What is Sciatica? Symptoms and Treatment

The sciatic nerve, known in medical terminology as the nervus ischiadicus, is the thickest and longest nerve in the body, going down from the hip to the heel by the union of the L4 – L5 – S1 – S2 and S3 nerve roots located in the lower part of the waist. The disease, popularly known as sciatica, is actually a clinical picture that manifests itself with pain, numbness, tension and sometimes tingling radiating from the waist to the hip and back of the thigh as a result of stretching or compression of the sciatic nerve.

What is Sciatica Pain?

The sciatic nerve runs down the back of the leg. When it reaches the knee joint, it divides into branches and creates motor and sensory functions. The function of the sciatic nerve is to transmit the motor messages it receives from the spinal cord to the hip, leg and foot muscles and to transmit the sensations it receives from the foot, leg and hip to the spinal nerve. .

If the sciatic nerve is damaged as a result of stretching, compression or trauma, a pain will be felt starting from the waist and radiating to the leg area. These pains have been known since ancient times. Cotugno first mentioned sciatic symptoms in 1746. In the ancient Greeks, ‘ischias’ was defined as pain around the hips, waist and legs, and Hippocrates defined it as pain affecting men between the ages of 40-60.

Sciatic pain can occur in two ways. The pain is either constant but mild, or occasionally occurs as severe, sudden pain. These pains are defined as sciatica pain. This disease, known as sciatica disease, is popularly referred to as sciatica.

Types of Sciatica Pain

Sciatica can occur in different types:

1. Acute Sciatica:Acute sciatica is the sciatic nerve network that is in the initial stage and lasts for 4-8 weeks. The pain is mild and usually does not require treatment.
2. Chronic Sciatica:Chronic sciatica is persistent sciatic pain that lasts longer than 8 weeks and does not decrease. Treatment is required.
3. Alternate Sciatica:Alternate sciatica is sciatic nerve pain that affects both legs alternately. This is a rare type of sciatica and can be caused by degenerative problems in the joint.
4. Bilateral Sciatica:Bilateral sciatica occurs in both legs together. This type of sciatica is rare. It can be caused by degenerative changes in the vertebra or disc or serious conditions such as cauda equina syndrome.

Sciatica Symptoms

Sciatica occurs as a result of damage or injury to the sciatic nerve. Pain extending from the waist area to the hip area and legs is typically sciatica. Different symptoms may also occur along with pain:

• Pain radiating from the hip and back of the thigh to the leg (the most common and obvious complaint)
• Tingling, numbness or weakness in the lower leg and foot,
• Feeling like needles are sticking in your heels and toes,
• Loss of sensation and difficulty in movement,
• Symptoms increase when sitting (sciatic nerve is stretched), symptoms decrease when standing up
• Pain that worsens with movement, coughing or sneezing,
• Urinary and gas incontinence,
• Difficulty in standing upright, bending and turning movements,
• In later cases, thinning of painful leg muscles.

What Causes Sciatica?

Sciatica can occur for many different reasons:

• Lumbar disc herniation:Progressive age-related changes such as herniation in the spine are among the most important causes of sciatica.
• Sciatic nerve compression syndrome:As the sciatic nerve passes from the hip to the leg, it can become compressed between the thigh bone and the sciatic notch. In this case, if there is no bone protrusion, local cortisone injection can be performed under computerized tomography. If there is a bone protrusion, the bone compressing the sciatic nerve must be surgically removed.
• Piriformis Syndrome:It is the development of pain, numbness and tingling in the hip and leg as a result of the Piriformis muscle compressing the sciatic nerve.
• Trauma:Traumatic hip dislocation, wrong hip injection, pelvis fractures can cause direct and acute damage to the sciatic nerve itself. A fall or a blow to the sciatic nerve area can cause pain and loss of function.
• Obesity:Excessive body weight increases stress on the spine, triggering sciatica.
• Occupational Exposure:If you work in a job that requires you to constantly bend your back, carry heavy loads, and operate a motorcycle for long periods of time, the sciatic nerve may be affected.
• Prolonged Immobility:Sitting in the same position for a long time, keeping the ankle in the same position and a sedentary lifestyle can also cause the development of sciatica.
• Diabetes:Sudden changes in blood sugar can cause damage to the nervous system and trigger sciatica.
• Pregnancy:The weight the mother gains during pregnancy can put pressure on the spine. Growth in the abdomen and breasts can also cause damage to the sciatic nerve by causing the body’s center of gravity to change.
• Some congenital disorders, spine and internal organ tumors can also cause sciatica.

