Monday, November 30, 2009

Sciatica Nerve (Causes and Treatment)

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Sciatica is a pain that shoots along the sciatic nerve, radiating through the buttocks and down the back of the leg and as far as the foot. The two sciatic nerves (one on each side of the lower body) are the longest in the human nervous system, running all the way from the lower back through the thighs and calves to the feet.

Sciatica is caused by different types of pressure on the sciatic nerve in the lower back or buttocks. It can also be the result of damage to the nerve roots that feed into the sciatic nerve. Sciatica is usually felt only on one side of the body. The pain can occur along the entire length of the sciatic nerve.
Sources: MedBroadcast, Mayo Clinic, 
Causes of Sciatica
Pressure on the sciatic nerve can have many causes, some serious and some more minor. Sciatica may be the result of something as simple as bad posture, muscle strain or spasm, pregnancy, being overweight, wearing high heels, or sleeping on a too-soft mattress. More seriously, it can result from pressure exerted on the sciatic nerve or its nerve roots by a slipped disc in the back. In some cases, sciatica is due to nerve inflammation caused by a form of arthritis, or is caused by the squeezing of the sciatic nerve by a tumour wrapped around the spinal cord in the lower back (the lumbar spine).

The spinal cord is a soft bundle of nerves that starts at the base of the brain and runs down the middle of the back. It's the main pathway for communication between the brain and the rest of the body. The cord is covered by the protective spinal column (the vertebrae). Nerves enter and exit the spinal cord all the way down its length, passing through small openings between each vertebra. Nerve roots also stick out through these openings, exchanging nerve signals with the rest of the body.

The vertebrae are separated from each other by discs made of cartilage, a substance like bone but softer. Each disc has a tough outside layer and a soft inside part that acts as a shock absorber, cushioning the vertebrae when the body moves around. If the disc is damaged by injury or through aging, the inner part can bulge or slip through the outer layer. The "extruded" or "herniated" inner part of the disc may then compress or inflame a nerve root sticking out between two adjacent vertebrae. The disc may even injure the nerve root. If this happens in the lower back area, it leads to pain travelling down the sciatic nerve in the leg.

Degenerative arthritis (osteoarthritis) is another common source of nerve root damage that may cause sciatica. Osteoarthritis is characterized by the formation of bone spurs - bits of protruding bone - that may press on the nerve roots. Sometimes, older people may also develop a condition called spinal stenosis, where the space around the spinal cord narrows and squeezes nerves. More rarely, infections like meningitis or spinal cord tumours can affect the nerves. It's also possible for the sciatic nerve to be compressed further outside the spinal column in the pelvis or buttocks.

Symptoms and Complications of Sciatica
The main symptom of sciatica is pain that radiates through the buttock and down the back of the thigh and leg. The pain may stop below the knee or continue right down to the foot. Pain from sciatica can change: it can be shooting or burning, sharp or dull, non-stop or intermittent. Pain is usually only felt on one side of the body. Some people complain of intense and acute pain. Others experience a numb and weak feeling in the parts of their leg where it hurts. This may sometimes indicate more serious neurological problems. Sneezing, coughing, straining, bending, or lifting can make it worse.

In rare cases, people suffering sciatica as a result of a slipped disc are confined to bed for a few days. Another uncommon situation is disturbance of bowel and bladder control as a result of pressure on the nerves in the lower portion of the spine. Consult your doctor immediately if this occurs.

Diagnosing Sciatica
Because of the many conditions which can compress nerve roots and cause sciatica, treatment and symptoms
often differ from patient to patient. Diagnostic tests can come in the form of a series of exams a physician will perform. Patients will be asked to adopt numerous positions and actions such as squatting, walking on toes, bending forward and backward, rotating the spine, sitting, lying on back, and raising one leg at a time. Increased pain will occur during some of these activities. Checking the spine for areas of tenderness. Tests for sensation, coordination, muscle strength, and reflexes may be performed, especially when a slipped disc is suspected. Straight-leg-raise test - lifting the leg to a 90-degree angle without bending the knee - to help locate the point of pain. Other tests may include an X-ray, or scans like computed assisted tomography (CT or CAT) or magnetic resonance imaging (MRI).

Treating and Preventing Sciatica
Sciatica can be relieved by treating symptoms and any specific cause that exists, such as a slipped disc. Your doctor may prescribe muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), painkillers, or corticosteroids to reduce inflammation. Moderate exercise is recommended if pain is minimal. When the symptoms have lessened, therapy to strengthen abdominal muscles and back muscles is important to prevent a return of symptoms.

Here are some other things that may help. Many of them are similar to ways of dealing with other common lower back problems:
  • Sleep on a firm mattress on your side or back with knees bent.
  • During bad attacks, sleep with a pillow under or between your knees.
  • Try not to sleep on your stomach.
  • Adjust the height of chairs so your feet are flat on the floor and the knees are a little higher than the hips.
  • Keep your feet flat on the floor and do not cross your legs when sitting.
  • Sit in chairs that have firm back support and sit up straight against the back of the chair.
Other Causes

Spinal stenosis
Other compressive spinal causes include spinal stenosis, a condition wherein the spinal canal (the spaces through which the spinal cord runs) narrows and compresses the spinal cord, cauda equina, and or sciatic nerve roots. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that travel to the sciatic nerves.

Piriformis syndrome
In 15% of the population, the sciatic nerve runs through the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Conditions of this type are generally referred to as entrapment neuropathies; in the particular case of sciatica and the piriformis muscle, this condition is known as piriformis syndrome. It has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket will compress the muscles of the buttocks and sciatic nerve when the bearer sits down. Piriformis syndrome may be the major cause of sciatica when the nerve root is normal. 

Trigger points
Another source of sciatic symptoms is active trigger points of the lower back and the gluteus muscles. In this case, the referred pain is not consequent to compression of the sciatic nerve, though the pain distribution down the buttocks and leg is similar. Trigger points occur when muscles become ischemic (having low blood flow) due to injury or chronic muscular contraction. The most commonly associated muscles with trigger points triggering sciatic symptoms are: the quadratus lumborum, the gluteus medius, the gluteus minimus, and the deep hip rotators.

Sciatica may also be experienced in pregnancy, primarily resulting from the uterus pressing on the sciatic nerve, and, secondarily, from the muscular tension and/or vertebral compression consequent to carrying the extra weight of the fetus, and the postural changes inherent to pregnancy.

The risk of self-inflicted sciatica has increased in recent years with, for instance, sitting on a wallet or feet for prolonged hours every day which can cause self-inflicted sciatica. Symptoms of numbness and or pain behind the knee cap are associated with this form of sciatica. Work-related sciatica may be caused by the use of tool belts which hang around the hips and cause significant misalignment of the sacral vertebrae over long time periods.

Source from: C.Health MediResource & Wikipedia

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