6 Leading Causes of Sciatica
Sciatica is derived from a Greek word that essentially means ‘leg pain’.
Usually when the term sciatica is used, it is not a diagnosis in it’s own right. It is merely that you are presenting with diffuse leg or thigh pains, often affiliated with lower back pain.
Several different lumbar spine (low back) disorders can cause sciatica.
Sciatica is usually caused by compression of one or more of the five sets of nerve roots in the lower back. Sometimes doctors call sciatica a radiculopathy.
Radiculopathy is a medical term used to describe pain, numbness, tingling, and weakness in the arms or legs caused by a nerve root problem. If the nerve problem is in the neck, it is called a cervical radiculopathy.
However, since sciatica affects the low back, it is called a lumbar radiculopathy.
Pathways to Sciatic Nerve Pain
Five sets of paired nerve roots in the lumbar spine combine to create the sciatic nerve. Starting at the back of the pelvis (sacrum), the sciatic nerve runs from the back, under the buttock, and downward through the hip area into each leg.
Nerve roots are not ‘solitary’ structures but are part of the body’s entire nervous system capable of transmitting pain and sensation to other parts of the body. Radiculopathy occurs when compression of a nerve root from a disc rupture or bone spur occurs in the lumbar spine prior to it joining the sciatic nerve.
Sciatic Nerve Compression
Several different types of spinal disorders can cause spinal nerve compression and sciatica or lumbar radiculopathy. The six most common are:
- bulging or herniated disc
- lumbar spinal stenosis
- piriformis syndrome
- spinal tumours
Each condition is briefly explained below.
Common Sciatica Cause #1: Lumbar Bulging or Herniated Disc
A bulging disc is also known as a contained disc disorder. This means the gel-like centrer (nucleus pulposus) remains ‘contained’ within the tyre-like outer wall (annulus fibrosus) of the disc.
A herniated disc occurs when the nucleus breaks through the annulus. It is called a ‘non-contained’ disc disorder.
Whether a disc bulges or herniates, disc material can press against an adjacent nerve root and compress delicate nerve tissue and cause sciatica.
The consequences of a herniated disc are worse. Not only does the herniated nucleus cause direct compression of the nerve root against the interior of the bony spinal canal, but the disc material itself also contains an acidic, chemical irritant (hyaluronic acid) that causes nerve inflammation.
In both cases, nerve compression and irritation cause inflammation and pain, often leading to extremity numbness, tingling, and muscle weakness.
Common Sciatica Cause #2: Lumbar Spinal Stenosis
Spinal stenosis is a nerve compression disorder most often affecting mature people. Leg pain similar to sciatica may occur as a result of lumbar spinal stenosis.
The pain is usually positional, often brought on by activities such as standing or walking and relieved by sitting down. Spinal nerve roots branch outward from the spinal cord through passageways called neural foramina comprised of bone and ligaments.
Between each set of vertebral bodies, located on the left and right sides, is a foramen. Nerve roots pass through these openings and extend outward beyond the spinal column to innervate other parts of the body.
When these passageways become narrow or clogged causing nerve compression, the term foraminal stenosis is used.
Common Sciatica Cause #3: Spondylolisthesis
Spondylolisthesis is a disorder that most often affects the lumbar spine. It is characterised by one vertebra slipping forward over an adjacent vertebra.
When a vertebra slips and is displaced, spinal nerve root compression occurs and often causes sciatic leg pain.
Spondylolisthesis is categorised as developmental (found at birth, develops during childhood) or acquired from spinal degeneration, trauma or physical stress (i.e. weightlifting).
Common Sciatica Cause #4: Trauma
Sciatica can result from direct nerve compression caused by external forces to the lumbar or sacral spinal nerve roots.
Examples include motor vehicle accidents, falling down, football and other sports. The impact may injure the nerves or occasionally fragments of broken bone may compress the nerves.
Common Sciatica Cause #6: Piriformis Syndrome
Piriformis syndrome is named for the piriformis muscle and the pain caused when the muscle irritates the sciatic nerve.
The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle.
Piriformis syndrome develops when muscle spasms develop in the piriformis muscle thereby compressing the sciatic nerve. It may be difficult to diagnose and treat due to the lack of X-ray or MRI findings.
Other Causes of Sciatica
Muscular problems within the lower back and the posterior aspect of the pelvis may cause radiation of pains into the posterior thigh and leg. An example of this is a Myofascial (muscular) pain syndrome of the gluteal muscles. In particular gluteus medius or gluteus minimus which are located quite deep in buttocks region.
These muscular problems often associated with lower back complaints can mimic much of the pain suffered by a patient who has sciatica from a lumbar disc injury.
Spinal tumours are abnormal growths that are either benign or cancerous (malignant). Fortunately, spinal tumours are rare. However, when a spinal tumour develops in the lumbar region, there is a risk for sciatica to develop as a result of nerve compression.
If you think you may be suffering from sciatica, contact a spine specialist in your community. The first step toward relieving pain is a proper diagnosis!