How to Prevent Sciatica (Sciatica)?

A few simple precautions you can take in your life can help prevent sciatic nerve damage or sciatica from recurring:

• Exercise frequently and regularly.
• Do not lift weights while sitting (reduce your risk of a herniated disc)
• Don’t smoke (do not impair your disc health and increase your risk of hernia)
• Remove any external factors that compress your hips while sitting (wallet, mobile phone, etc.).
• Avoid sudden movements.
• Bend your knees and keep your back straight when lifting heavy objects.

How to Relieve Sciatica Pain?

Sciatica pain that occurs with mild symptoms can be relieved with commonly recommended home treatment methods. With rest, analgesic and anti-inflammatory drugs, and muscle relaxants, mild sciatica usually resolves itself within a few weeks.

Surgical treatment can be applied to severe sciatic pain if there is an underlying herniated disc. Surgical treatment can be applied in cases where conservative treatment does not provide any benefit after 6 weeks, in cases where there is loss of strength in the leg or foot drop develops.

Which Doctor Should You See for Sciatica Pain?

In case of sciatica, it is necessary to first consult an orthopedic doctor. After the examination, if necessary, your physician may refer you to physical therapy, neurology or rheumatology departments.

How Is Sciatica Diagnosed?

During the orthopedic examination, the physician checks the person’s muscle strength and reflexes. You may be asked to walk on your toes or heels, rise from a squatting position, and lift your legs one by one while lying on your back. Pain from sciatica often tends to worsen during these activities.

Apart from physical examination, sciatica disease is diagnosed by easily determining the pressure on the nerve, herniated discs, bone and soft tissue injuries, and the reactions of your muscles with diagnostic tests such as x-ray, MRI, CT scan, electromyography (EMG).

Sciatica Treatment

If sciatic pain does not improve with personal care, it should be treated by a specialist doctor. Sciatica needs to be treated early to prevent symptoms from progressing. Treatment of sciatica may include non-surgical or surgical methods. In the treatment of sciatica, non-surgical methods are primarily preferred. Treatment is applied through the combined use of physical therapy, medications, therapeutic injections and alternative treatments.

The treatment to be applied varies depending on the severity of the disease, the general condition of the patient and the cause of the pressure on the sciatic nerve. In cases with mild symptoms, painkillers, muscle relaxants and anti-inflammatory drugs are sufficient for the treatment of sciatica.

Epidural steroid drug injection can be applied to patients with complaints that persist despite drug treatment. Corticosteroid medications are injected into an area called the epidural space, which is the canal surrounding the spinal cord. Sciatica pain can be treated with injection.

When your acute sciatica pain decreases with medication and injection therapy, physical therapy can be applied to prevent the disease from recurring and to have a stronger body posture. Physical therapy involves a combination of strengthening, stretching and aerobic conditioning. Physical therapy is an essential element of many sciatica treatment plans. Therapeutic exercises may be included in a program of physical therapy programs. The main purposes of physical therapy and exercises applied in sciatica treatments are as follows:

• Strengthening the spine and muscles of the waist, abdomen, hips and buttocks,
• Increasing core strength,
• Stretching tight and inflexible muscles.

If the pain continues or even increases after non-surgical sciatica treatment methods, surgical intervention may be performed. Sciatic pain can be treated with surgical methods such as lumbar laminectomy and discectomy, depending on the source of the pain. While the aim of lumbar laminectomy is to eliminate sources of nerve root compression or irritation, in discectomy a small piece of the disc material under the nerve root or the bone on the nerve root is removed. Sciatica can be treated by achieving successful results in both surgical procedures.

What Happens If Sciatica Is Left Untreated?

Although acute sciatica usually improves without treatment, progressive and untreated sciatica can cause permanent nerve damage. Loss of strength and sensation may occur in the affected leg. If there is sciatica pain along with serious spinal cord compression due to a herniated disc and is not treated, urinary and fecal incontinence may develop.

Sciatica is a disease that causes serious consequences if the necessary treatment is not applied. If you experience sciatica symptoms, consulting a specialist will prevent possible complications.