Sciatica is medically defined as a series of symptoms, particularly pain, which often extend along the sciatic nerve. The symptoms generally begin in the lower back, radiating down the buttocks and legs, through the back of the thighs and into the calf and foot.
The characteristic symptom of pain associated with sciatica can manifest abruptly or may develop gradually over time. Individuals diagnosed with sciatica describe the pain as a sharp, shooting or electric shock-like in nature. Movement of the lower extremities can aggravate the pain and it may be evenly distributed along the leg, although there can be specific spots where the pain may be more intense. Other symptoms reported by sciatica sufferers include tingling sensations and numbness in the distribution of the sciatic nerve.
Sciatica is commonly caused after an injury or condition results in the irritation and inflammation of the structures surrounding the lumbar region of the spine, which may in turn lead to the compression or impingement of the sciatic nerve and/or the surrounding nerve roots. The added pressure can be due to a variety of common injuries and conditions, including: ruptured intervertebral discs, spinal stenosis or the narrowing of the spinal canal.
Anatomy of the Sciatic Nerve
The sciatic nerve is the longest and widest nerve in the body, measuring approximately three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves found in the lower back, along the lumbosacral region of the spine. The lumbosacral spine refers to the area where the lumbar spine and the sacrum come together. The sciatic nerve and it’s nerve root branches’ primary function is to allow movement and provide feeling in the thigh, knee, calf, ankle, foot and toes.
The sciatic nerve itself can be found running through the low back or the lumbar region of the spine. The nerve roots in this area are found along the L4 and L5 vertebrae. The sciatic nerve also travels through the pelvic region or sacrum.
In most individuals, the sciatic nerve runs under the piriformis muscle, the important muscle which is in charge of moving the thighs from side to side. The sciatic nerve then descends from the piriformis muscle, through the buttocks and the back of the thighs. By the area behind the knee, the sciatic nerve branches out into smaller nerve roots which continue traveling down and into the feet.
The sciatic nerve is part of the body’s nervous system, a complex network of nerves responsible for transmitting signals of sensation along with sensations of pain to other areas of the body. With sciatica, an injury or condition, such as a herniated disc, which causes irritation and inflammation along the tissues and other structures surrounding the sciatic nerve, can compress and apply unnecessary pressure to the nerve roots, radiating pain down the legs.
The sciatic nerve exits the sacrum in the pelvic area through a nerve passageway known as the sciatic foramen. At the upper part of the sciatic nerve, two branches form: the articular branches; and the muscular branches. The articular branch goes to the hip joint while the muscular branch serves the leg flexor muscles to enable movement. Other complex nerve structures are also involved: the peroneal nerves; and the tibial nerves. The peroneal nerves originate from the nerve roots along the L4 and L5 vertebrae of the spine and in the S1 and S2 vertebrae of the sacrum. After the peroneal nerves exit the pelvis, they travel down the front and side of the leg into the outer side of the knee and foot. The tibial nerves originate from the nerve roots at the L4 and L5 as well as the S1 through S3 vertebrae of the spine. The tibial nerves travel in front of the knee and down into the foot. When the sciatic nerve becomes compressed or impinged, it can cause painful symptoms along these pathways, characteristic of sciatica.
Should Sciatica be Treated with Surgery?
Most patients diagnosed with symptoms of sciatica can experience relief from non-surgical treatments, such as chiropractic care, and surgical interventions are generally not required to treat it. However, when the compression or impingement of the sciatic nerve manifests more serious symptoms, it may be necessary to receive further advice from a healthcare professional on the best form of treatment you should follow.
Severe symptoms such as: bowel or bladder dysfunction; advanced stages of spinal stenosis; neurological dysfunction including severe leg weakness; and intense symptoms where non-surgical treatments are no long effective; could indicate the need for surgery to treat sciatica.
The two common spinal surgeries for sciatica are:
- Discectomy and microdiscectomy. With both of these procedures, the surgeon removes all or part of a herniated disc which may have been applying pressure against the sciatic nerve, causing your symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, many patients recover quicker from this type of surgical procedure.
- Laminectomy or laminotomy: These procedures both involve a part of the spine called the lamina, or the bony plate which functions to protect the spinal canal and spinal cord. A laminectomy involves the removal of the entire lamina; a laminotomy involves the removal of only a part of the lamina. These procedures can create more space for the nerves, reducing the risk of the nerves being compressed or impinged.
Over-the-counter medication, such as non-steroidal anti-inflammatory drugs or NSAIDs, can help reduce the irritation and inflammation of the body which may relieve the symptoms of pain. These however are only considered temporary treatments and the source of the individual’s sciatica should be addressed to promote overall health and wellness. Be sure to consult your healthcare provider on the best treatment option for your sciatica.
By Dr. Alex Jimenez
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient’s strength, mobility and flexibility.
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