What is sciatica?
Sciatica is the symptom of an underlying medical condition, not a medical diagnosis. However, this term has been incorrectly used to describe pain in back and leg symptoms by the general population. This is a term to describe a pain symptom that radiates from the middle or lower buttock down to the back and the side of the leg along the sciatic nerve, sometime it could radiate below the knees into the foot and toes. Sensory symptoms may also be reported by the patient. Usually, the pain only affects either left or right rather than both sides. Other thing to note is that Low back pain is not a consistent feature seen in sciatica but may also present in patient.
Symptoms and examination
Research has found that 90% of the cases are due to herniated disc that compress the nerve root from L4 to S1. Different levels of compression will present slightly different clinical features. With L4 compression, the pain is front and to the side of the thigh, which may sometimes mistake as a hip disease. Vis versa, L5 compression show pain at the back and the sides. Some other causes of sciatica might be lumbar canal or foraminal stenosis and tumors or cysts.
To examine whether a patient have sciatica, Straight Leg Raising Test have shown high sensitivity of 91%. When the patient is lying down and facing up, raising the whole leg straight can stretch the nerve root of the protruding disc. This will reproduce the pain and discomfort that the patient complains. If the leg is angled between 30 to 70 degrees with pain from buttock to below knee, disc compression of nerve root might be the cause of radiated pain.
Sometimes, sciatica might be mixed up with non-specific low back pain. Some major signs to justify sciatica are radiated pain towards foot or toes, numbness and paranesthesia.
Conservative non-surgical treatments are recommended for patient. Most common initial treatment will be pain control by medication prescribed by family doctor, which could provide relief to patient’s discomfort. The most common medication is naproxen, used to relieve pain for various conditions. Other conservative treatment such as acupuncture, steroid injections, etc. might be beneficial but studies has been inconsistent with pain relief of sciatica. However, rest and bed rest are not recommended to reduce pain as it might lead to acute low back pain although it might provide instant relief. Staying active likely to be more beneficial in improving sciatica and aid in faster recovery.
Another conservative treatment is spinal manipulation. It is widely used to provide a short-term benefit in relief pain symptoms in addition to exercise program targeting the low back and hip. Study had found that patient who has sciatica of at least six weeks, both conservative and disc surgery might improve patient’s pain and function. But we must aware of possible confounding in the study due to self reported data and patients’ preference for treatment may also affect treatment outcome.
If pain does not diminish in six to eight weeks, patient should meet a neurologist, neurosurgeon, or orthopedic surgeon to discuss other treatment methods such as surgery. It is always the last resource to treat sciatica when practitioner suspect a disc herniation or disc rupture. However, evidence has shown controversial outcomes with surgery. Studies has shown patient who did surgery has faster relief of pain compare to conservative treatment.
Exercise is always the best prevention protocols that a patient could do during their free time. Specific strengthening exercise that targets the core and the lower back can help protect the spine and maintain good posture. Patient can also stay active by jogging around the neighborhood or swimming and the pool.
Maintaining a good sitting posture is also important to prevent disc compression. Prevent bending the lower back which could reduce pressure on the discs and ligaments. Moreover, take a small break every 30 minutes of sitting can relief the pressure in the disc.
Harvard Health Publishing. (2020, September 24). 5 tips with coping sciatica. https://www.health.harvard.edu/pain/5-tips-for-coping-with-sciatica
Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313–1317. https://doi.org/10.1136/bmj.39223.428495.be
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240–1248. https://doi.org/10.1056/nejmra1410151
Valat, J. P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), 241–252. https://doi.org/10.1016/j.berh.2009.11.005