Sciatica: A Real Pain in the Behind
Dr. Sarah Leahy Granite
Sciatica is a term that is thrown around quite often. Everyone thinks they’ve had it at one time or another, and if it hasn’t yet affected you, it’s likely affected someone in your family or a friend after a serious snow-shoveling session. But how do you know if what you’re experiencing is really sciatica, and what can you do if it is?
Sciatica is actually not a diagnosis but rather a term for a group of symptoms. Typical symptoms of sciatica include pain, numbness, tingling and weakness in the region of the buttocks or down the leg, and are usually felt on only one side of the body. The level of pain or discomfort can vary widely, from a minor tingling to pain so severe that any movement is excruciating.
The sciatic nerve is a large, thumb-sized nerve that travels through the gluteal region on each side of the body, and then down the leg toward the foot. When this nerve is compressed or inflamed, symptoms of sciatica can occur. This compression or inflammation can be caused by a number of factors including herniated discs, fractures, and inflammation of muscles or tissues near the lumbar and sciatic nerves.
Strain to the piriformis muscle, a tiny muscle in the gluteal region, is a common cause of sciatica. The piriformis rotates the leg and, due to its proximity to the sciatic nerve, can press on the nerve if it is strained or inflamed. The sciatic nerve is located slightly differently in each person, either travelling underneath or through the piriformis. When posture changes due to pregnancy or abdominal weight gain, the piriformis can become tightened, squeezing the sciatic nerve and causing symptoms on the affected side. When the piriformis is involved in a case of sciatica, it is referred to as Piriformis Syndrome.
Another common cause of sciatica is a herniated disc; also know as a slipped, bulging, or ruptured disc. Between each set of vertebrae in the spine is a disc that resembles a jelly doughnut. Each disc is comprised of a thin, tough outer layer known as the annulus, and a jelly-like middle known as the nucleus. These discs function as cushions for the spine and absorb compressive forces, such as the pressure created when a person lands after jumping or carries a heavy object. Over time these discs may weaken due to repetitive, improper bending and the “jelly” may rupture through the outer layer. This rupture can put pressure on the nerves of the lower back, which form the sciatic nerve, causing pain, numbness or weakness down the leg.
Sciatica is a condition that will affect many Americans within their lifetime. Proper treatment of this condition depends on what caused the symptoms in the first place. In order to determine the cause of sciatica and the best course of treatment, a doctor should perform a proper history and conduct a postural, orthopedic and neurological evaluation. Imaging such as an X-ray or MRI may also be ordered if warranted. Conservative treatments, such as chiropractic care, have favorable outcomes in treating sciatica. When possible, it is best to try conservative treatments before moving on to more invasive treatments with high risks of complications, such as spinal injections or surgery. As physicians, we all take an oath to “first, do no harm.” By recommending more conservative, cost-effective approaches to care before more risky, expensive procedures, we are caring for both our patients’ health and their wallets.