Sciatic Pain and How to Deal with It
The largest nerve in the body is the sciatic nerve. It starts at either side of the lower spine, and continues through the buttock. From there, it continues to the back of the thigh, right down the leg, and ends up at the foot. It is the nerve that is responsible for linking the muscles in the leg and foot to the spinal cord. If you feel any kind of pain or find yourself suffering from neurological symptoms that could be connected to this nerve, then the condition is known as sciatica and needs to be treated. Dr. Namrata Khimani in NYC Center treats this condition.
The pain known as sciatica normally starts when there is pressure applied to the nerve in the lower back, controlled by the spine. While we refer to this as sciatica it does have a medical name and that is lumbar radiculopathy or sometimes just radicular pain. This is because the symptoms begin in the spine and more specifically in the radicular nerve.When there are certain problems centered on the lower back, there will often be pain felt in various places along the sciatic nerve. There does tend to be one issue that occurs more often than others and is responsible for the pain.
A herniated disc can irritate the S1 or L5 nerve, and when this happens there is a significant amount of pain felt. It is a worse pain than can be felt elsewhere as the sciatic nerve has roots that are incredibly sensitive. This is coupled with the fact that the disc has an inner portion that is prone to herniated, and is full of proteins that can irritate the nerve with ease due to being so inflammatory. By the time this happens, the pain has moved around a lot and is in the back of the calf and thigh as well as in the buttocks. The pain can vary and take on a few angles including prickling, burning, tingling or numbness.
There are a few other causes, and the pain will be just as bad. At times, the spinal canal at the base of the back can start to narrow. This is known as lumbar spinal stenosis. Damaged discs are also going to compound the problem. The discs lie between the vertebrae and prevent them from rubbing against each other. Once they start to decay – usually as the person gets older, the pain will begin.
Pregnancy can be a cause and while there is an improvement for some people when the baby has been born, unfortunately, this is not always the case. Spondylolisthesis is the name given to the problem of one of the vertebra slipping forward so that it ends up covering another one. Vibrations can set of a bout of sciatica and often this happens because of work. When machines are being used and there are machines that vibrate, there is a definite chance that it is going to occur.
Symptoms of Sciatica
There are a variety of symptoms and therefore it can be difficult for a doctor to fully diagnose sciatica when the visit is first made. Therefore, a pain expert evaluation is recommended.
The symptoms include: –
- Lower back pain – This can occur often when there are long periods of standing, but there are also cases of it when sitting or lying. It is hard to get into a position that will relieve the pain.
- Buttock pain – The pain will be sharp a lot of the time and again settling in a way to alleviate the pain is not easy.
- Leg pain – This can be in any part of the leg, but often it will be in the calf.
- Numbness – This is going to be difficult to deal with when seated, but when walking numbness can be very problematic. There will be the fear that the leg is going to give way and you will fall. The best thing to do will be to stop until it passes and you feel confident walking again.
- Tingling – Again this is going to be very uncomfortable and you will be well advised to slow down until things go back to normal.
- Calf muscle weakness – As with many of the other symptoms, this is going to make motion difficult.
- Toe and Foot Weakness – Not feeling secure on your feet is going to be a strange experience.
It should be clear by now that the symptoms are going to make walking difficult. It will be bad enough trying to carry on through the pain, but when there is also uncertainty as to whether you can keep standing, it is going to make matters much worse. Some people will have a great deal of pain, while others will find it is mild and quite easy to cope with. For most sufferers it tends to be one side of the body or the other with very few being unfortunate enough to suffer on both sides.
What can worsen the pain?
Sufferers will get to know what makes the pain worse for them. Often it will be a case of trial and error, but the longer they suffer, the more they will learn about their condition. For a lot of people, the catalysts for pain will be: –
- Sitting for long periods – This is clearly going to be a problem in certain jobs. Office workers may be able to get up and move around to alleviate the pain, but train drivers, judges, and call centre staff will be more limited.
- Sneezing – Strange as it may seem, the movement when sneezing can jar the nerve and set of the cycle of pain.
- Forceful coughing – The reasons here are the same as for sneezing.
