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Having a backache often? Here’s why you have to read about sciatica. No matter whether you are in your 20s or middle-aged, most of us experience a backache at some point in our lives. Some may complain of pain at the lower back/ upper part of the buttock, some may feel the pain over the lower back and even down to the legs. Well, sciatica is the term describing intense pain starting from the buttock to the thigh and calf, most commonly one side of the legs. It is thus not a diagnosis, but a symptom that can be seen in several diseases involving the spine.
First of all, let’s understand a little more about the human spine (and the disc in between) before you wish to finish this article. The human spine is made up of vertebrae (plural) and in between each vertebra body interposed a disc to function as a shock absorber and to prevent friction between the rough surfaces of the upper and lower vertebrae.
There are 23 discs throughout the spine, thinnest in the thoracic region and thickest in the lumbar region, aka the waist level. Basically, the disc consists of two parts: an inner core (nucleus pulposus) which contains water, salt, collagen and some gelatinous material, and an outer layer (annulus fibrosus) of thick collagen and fibrous tissue. With age, the water content of the disc decreases, and more and more collagen and fibrous tissue accumulate, making the disc stiffer and more vulnerable.
The sciatic nerve is the largest nerve in your body. It is the combination of a few nerves (spinal nerves L4 to S3) which travels from the lower back area through the buttocks to the rest of the legs by dividing into branches to supply each muscle. The pain follows the route of the nerve distribution – sciatic nerve. Problems arise when the sciatic nerve is compressed or inflamed.
5 ways to tell if you have Sciatica
- Constant pain in one side of the buttock or leg (rare in both legs)
- Pain usually begins in the lower back, traveling down to the buttock and thigh
- Repetitive low backache and buttock pain which is relieved by rest
- Burning and tingling (prick and needle) sensations over affected area
- Leg pain is minimal and backache is predominant
Causes of Sciatica
Disc Herniation
What is Herniation?
Hernia is the protrusion of an organ/material through the wall of a cavity in which it normally resides. There are a few levels of disc herniation, starting from bulging to protrusion to rupture of the disc. In this case, the inner material of the disc has flown out possibly due to a tear in the outer layer and compressed the sciatic nerve. This condition is commonly known as a slipped disc. This is usually due to age-related degeneration, rarely traumas, lifting injuries or straining. Anyhow, the compressed nerve results in severe pain, sensory changes, and muscular weakness.
Narrowing of spinal canal
Spinal stenosis
It is called so in the medical world. This is the condition where the space in the vertebra that usually homes the spinal nerve becomes narrow and leads to compression of the nerve, which explains the sciatic symptoms when the sciatic nerve is affected. Have you ever wondered what actually narrows down the canal? Here:
1) As people age, the connective tissue around the canal grows thicker and narrows down the pathway. Too bad it is unlike a clogged drain where cleaning can cure the problem.
2) Arthritis (inflammation of joints) leads to the growth of bony spurs that push on the nerves.
3) Disc herniation too.
4) Degenerative disc disease (DDD). Over a long period of time, the disc wears out and the friction produces proteins which irritate the surrounding nerve and causes inflammation and pain.
Spondylolisthesis
As complex as the name may sound, it is a condition in which one vertebra slips forward over the lower one. If you are lucky enough, you might not have any symptoms at all. This occurs most commonly in traumas, stress fracture from overusing, or arthritis. This affects children and teens who are active in outdoor activities and sports.
Other causes
Being pregnant carries a lot of risks for a variety of diseases including the one topic we are discussing today (yes, always be grateful to your mom). As the fetus grows larger each day each second, it has a tendency to compress the nerve and results in the above symptoms. The only way to end this is to give birth to the baby.
Rarely, tumor in the spinal area can impinge on the spinal cord and causes the same thing. With severe back pain, bladder and bowel dysfunction, weakness of muscles of lower legs, sexual dysfunction and loss of balance while walking, cauda equina syndrome can be suspected, which is the loss of function of the spinal nerve.
How to get rid of sciatic nerve pain?
Non-surgical method
- Bed rest
- Anti-inflammatory drugs like steroids or NSAIDS
- Ice packs
- Proper postural habits
- Stretching exercise
Image from Textbook of Orthopedics 4e (John Ebnezar)
How does exercise relieve a low backache?
Exercise pumps the disc and increases the water content. It also relieves muscle spasm and increases motion while decreases the swelling around the nerves. Plus, repetitive motion helps you to overcome the fear of movement!
We shall leave the surgical part of the management to your doctor. Remember, proper posture is very important. Now, straighten up your back!
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by Angie Loh
A medical student with nothing but passion and a pen. Poems and novels never fail to make me feel alive. I'm inspired to make the world a better place and fill it with a little bit more love. But first, where's my coffee? View all articles by Angie Loh.
