The spinal cord is part of the central nervous system which also includes the brain. The spinal cord starts at the brainstem and ends in the lower back at the first lumbar vertebrae (L1). Nerves exit the spine from the spinal cord and provide sensory and motor functions to the entire body including the upper extremities (arms/hands/fingers) and lower extremities (legs/feet/toes). Nerve impulses allow your upper and lower extremities to function and sensory input is provided via these nerves which is perceived in the brain as pain, hot, cold, etc. Keeping fit with a strong core helps protect your precious spine, spinal cord and nerves that innervate your extremities.
Spine Anatomy & Common Causes of Sciatica
The bones in the spine are called vertebrae. For naming purposes they are divided into cervical (neck), thoracic (mid-back), lumbar (low back) and sacral (buttocks area) regions. Vertebrae support your entire body and help us to sit, stand, walk and move. The most important function of the vertebrae is to protect the spinal cord and spinal nerves. When the vertebrae, discs (shock absorbers between vertebrae), and soft tissue are injured, compression of a nerve can occur (pinched nerve). When the pinched nerve is in the lumbar spine not only can back pain occur, but a condition causing pain to go down one or both legs called sciatica can also manifest. Sciatica can be very painful and disruptive to your life.
Sciatic nerve pain is a fairly common example of nerve pain. The sciatic nerve is the largest nerve in the body and runs down the back of your legs. When this nerve is injured, pain can radiate from the lower back to the buttocks, hips, and legs. Patients who suffer from sciatica may also feel numbness, weakness, or a tingling sensation. Usually only affecting one leg, sciatica pain symptoms tend to appear very suddenly and can last for weeks. Although most people experience back pain with sciatica sometimes sciatica is the only symptom of a pinched nerve in the back.
Common causes of sciatica are:
- Muscle spasms in the back or buttocks. This can irritate or compress the sciatic nerve.
- Pregnancy: Pregnant women may develop sciatica because the uterus can put pressure on the sciatic nerve.
- Degenerative disc disease. Discs act as cushions between the vertebrae.
- Herniated discs. Discs get weaker and more vulnerable to injury as we age. When the center of a disc pushes through its lining and presses on the sciatic nerve, it can result in sciatica.
- Lumbar spinal stenosis. This is a narrowing of the spinal canal in the lower back. It can be caused by natural wear and tear associated with aging and is most common in people over 50.
- Spondylolisthesis. Spondylolisthesis is a condition where one vertebra slips forward or backward over another vertebra, causing narrowing of the spinal canal and/or narrowing where the nerve roots exit.
Sciatica Pain Relief
Episodes of sciatica can be extraordinarily painful and debilitating. However, most patients will NOT need surgery and will see resolution in 6-8 weeks. Identifying the underlying cause of sciatica is the best way to move forward with a treatment plan, so it is always a good idea to talk to your doctor before beginning treatment. The following are a few ways to alleviate the pain associated with sciatica.
- Strengthen your core and back. Poor posture and weak or tight muscles can mess up the alignment of your spine, thereby increasing your risk for back pain.
- Stretch out your hips, glutes, and hamstrings. Stiff muscles in your lower body can affect your posture and increase the stress placed on your lower back. Many types of back pain including sciatica may improve with a regular stretching routine that targets the hips, glutes, and hamstrings.
- Drugs such as anti-inflammatories, muscle relaxers, and steroid injections.
- Hot and cold therapy. These help to loosen up the muscles in the lower back.
Treatment of sciatica is usually multi-modal and includes anti-inflammatories, physical therapy, and often epidural steroid injections. Patients are encouraged not to rush into surgery unless they are experiencing bowel/bladder dysfunction, neurological dysfunction such as a foot drop or profound weakness, or severe intractable pain not responding to more conservative treatment.
If you experience sciatica, talk to your doctor to help determine the underlying cause. Your doctor can prescribe medications and put together a treatment plan that will get you back on your feet and improve your quality of life.