Sciatic nerve is the largest and longest nerve in the body. It originates in the lower back, runs along the hip and back of the leg and finally terminates in the foot. Sciatica is characterized by severe pain in the leg resulting from compression or damage to this nerve. The pain is usually present below the knee and may also extend to the foot. The intensity of pain varies from a mild pain to a sharp pounding pain. This may also be associated with numbness, tingling or burning sensation in the hip, leg and foot. The pain is usually intensified at night and exaggerated by coughing, laughing, sneezing, sitting and standing. Sciatica may also result in muscle weakness. In rare cases bladder and bowel function may also be affected (cauda equine syndrome) requiring emergency medical intervention.
Some of the common causes of sciatica include herniated disc, piriformis syndrome, hip injury or fracture and tumors of the lumbar spine. Other conditions of the lumbar spine that may cause sciatica include compression fracture, degenerative disc disease, spinal stenosis, spondylosis and spondylolisthesis. Poor posture, prolonged sitting, lack of proper exercise, smoking, diabetes and a fall can also lead to sciatica.
Sciatica is a symptom rather than a disease and can be secondary to a number of conditions, some of which have been mentioned above. Diagnosis of the exact underlying cause is very crucial in determining effective treatment. Diagnosis of sciatica includes medical history along with a physical and neurological examination. Neurological examination helps to detect any signs of neurological injury and also evaluates muscle weakness, numbness and abnormal reflexes. Imaging tests such as X-rays may be required for severe and chronic sciatica pain. CT and MRI scans are more sensitive and may also be performed to identify changes in soft tissue such as intervertebral discs and nerves.
Sciatica may often resolve by itself, without any treatment. Sometimes conservative treatment is recommended to reduce the pain and inflammation around the nerve. Conservative management of sciatica includes activity modification, ice pack application followed by heat treatment, pain medication, non-steroidal anti-inflammatory drugs, muscle relaxants, spinal injection and physical therapy. Back braces may also be recommended to support the back and keep the lower back still to reduce mechanical pain. Acupuncture may also be beneficial in a few cases. Spinal surgery may be indicated if the symptoms do not respond to a conservative approach.