Dr. Hooper’s Comment
Sciatica, usually involving lower back and leg pain can be quite debilitating. I believe that the correct diagnosis of the cause of sciatica is essential for full resolution and prevention of further injury.
The problem is that there can be quite conflicting views regarding the cause of your sciatica, when you are reviewed by different health practitioners.
Practitioners can use different terms to mean the same thing. Or a number of practitioners could be partially right as to the cause of your pains. Indeed sciatica can be due to a combination of problems within the lower back and posterior aspect of the pelvis that results in your leg pains.
Some practitioners dismiss the problem as no big deal and it will probably go away by itself, while others devote their entire lives to dealing with and treating debilitating sciatica.
So, what can You do to help?
1. Don’t ignore the pain. Pain is there for a reason.
Be careful not to aggravate your condition by lifting heavy or bulky
items, and remember to use your knees, not your back, to bend over.
Always use correct lifting procedure when moving heavy objects, and use trolleys whenever possible.
Don’t be a hero or a martyr. You are no good to anyone if you are crippled with pain.
Identify your limitations; which will vary from day to day. Get others to help when you can.
Rotate your duties and don’t get stuck doing one task or in one position for extended periods.
2. Don’t lay in bed all day.
Years ago, doctors used to recommend prolonged bed rest for lower back pain and sciatica. Unfortunately laying in bed all day will make it worse. Get up. Move around. No sooking!
Sure you can lay down for a while, but not for hours on end.
Otherwise you will feel rancid and muck up your sleep patterns of an evening.
Sleep on a firm mattress on your back or side; avoid sleeping on your stomach which puts increased pressure on your spine.
Try lying on the floor with a pillow under the lower back to relieve
pressure on the spine. Or try putting a hard board under your mattress for more support if required.
3. Adequately warm up prior to exercise.
Consider wearing a back brace or support if you are required to do tasks that you know that you should not really be doing, but you have to as a result of your work or home requirements.
We have a number of different back braces, follow the link for a good cost effective back brace.
Remember to warm-up and stretch your muscles before commencing any exercise activity.
Develop good posture habits and make sure your chair has firm back
support. Try not to slouch and make sure your feet are flat on the
4. Increase Your Magnesium
No matter what the cause of the sciatica, muscles will invariably be involved some where in the equation. Increase your magnesium. It is very important.
Magnesium is one of THE most important natural muscle relaxants you can take. Indeed most patients with back, neck or leg pains would benefit from using magnesium.
The mineral magnesium is anti-spasmodic and will help to relieve muscle spasm, muscle cramping, muscle tightness, and myofascial (muscle) pain syndromes.
The best sources of magnesium are located on the Muscle Relaxant Section of the website.
The most popular products include:
- Bioceuticals Ultra Muscleze; the high dose magnesium powder for muscular ache, pains and cramping
- Bioceuticals Musclease; high dose magnesium supplement in the convenience of a tablet
- Eagle Pharmaceuticals Mag-Oro; the high dose magnesium tablet for muscle cramping and pains
5. Consider using a Natural Anti-Inflammatory
Anti-inflammatory medication can be very useful in the treatment of some of the causes of sciatica – particularly when there is lumbar disc involvement.
The disc itself can cause local irritation and inflammation of the exiting nerve root, or the chemicals released by an injured disc can cause further inflammation.
When a patient has a disc injury or is chronically inflamed one one of the most popular products we use is Eagle Pharmaceuticals Hernidisc. Hernidisc is used extensively for people with muscle and skeletal
problems, and in particular, disc herniation or disc protrusions. Hernidisc acts as a good anti-inflammatory and muscle
relaxant to assist in recovery from disc injuries and disability
The best sources of natural medications to reduce pain and inflammation are located on the Anti-inflammatory Section of the website.
6. Try some Heat
The use of a wheat-bag heat pack applied to the
lower back may also help to reduce inflammation and pain.
Alternatively the use of FlexEze Heat plasters is very popular among our patients. Flexeze is an adhesive plaster that you can stick on your skin or underwear to provide continuous low level heat.
The beauty of these heat plasters is that they provide 12 to 14 hours of continuous low level heat, that has been proved to be more effective that over the counter drug medications. Without the side effects.
Worthwhile considering if you have chronic pain.
7. Seek Professional Advice
If you have had problems for a while, they keep returning, your legs are going numb or the pains are getting extreme go to an appropriate health professional.
Unfortunately this may be beyond the scope of some general practitioners who are providing 6 minute consultations to 100 patients a day.
If the diagnosis and treatment dose not make sense then take your very important sciatic nerve somewhere else.
Acupuncture is often effective in the treatment of sciatica, but be sure your practitioner is suitably qualified.
Chiropractic, Osteopathy and physical therapies can also assist in the management and prevention of your sciatica.
If you like this article be sure to visit the Spinal Centre website at www.thespinalcentre.com.au and view more content by Dr. Hooper and the Spinal Rehabilitation Team.
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