by Pregnancy.org Staff
Sciatic nerve pain often comes on suddenly, creating immediate distress. And while it usually resolves in a few weeks, the pain may linger for months or years, disrupting lives. This develops into a condition called Sciatica. You can probably name several examples from your own experience, or maybe you've had sciatic nerve problems yourself.
At least 80% of the world's population suffers from lower back pain, with or without sciatica, at some time in their lives. The pain often comes suddenly, creating immediate distress. And while it usually resolves in a few weeks, it may linger for months or even years, changing lives and lifestyles. Potentially the most serious of lower back problems, sciatica results from compression of the sciatic nerve, the largest nerve in the human body.
About the width of a thumb when it branches out from nerve roots on the lower spine, the sciatic nerve threads its way behind the hip joint, deep into the buttocks, down the hip and along the back of the leg all the way to the foot. Typically, the pain results when the nerve on one side becomes stretched or pinched usually by something which narrows its passageway such as arthritis or a bulging or herniated disk. The result can be sharp pain in one part of the hip or leg but is more likely to be some combination of pain, numbness, burning, tingling or needles and pins sensation anywhere from the hip to the toe usually on one side only. The pain typically gets worse after a long period of standing or sitting such as riding in a car and it may also be aggravated by coughing, sneezing or laughing.
Who is Vulnerable
Some studies have found sciatica more prevalent among sedentary persons particularly smokers and those who spend many hours behind the wheel of a motor vehicle. But as the JAMA and Lancet articles indicate, highly active persons are also vulnerable.
A study showed that bed rest offered no benefits over gentle movement and actually has negative effects such as tightening of muscles and loss of strength and flexibility. Even as recently as 1997, bed rest was considered a routine part of early therapy. That changed with the publication of a study in the New England Journal of Medicine [February 11, 1999] showing that bed rest failed to provide any benefits over gentle movement in terms of resolving pain and speeding the healing process.
And because bed rest has negative effects such as tighter muscles and loss of strength and flexibility most doctors today tell their patients to keep moving as much as they can while avoiding heavy lifting, bending from the waist, stooping and other activities that might stress the lower back. Sitting also stresses the lower back, and soft chairs are usually considered off limits.
Anti-inflammatory medications such as ibuprofen help reduce the pain and inflammation. [Editor's note: Pain relief medications such as aspirin and ibuprofen are not recommended during pregnancy.] And in bed, a firm surface is recommended, lying on one's side back with knees bent. As always, do not take medicine without consulting your doctor first. Some studies have found bulging or protruding discs on the scans of 60% of individuals with apparently healthy backs. Lower back pain with sciatic nerve involvement is generally more serious than simple back pain. Nevertheless, about half of patients get better in the first two weeks and 70 percent recover within six weeks. When the problem lingers or recurs, however, the treatment challenge is substantial.
Non-surgical treatments include exercise, chiropractic manipulation, steroid injections, massage, ice, heat, physical therapy, acupuncture and pain management measures such as biofeedback and relaxation therapy. The trend is to focus on helping patients improve their tolerance to physical activity rather than merely fighting the pain. Physical activity has many benefits, both physical and emotional, while inactivity accentuates pain and causes weakening and shortening of connective tissues. However, the type of exercise may have to be adjusted to the symptoms of the patient. High impact activities such as running, for example, are sometimes considered risky.
Many patients report being helped by spinal manipulation, and the procedure has a good safety record when performed by a skilled chiropractor. Steroid injections work by reducing inflammation at the nerve root. While usually considered a short-term measure, injections have sometimes provided longer lasting relief. For long-suffering sciatic patients, it is easy to lose patience. While a doctor may offer no easy answers, continuing medical care is essential to monitor symptoms, make sure that the condition doesn't worsen, rule out even more serious problems...and, perhaps most important, provide counsel and support.
Sciatica is a condition involving impaired movement and/or sensation in the leg, caused by damage to the sciatic nerve.
The main nerve traveling down the leg is the sciatic nerve. Pain associated with the sciatic nerve usually originates higher along the spinal cord when nerve roots become compressed or damaged from narrowing of the vertebral column or from a slipped disk. Symptoms can include tingling, numbness, or pain, which radiates to the buttocks legs and feet.
Cause, Incidence and Risk Factors
Sciatica is a form of peripheral neuropathy. It occurs when there is damage to the sciatic nerve, located in the back of the leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Incomplete damage to the sciatic nerve may appear identical to damage to one of the branches of the sciatic nerve (tibial nerve dysfunction or common peroneal nerve dysfunction).
A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy. The usual causes are direct trauma (often due to an injection into the buttocks), prolonged external pressure on the nerve, and pressure on the nerve from nearby body structures. It can also be caused by entrapment -- pressure on the nerve where it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve.
The sciatic nerve is commonly injured by fractures of the pelvis, gunshot wounds, or other trauma to the buttocks or thigh. Prolonged sitting or lying with pressure on the buttocks may also injure it. Systemic diseases, such as diabetes, can typically damage many different nerves, including the sciatic nerve. The sciatic nerve may also be harmed by pressure from masses such as a tumor or abscess, or by bleeding in the pelvis.
Treatment is aimed at maximizing mobility and independence. The cause of the nerve dysfunction should be identified and treated as appropriate. In some cases, no treatment is required and recovery is spontaneous.
Conservative treatment is usually appropriates if there was sudden onset, minimal sensation changes, no difficulty in movement, no history of trauma to the area, and no evidence on testing of degeneration of the nerve axon.
Surgical removal of lesions that press on the nerve may help in some cases. In cases of severe injury to the nerve, such as laceration, recovery may be not possible or may be limited.
Over-the-counter or prescription analgesics may be needed to control nerve pain (again check with your healthcare provider if you are pregnant). Various other medications may reduce the stabbing pains that some people experience, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline. Steroids may help with nerve inflammation related to a herniated disc. Whenever possible, their use should be avoided or minimized to reduce the risk of medication side effects.
Physical therapy exercises may be appropriate for some people to maintain muscle strength. The use of braces, splints, orthopedic shoes or other appliances may help to compensate for lost or impaired function. Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended.
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