Typical Causes, Symptoms, and Treatments of Sciatica Related Lower Back Pain

Sciatica is an inflammation of the sciatic nerve, which is the longest nerve in the body running from the spinal cord across the buttock and hip area and down the back of each leg. It is actually a secondary symptom of another problem placing pressure upon the nerve, most often a herniated disk. Most prominent among the symptoms of sciatica is pain along the area of the nerve, which may cause considerable discomfort in acute cases. While this pain generally goes away on its own in four to eight weeks or so, it can reoccur if the underlying problem isn't addressed. In most cases, treatment involves self-help measures to ease sciatica related lower back pain. However in severe cases, doctors may suggest more aggressive treatments.

Sciatica is most commonly associated with pain radiating from the lower (lumbar) spine to the buttock and down the back of the leg. Discomfort can be localized to a certain area along the nerve pathway (i.e. the lower back, right buttock, left calf, etc.), but it usually follows a path along the lower back to the buttocks and back of the thigh and calf.

The pain can vary greatly, from mild aches; sharp, burning sensations; or excruciating discomfort; and often feels like a jolt or electric shock. This discomfort can be aggravated by lack of exercise, prolonged sitting, bad posture, and improper lifting techniques; and may be exacerbated by coughing or sneezing. Usually, only one lower extremity is affected.

In more severe cases, sciatica can cause several additional symptoms. This can include numbness or muscle weakness occuring along the nerve pathway of the legs or feet. Pain may appear in one part of your leg with numbness in another and tingling or a pins-and-needles feeling in the toes or part of the foot can also occur.

Although it is rare, sciatica can potentially lead to permanent nerve damage including loss of feeling and/or movement in the affected leg. Additionally, extremely rare instances result in a loss of bladder or bowel control; a sign of cauda equina syndrome, a serious condition that requires immediate medical care. Untreated, it can lead to paralysis of the legs.

Sciatica related lower back pain most frequently occurs as a result of a compressed nerve due to a herniated disk in the lower (lumbar) spine. These disks, which are pads of cartilage that separate the spinal bones (vertebrae), keep the spine flexible; acting as shock absorbers to cushion the vertebrae during movement. They consist of a tough, fibrous outer covering with a jelly-like substance in the center.

However, the disks can deteriorate as we age, becoming drier, flatter and more brittle. Eventually, the outer portion of the disk may develop tiny tears, causing the inner material to seep out (herniate or rupture). The herniated disk may then press on a sciatic nerve, causing pain in your back, legs or both. If the damaged disk is in the middle or lower part of your back, you may also experience numbness, tingling or weakness in your buttock, legs or feet.

In addition to herniated disks, there are several other conditions which can lead to sciatica related lower back pain including:

• Lumbar spinal stenosis, in which one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of the branching nerves.
• Spondylolisthesis, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves your spine.
• Piriformis syndrome, which causes the piriformis muscle, that runs directly above the sciatic nerve, to tighten or go into spasms.
• Tumors inside the membranes (meninges) that cover the spinal cord or in the space between the spinal cord and the vertebrae, Which can compress the cord itself or the nerve roots as it grows.
• Trauma from a car accident, fall, or blow to the spine.

There are many risk factors which make it more likely for a person to develop sciatica related lower back pain including:

• Age; most herniated disks develop among people who are in their 30s and 40s.
• Pregnancy; due to pressure from the fetus on the spine.
• Occupations requiring frequent twisting and bending; heavy lifting; or driving for long periods.
• Sitting for prolonged periods or an excessively sedentary lifestyle.
• Diabetes, which affects the way your body uses blood sugar often leading to nerve damage.

Medical treatment is not required for mild cases of sciatica related lower back pain, which usually goes away with a little time and patience. However, a doctor should be consulted if self-help measures fail to ease the symptoms or in case of progressively severe and/or prolonged pain (exceeding four weeks). In addition, immediate medical attention should be sought in cases that include sudden, severe pain and numbness or muscle weakness in the lower back or leg; pain following a violent injury, such as a traffic accident; trouble controlling the bowels or bladder.

