deep tissue massage of the lower back could be very effective for the minor/moderate sciatica pain. This kind of massage:
- Improves the blood circulation to the muscles, which will help in alleviating the pain.
- Will loosen up the muscles, this will release the pressure on Sciatic Nerve.
- Massage would induce the release of natural endorphins. These are natural pain killers.
The need for a doctor to help sciatica pain
If the above self-help/home remedies don’t work, then the alternative left is to consult a doctor.
Medical treatment would have the following options:
Medications
Drugs like anti-inflammatory, muscle relaxants, anti-depressant and narcotics could be used in some combination by the doctor to relieve the pain.
Physical Therapies
Once the pain is under control, probably the next step of treatment would be some specially designed physiotherapy sessions, to prevent reoccurrence and generally strengthen the muscles around the lumbar area of the spine.
Steroid Injection
A severe kind of Sciatica onslaught which does not respond to the above stated normal medication may have to be treated with steroid injections. These are a strong and advanced stage of medication and should be administered by very experienced Doctors.
- Epidural Steroidal injections
- Selective nerve root block injections.
Surgery
In case, none of the above brings in any kind of relief, then probably a surgery could be attempted to correct the underlying cause of Sciatica. Surgery may be advised in the following cases:
- Infection in the pelvic region
- Tumours in the affected region
- Bilateral Sciatica – both legs affected by Sciatica
Depending upon the underlying cause, different kinds of surgeries may be done to:
- Rectify the herniated disc
- Manage extended bone growth.
- Remove tumour.
- Manage ‘narrowing’ of the spinal canal
TENS unit for Sciatica pain relief
TENS is an acronym for Transcutaneous Electrical Nerve Stimulation. A small portable, battery-operated, handheld device delivers very low voltage electrical impulse.
Click Here for a detailed guide on how TENS unit works
TENS is an acronym for Transcutaneous Electrical Nerve Stimulation. A small portable, battery-operated, handheld device delivers very low voltage electrical impulse.
These controlled electrical pulses are transmitted to the skin, through the wires and pads. The underlying nerves are stimulated by these electrical impulses, that travel through the skin to reach them. These stimuli interfere with the way the pain signal is sent to the brain and also promotes the release of natural endorphin hormones. Endorphin is a natural pain killer released by the body in response to appropriate stimulation. Individually or combined, these two reasons are responsible for reducing the perception of pain in the patient.
It is a totally non-invasive treatment with no side effects or reactions for most of the users.
The Merc manual has the mention of Transcutaneous Electrical nerve Stimulation as a viable pain management therapy.
TENS therapy is very prevalent and popular in Europe and the USA. USFDA has also approved the over-the-counter sale of TENS unit in the USA.
We see here a TENS unit that creates, an electrical impulse in accordance with the settings. These signal gets transmitted to the skin through the wired electrode pads. The stimulating pulses excite the nerve ends and this triggers further pain blockage or endorphin release.
How to use TENS unit for Sciatica pain?
Initially, a TENS unit can be used for about 30 minutes per session. In a day 3 – 4 sessions can be planned. As the pain reduces and time duration and frequency can be brought down and physical therapy or exercises can be introduced in the programme.
If the pain is severe the duration of each session can be increased up to 60 minutes too.
The pad placement and the control setting of the unit is the determining factor of the effectiveness of TENS therapy.
For Sciatica pain, the pads may be placed as indicated below.
The above diagram clearly shows the placement of the pads around the lower back, hips and buttock of the patient. One channel of the TENS UNIT has two electrodes connected to it. For Sciatica, a 2 channel, with 4 electrodes would be a better choice.
Carefully observe the diagram and note how the sets of electrodes are to be placed. These are indicative diagrams and check out for the best configuration which works for you.
How to Use a TENS Unit?
- The Unit should be set at the lowest setting initially. The frequency and amplitude should be at the minimum. Do not switch on the unit until pads have been properly placed and secured on the body.
- The electrode pads are generally self-sticking in nature. Place the pad at the appropriate locations and preferably secure them with micropore tape. Then connect the pad wires to the unit.
- Now switch on the unit.
At the lowers setting you should feel a slight tingling sensation. Gradually increase the setting until you feel slight muscle twitch and perceptible muscle and nerve stimulation. If you feel any discomfort or too strong muscle twitch, reduce the settings immediately.
It would be worthwhile to check the user manual before using the TENS machine.
Though there is a lack of documented evidence to show that Sciatic pain is managed by TENS Unit, a large number of patients and doctors are of the opinion that TENS machine reduces the pain substantially in the initial stages.
With reduced pain, the patient responds well to physical therapies, walking and stretching and this ultimately gets rid of the Sciatica Syndrome.
The TENS unit should not be used
- For pregnant women
- If the patient has a pacemaker or any other electronic implant in the body
- If the patient has epilepsy.
In some cases, the patient may develop skin burn or patches at the place the electrode pads are stuck. These can be treated locally with some cream or lotion.
Do not use the unit at the same spot, unless the skin has fully recovered.
Do not place the electrode pad on wounds or broken skin.
Sciatica is more prevalent in men and manifests around 40 years of age. People exposed to strenuous physical activities or those who sit for long hours or have a higher incidence of Sciatica. The manifestation of Sciatica can be from a very mild form to severe ones.
Various kinds of treatment and therapies are available to treat this condition and normally it is not a very serious malady and the patient recovers soon. Only some cases may need an operation and such intense medical procedures.
Conclusion
Rеlіеvіng еxtrеmе ѕсіаtіса pain dоеѕ nоt аlwауѕ rеԛuіrе аn еxtrеmе trеаtmеnt approach.
Rеlіеvіng ѕсіаtіс nеrvе раіn аt hоmе wіth light еxеrсіѕе, ісе аnd hеаt thеrару, proper роѕturе аnd mеdісаtіоn саn ѕрееd uр уоur rесоvеrу. But thе mоѕt іmроrtаnt thіng уоu саn dо fоr уоur lower bасk аnd leg раіn іѕ tо tаkе іt seriously – аlwауѕ call уоur dосtоr іf уоu аrе nоt fееlіng rеlіеf.