Sciatica – Causes

Sciatica is caused by irritation and inflammation of the nerve root. This nerve root can be inflamed due to compression possibly due to disk herniation or a synovial cyst or an osteophyte. The injury is essentially a chemical injury due to decreased blood supply to the nerve root leading to inflammation.

Sciatic nerve is formed by the fusion of multiple nerve roots in the lower back. These nerve roots come out at different levels and immediately after coming out merged to make a big nerve, which is called the sciatic nerve. This sciatic nerve travels along the back of the hip and the thigh up to the knee where it is divided into two main nerves, the common peroneal nerve and the tibial nerve. The sciatic nerve essentially supplies the muscles below the knee and controls the movement of the foot and toes.

Patients with sciatica may have difficulty sleeping, especially lying supine. They can put pillows under the knee to bend the knee and the hip and therefore, relax the sciatic nerve. Sleeping by the side with the knee and hip bent can also help.

Sciatica pain is usually treated with the short-term rest, antiinflammatory medications in the form of Aleve or Advil, corticosteroid medications like Medrol Dosepak and physical therapy or chiropractic care. Patients who do not get relief may also need cortisone injection in the form of epidural or selective nerve root block.

Patients who do not get relief with all the above-mentioned treatments may need surgical intervention. Patients who also have worsening pain or neurological deficit in the form of weakness or involvement of bowel or bladder imbalance may also need surgical treatment as an emergency to stop the progression and optimized recovery.

It is difficult to say that the sciatica can be cured permanently because it can happen at multiple levels and can have recurrence at the same level and on either side. Sciatica is essentially treated symptomatically initially, but may need surgical treatment to remove the compression on the nerve root. Even after the surgery, there are chances of recurrence at the same level as well as on the other side or at other levels, which may or may not be related to the initial sciatica.

Sciatic pain can radiate along the back or the outer aspect of the hip and can sometimes be confused with a hip pain and itself. Thorough history and examination by the physician as well as radiological examination in the form of x-rays and MRI may be needed to differentiate the two pains.

Patients with sciatica may have difficulty sitting. Such patients should sit such that their knees are bent 90 degrees while they are resting on the floor. They should sit on a soft comfortable seat with the lumbar back support to support their back. These patients may need to bend forward a little bit to relieve the pressure over the nerve root.

Sciatic nerve presents with pain along the outer aspect of the back of the thigh, knee, leg and foot. Pain in the sole of the foot or on the dorsum of the foot involving either the outer toes or the inner toes may be related to sciatica on examination by the physician along with radiological examination may help find the cause of the pain.

Though the sciatic nerve runs along the back of the hip and can present with pain along the back of the hip and over the outer aspect of the hip, it is highly unlikely for it to cause groin pain. The groin pain can usually be caused by hip joint problems or issues like inguinal hernia. Occasionally compression of higher nerve roots, which suffered a femoral nerve can present with groin pain.

When sciatica is improving, the pain that radiates from the back into the leg decreases in intensity as well as frequency. The tingling and numbness will also improve. The patient will have more relief and longer durations of pain free period. This is a good sign and indicates a path towards complete resolution of sciatica.

Occasionally, sciatica may be associated with the trigger points in the muscles on the side of the back or even into the hip area. Deep massage of these trigger points can help decrease the pain and relieve the spasm. The deep massage is usually done by another person with the use of the elbow or palm or the thumb. Knuckle of the fingers can also be used. There are many mechanical devices that are available in the market, which can also be used for deep massage.

There are multiple reasons for calf pain, one of the dreaded one is blood clots and should always be checked for sciatica. Especially the involvement of S1 nerve root can also cause pain along the calf. This pain is usually felt around the back of the thigh as well as the calf into the foot. If it is caused by sciatica, it may be associated with tingling and numbness and occasionally weakness.

Sciatica is not permanent, though it can be a recurrent. Patients who have had one episode of sciatica are at a higher risk of getting recurrence over the period of months and years. If the patient gets relieved with recurrent episodes of sciatica in shorter duration of time then it can be still treated nonoperatively.

Patient who have recurrent or prolonged episodes of sciatica, not relieved medications and physical therapy or patients who have neurological deficit or worsening pain, may need surgical treatment.

Sciatica or lumbar radiculopathy causes pain radiating from the back or the hip into the lower extremities down the leg. The pain radiates along the back or the side of the thigh and leg and radiates down foot. An isolated ankle pain may not be caused by radiculopathy. If the pain is on outer or inner side of the ankle and is radiating down or coming from the top then it may be associated with sciatica or lumbar radiculopathy.

Occasionally, sciatica can present with pain in the back muscles only or the muscles of the hip. Such pain causes soreness or pain in one or both hips on the back or the outer aspect. Such pain can be confused with the pelvic pain. True pelvic pain will usually be on the front of the belly or on the side of the belly. These pains can also be confused with a hip pathology. A thorough history as well as examination with or without further imaging may be helpful to rule out pelvic cause, sciatica.