When diagnosing sciatica related lower back pain, doctors attempt to determine which nerves are affected and how severely. This involves reviewing a patients medical history and performing a thorough physical exam, emphasizing the spine and legs. Exams may include basic tests of muscle strength and reflexes, such as asking the patient to walk on their toes or heels; stand from a squatting position; or lift their legs one at a time from a prone position. Pain that results from Sciatica related back pain will usually worsen when performing these types of movements.

They may also request one or more imaging tests to help identity what is causing pressure on the sciatic nerve and to rule out other possible conditions. These tests may include:

• Spinal X-rays, which can't detect herniated disk problems or nerve damage, but can help rule out cancers affecting the bony structures of the spine, narrowed disks, spondylolisthesis and other nerve root impingement as possible causes.
• Magnetic resonance imaging (MRI), which uses a powerful magnet and radio waves to produce cross-sectional images of the back. Probably the most effective test for diagnosing sciatic related lower back pain, MRI tests can detect damage to spinal disks and ligaments and the presence of tumors. An MRI machine; essentially a large magnet with a movable table that the patient lies on; is a noninvasive procedure without any harmful side effects.
• Computerized tomography (CT) scan, which produces detailed, cross-sectional images of the spine using a narrow beam of radiation. A contrast dye is injected into the spinal canal before the X-rays are taken, causing the spinal cord and spinal nerves to appear white when scanned.

In most cases, sciatica can be treated with self-help measures. Continuing usual activities, while avoiding what may have triggered the pain may ease symptoms. Resting may also prove beneficial although, excessive inactivity could worsen symptoms. Some self-help measures that may help:

• Cold packs may help reduce inflammation and relieve discomfort, when applied to the painful areas for at least 15 to 20 minutes.
• Hot packs should be applied to painful areas or alternated with cold packs.
• Stretching the low back at least 30 seconds can help alleviate pain and relieve nerve root compression.
• Over-the-counter medications, such as aspirin and ibuprofen, and acetaminophen (Tylenol, others) can be helpful for sciatica related lower back pain. However, there's a limit to how much pain they can control and they can cause side effects; including nausea, stomach bleeding or ulcers.
• Regular exercise, low-impact exercises such as a stationary bicycle or water exercise can help patients stay active without aggravating the symptoms. Also, once the pain lessens, aerobic activity with strength training and core exercises to strengthen the back muscles and limit spinal disk degeneration.

In severe cases, doctors may recommend more aggressive treatment beyond the self-help measures including:

• Physical therapy typically involving exercises to correct bad posture, strengthen the back muscles and improve flexibility, can play a vital role in recovery for a herniated disk and help prevent recurrent injuries.
• Prescription drugs such as anti-inflammatory medication or muscle relaxers may be used for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs may also ease chronic pain, by blocking pain messages to the brain or enhancing endorphin production, which act as natural painkillers.
• Epidural steroid injections, which suppress inflammation around the irritated nerve, and help to relieve pain. However, the number of injections you can receive is limited (usually to three per year) by the potential side effects and therefore are only usefull as a short-term solution.
• Surgery options are usually reserved for cases involving extreme weakness; bowel or bladder incontinence; or pain that gets progressively worse or doesn't improve with other therapies. Lumbar laminectomy and microdiskectomy involve removing the portion of a herniated disk that's pressing on a nerve, while leaving as much of the disk intact as possible.

Some medical and health care systems, practices, and products that aren't considered a part of conventional medicine, known as complementary and alternative medicine (CAM), have proved to be very effective in treating sciatica related lower back pain.

• Acupuncture, based on the theory that health can be affected by a vital energy called qi (pronounced "chee") which flows throughout the body. It's believed that inserting fine needles into specific points will unblock energy flow and restore qi balance.
• Chiropractic, based on the philosophy that restricted spinal mobility can cause a reduction in functioning and pain. Chiropractors employ spinal adjustment (manipulation), from different positions; using varying degrees of force, to restore spinal movement and relax muscles.
• Massage can have varying effectiveness depending on the skill of the masseuase, but studies have suggested it can help alleviate sciatica related lower back pain.
• Hypnosis creates a state of deep relaxation, in which a patient's mind is narrowly focused and open to suggestions that decrease pain sensitivity and increase coping abilities.