By Donell Irungo
What is sciatica and why is the pain so bad?
Sciatica is a pain that radiates along the path of the sciatic nerve, the longest nerve in the human body. This nerve runs from the lower back, through the back of the hips and buttocks and down the back of each leg.
Symptoms of sciatica
Sciatica typically affects only one side of the body, and the pain can be severe.
- Pain radiating down the back of the leg: The most common symptom of sciatica is pain that starts in the lower back or buttock and radiates down the back of your thigh and calf, sometimes into the foot.
- Numbness and tingling: You may feel a loss of sensation or a pins-and-needles sensation in the leg or foot along the sciatic nerve.
- Muscle weakness: Your affected leg may feel weak, making it difficult to move the foot or bend the knee.
- Burning or stabbing pain: The pain can be sharp, severe, and debilitating, often described as a burning or electric shock-like sensation.
Causes of sciatica
Sciatica is caused by irritation, inflammation or compression of the sciatic nerve in the lower back. This can happen for a number of reasons:
- Herniated or bulging discs: One of the most common causes of sciatica is a herniated disc. Discs are the cushion-like pads between the vertebrae in the spine that act as shock absorbers. When a disc herniates, the soft inner gel of the disc pushes out through a tear in the outer layer. This can press on the sciatic nerve.
- Spinal stenosis: This is a narrowing of the spinal canal, which can compress the spinal cord and affect the sciatic nerve. It often occurs as the spine changes with age.
- Piriformis syndrome: The piriformis muscle is in the buttocks near the top of the hip joint. When this muscle spasms or becomes tight due to direct trauma, prolonged periods of sitting, or increased muscle size, it can irritate the nearby sciatic nerve. Piriformis syndrome is only responsible for 0.3 to 0.6% of all sciatica cases.
- Spondylolisthesis: This condition occurs when one vertebra slides forward over the vertebra below it. This can compress the sciatic nerve.
- Injury or trauma: Direct injury to the lower back or spine can lead to sciatica if it damages the sciatic nerve.
Why sciatica pain is so bad
- Nerve sensitivity: The sciatic nerve is highly sensitive. When it's irritated or compressed, it can cause severe pain that radiates along its length, making simple movements excruciating.
- Length of the nerve: Because the sciatic nerve is the longest nerve in the body, the pain can travel from the lower back all the way down to the toes, affecting multiple areas and making it feel more widespread and intense.
- Impact on mobility: Sciatica can significantly impact your ability to move and perform daily activities. The pain can make standing, sitting, walking, and even lying down uncomfortable.
- Chronic nature: In some cases, sciatica can become a chronic condition, that is a condition that persists for months or even years. This can take a toll on you overall quality of life and mental health.
Alternative causes of back pain
It’s important to understand that not all back pain is caused by sciatica. Other conditions can have similar symptoms that will need to be ruled out.
- Muscle strains and sprains: These are the most common causes of back pain. They occur when muscles or ligaments in the back are overstretched or torn, often due to overloading the muscle rather than just sudden movements. Prolonged periods in certain positions or repetitive movements can also lead to muscle strains. Note: Poor posture is relative to the person; it’s not inherently harmful, but staying in a single position for too long can contribute to muscle strain.
- Herniated or bulging discs: Discs are the soft, cushion-like pads between the vertebrae in your spine. A herniated or bulging disc occurs when one of these discs becomes damaged and causes significant compression on a nerve. Typically, the pain associated with a herniated disc resolves within three months if managed properly to avoid secondary problems.
- Arthritis: Osteoarthritis is a normal process associated with ageing and can affect the lower back, causing pain and stiffness. This pain and stiffness are often a response by the surrounding soft tissue to arthritic changes in the vertebrae, such as the formation of bone spurs or narrowing of the spaces in the spine (Spinal stenosis). Note: Arthritic changes to the vertebrae may include the formation of osteophytes (bone spurs), disc degeneration, and facet joint inflammation.
- Osteoporosis: If untreated, this condition causes bones to progressively become weak and brittle, leading to stress fractures in the spine that can cause significant localised pain.
- Overloaded stress response: Stress can exacerbate back pain by increasing muscle tension and inflammation. It's crucial to manage stress through lifestyle changes, exercises to increase tolerance to these stresses, and mindfulness techniques to reduce its impact on back pain.
- Neural hypersensitivity: In some cases, the nerves in the lower back can become hypersensitive, amplifying the pain response to otherwise normal stimuli. This condition requires careful management through a combination of physiotherapy, pain education, and sometimes other medical intervention to reduce nerve sensitivity and improve pain tolerance.
Conclusion
Sciatica and back pain are complex conditions that require a comprehensive and individualised treatment approach. The key to managing sciatica effectively is a combination of education, exercise, posture awareness, and medical intervention when necessary.
Learn more about how you can relieve sciatica symptoms, make adjustments to daily life to reduce pain, and how physiotherapy can help with sciatica.
