The Dreaded Sciatica

Imagine this. One day you sit up from bed and suddenly feel a shocking pain in your lower back that travels down your leg. Or you bend forward to pick up something from the floor and suddenly there’s a pain in your lower back that travels down your leg. Or you’re sitting at work in front of the computer as usual and when you stand up, suddenly there’s a shocking pain in your lower back that travels down your leg. What’s going on?

When patients present with the symptoms of lower back and/or leg pain and possibly tingling, numbness, or weakness that starts in the lower back and travels down the buttocks and the back of the leg, they are given the diagnosis of sciatica. However, a common misunderstanding is that the term sciatica is the problem. Actually, sciatica is just a symptom of a problem. This is because the symptoms of sciatica can be caused by many, many issues including lumbar herniated disc, degenerative disc diseases, spinal stenosis, piriformis syndrome, sacroiliac joint syndrome, etc. 

First, let’s talk about the sciatic nerve. This nerve is very large and originates from individual nerve roots in the spine (L4–S3) that emerge from the lumbar spine and sacral regions, and join together to make one large nerve. This nerve travels from the lower back passes through an opening in the pelvis (greater sciatic foramen) and then travels down the posterior thigh. 

The specific sciatica symptoms depend on where the nerve is pinched. For instance, if patients feel that just the thigh is involved it may be due to the L4 nerve root, whereas if the pain travels to the toes it may involve L5 or S1 nerve roots. Usually, sciatica symptoms happen over time and are not necessarily due to one particular event or injury.

The most common causes of sciatica include:

1. Sacroiliac Joint Dysfunction

   
   

The joint between the bottom of the spinal column and the pelvis bones may be in a poor position leading to irritation of the sciatic nerve and leg symptoms. 

2. Piriformis Syndrome

   
   

This muscle in the buttock region covers the sciatic nerve as it travels in this area. If the muscle is tight or injured, it may irritate the sciatic nerve and lead to leg pain.

3. Lumbar Herniated Disc

   
   

This is when the soft inner material of the disc sticks out and irritates the nerve root leading to severe lower back and leg pain. 

4. Degenerative Disc Disease

   
   

Some people experience a lot of degeneration in their spinal joints due to accumulated wear and tear of the discs in the lower back that releases inflammatory proteins from inside the disc that may irritate the nerve roots and lead to sciatica. Bone spurs from degeneration may also pinch the nerves leading to leg pain. 

5. Lumbar Spinal Stenosis

   
   

This usually happens in older individuals as the joints degenerate. When the joints are wearing down and enlarged, there is swelling of the soft tissue and the discs are bulging then there is increased pressure and irritation of the nerve roots causing sciatica. 

6. Isthmic Spondylolisthesis

   
   

This happens when one vertebral body slips forward on another due to a small stress fracture and a decrease in disc space. It can lead to irritation of the nerves and lead to sciatica symptoms. 

Some other causes of sciatica may include scar tissue, muscle strain, infection, fracture, or even spinal tumors. If you experience any leg symptoms including pain, numbness, tingling, or weakness it is important to get examined by a healthcare practitioner to figure out the problem. Different reasons for sciatica require a different approach to treatment. As a chiropractor, every day I have many cases of sciatica but with different causes. A thorough examination will allow me to determine the true cause of the pain, which will lead to a speedy recovery.

So, if you ever experience lower back and/or leg pain and a health practitioner tells you that you have sciatica, remember to ask them the reason for the pain!