The sciatic nerve is the largest nerve in the body. It originates from the nerve roots of the spine and extends through the buttock region to the nerve endings of the lower limb. Sciatic nerve pain, commonly referred to as "sciatica," typically starts from the lower back (lumbar region) to the back of the thigh. It radiates to the knee and lower leg. This pain only appears on one side of the body, but it can alternate: once on the right, once on the left, for example.
Sciatica most often occurs as a result of a lumbar disc herniation (displacement of a disc in the lumbar region) which puts pressure on the sciatic nerve. However, any cause of irritation or inflammation of the sciatic nerve can reproduce sciatica symptoms. Irritation of the sciatic nerve can also be caused by irritation of nerves dependent on bones or adjacent muscles. Sometimes, sciatica can occur during pregnancy.
Risk Factors for Sciatica
There are two types of risk factors for sciatica: those directly related to health status and those related to lifestyle. Thus, certain conditions such as degenerative arthritis of the lumbar spine, lumbar discopathy (compression of the intervertebral disc located between two lumbar vertebrae), trauma, or injury to the lumbar spine predispose to sciatica. Pregnant women, people with vascular fragility (diabetic individuals) or venous insufficiency (heavy legs, varicose veins) are also at risk.
As for lifestyle, regularly carrying heavy loads (construction workers, dockworkers, movers), engaging in sports that put pressure on the lumbar regions (windsurfing, skateboarding, kite surfing, etc.), wearing high-heeled shoes, or being overweight are all risk factors.
Symptoms of Sciatica
Sciatica causes pain, burning sensation, numbness, or tingling radiating from the lower back and buttocks to the back of the thigh and leg. Sometimes, the pain radiates around the hip or buttock similarly to hip pain. Severe sciatica can make walking difficult, even impossible, and often symptoms are aggravated by walking or bending the torso. They are relieved by lying down or changing position. Generally, sciatica is diagnosed following a crisis through a physical examination which is confirmed by medical imaging scans (CT scan, MRI) as well as by studying medical history.
Treatment Options for Sciatica
Bed rest is traditionally recommended for the treatment of acute sciatica. But is it really useful? To study the effectiveness of bed rest in patients with acute sciatica, a research team in the Netherlands led by Dr. Patrick Vroomen randomly selected 183 patients. Some were assigned to bed rest for two weeks, while others were simply observed during this period. The results of this study, reported in the New England Journal of Medicine, showed that after two weeks, 64 out of 92 patients (70%) in the bed rest group and 59 out of 91 patients in observation (65%) reported an improvement in their condition (pain scores, symptom intensity, mobility, etc.). After 12 weeks, 87% of patients in both groups reported improvement.
The results of pain intensity, symptom, and functional status assessments showed no significant difference between the two groups. The researchers concluded that bed rest was not a more effective therapy than watchful waiting.
To treat sciatica, it is advisable to address the underlying cause while taking medications to relieve pain and inflammation (nonsteroidal anti-inflammatory drugs, cortisone) and relax muscles (muscle relaxants). For this purpose, homeopathy, aromatherapy, and herbal medicine are alternatives, especially in cases of chronic sciatica, to limit the side effects of allopathic treatments (devil's claw, meadowsweet, blackcurrant leaf, white willow, etc.).
Physiotherapy is also useful. It involves stretching and learning exercises to correct posture. Osteopathy can, in some cases, improve symptoms by realigning displaced vertebrae, for example. When pain is intense, it is possible to seek specialized therapists in pain management (acupuncture, chiropractic, etc.). Finally, in some cases, surgical intervention may be necessary for persistent sciatica caused by nerve compression between discs.
References: (1) Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003. Patrick, C.A.J. Vroomen, Marc C.T.F.M. de Krom, Jan T. Wilmink, D.M. Arnold, J. Kester, and Andre Knottnerus. "Lack of Effectiveness of Bed Rest for Sciatica." N Engl J Med 340 (1999): 418- 423.Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.