It is bad enough feeling pain and an evaluation with a pain specialist is recommended. However, there can be worse side effects. If the outbreaks of sciatica lead to any issues surrounding the control of the bladder or bowel, seek medical advice. Dealing with pain is one thing, but having your life disrupted to the extent that you may not be able to leave the house is another level altogether. There are some life choices that are going to exacerbate the pain, and the sooner they are dealt with the better. Being overweight is going to put additional pressure on the nerves and until this situation changes, there will be a price to pay.
Lack of exercise can also mean that pain is going to occur regularly, so setting up a taster session in the gym and talking through the options can put you on the road to recovery – or at least partial recovery. Another area where there can be a quick improvement is the sort of shoes that are worn. If they are high heels, they are going to put more pressure on the calves and move its way up and down the leg. Wearing sensible shoes may not be your first choice, but when it is that or a lot of pain; it makes sense to look for lower heels. Finally, your bed may be the problem. Really soft mattresses are not going to give the support required and you will need to get a harder one and get used to lying in a way to limit the pain.
The only person who can really diagnose sciatica correctly will be a pain doctor. Not all pain that has been described is going to be attributed to it. Firstly, you will need to pass on a lot of your medical history, and this needs to be totally accurate as any misinformation intended or not, could lead to a misdiagnosis. After that there will be an examination. This will cover the legs, hips and back and will cover four areas: –
If the tests carried out so far have not been conclusive, there are others that the pain specialist can turn to. These will require a visit for an imaging scan and will include, CT scans, X-rays, MRI scans and then tests on the nerves themselves to see how healthy they are. This is called nerve conduction studies and will give the pain specialist doctor a lot of the information they require.
There are two main aims when a program for treatment of sciatica is set up. There will be the dual attack of relieving the pressure that is on the nerve and dealing with the inflammation. The first part will be drug related. There will be anti-inflammatory drugs along the lines of ibuprofen, but there could also be oral steroids needed. The NSAIDs – nonsteroidal anti-inflammatory drugs – will be the best first option, but it could be that there must be the progression to steroids.
A more-risky form of steroids can be received via an injection. The sciatic nerve that is the problem will be identified and epidural steroid injections will be administered that way – into the root. After the treatment, physiotherapy can be helpful when it comes to preventing a re-occurrence of the outbreak. With more severe cases, it may be that there is no other option than to go under the knife. This will normally be a last resort and will only be considered once the patient can prove that they have tried all other treatments and are still not free of pain.
If you want to try a little self-help, there are practices that are said to bring some relief.
- Hot or cold – Use an ice pack or heat pack and sometimes both. When placed on the painful area, it can help to reduce it. Using one after the other often brings about the best result.
- Lift carefully – Bend from the knees. If there seems to be any pain, release what is being lifted right away.
- Try to sleep on your side. If pain begins, then put a pillow between your knees – this will be best for pregnancy as well as sciatica.
Sciatica in Pregnancy
There is nothing to say that becoming pregnant will leave you more open to sciatica, but it is often around when you are pregnant and is another form of discomfort that must be dealt with. The baby is not responsible for pressing on the nerve, and you are not taking greater risks of damaging one of the discs. As this will not be happening during pregnancy, it is nothing to worry about.
It is more likely to be the fact that you are less active. As pregnancy progresses you will want to rest more, and may struggle to be comfortable, so sit in an unusual position. Hard as it may be, you should try and remain active for as long as possible. You will know that you have sciatica rather than other issues if you have any of the listed symptoms – burning or shooting pain, lower back pain and numbness.
Treatment When Pregnant
Clearly there will have to be different treatment provided when you are pregnant. Exercises will revolve around strengthening the pelvic floor muscles along with back and stomach muscles. Posture will also be important and while it may seem alien to you at first, practicing standing correctly will prevent a great deal of pain. Knowing the tablets that can be taken will be ideal as you do not want to be in pain and be reading all the boxes to see if your tablets are suitable for sciatic pain or for when you are pregnant.
The Good Part
The main thing that can be said when it comes to sciatic pain is that is very rarely has any long-lasting effects. Once the pain has gone and the treatments have been endured, it is likely that there will not have been any damage to the nerves that will be permanent. It may be an uncomfortable few months that have to be dealt with, but after a matter of weeks, all symptoms should be gone.
This sadly does not mean that there will not be further outbreaks of sciatica, but after the first you should know what to expect and hopefully what you need to do to get relief as soon as possible.