What causes sciatica?
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.
Lumbar herniated disc.
Research suggests that up to 90% of sciatica is caused by a lumbar herniated disc. The herniated disc typically compresses one or more spinal nerve roots (L4-S3) that form the sciatic nerve. A lumbar herniated disc can cause sciatica in two ways:
- Direct compression. Direct compression of the sciatic nerve can occur when a lumbar disc bulges (contained-disc-disorder) or when the soft inner material of the disc leaks out or herniates through the fibrous outer core (non-contained disc disorder) and presses against the nerve.
- Chemical inflammation. An acidic chemical irritant from the disc material (hyaluronan) may leak out and cause inflammation and irritation in the area around the sciatic nerve.
A herniated disc may compress the sciatic nerve on one side, causing symptoms in one leg, or the disc may bulge or herniate from both sides, causing symptoms in both legs (bilateral sciatica). Bilateral sciatica may also be caused by two adjacent segments discs herniating on either side, although this possibility is rare.
Degeneration of tissues in the lumbar spine can compress or irritate the sciatic nerve. Degeneration of the facet joints can also cause the synovial tissue in the joint’s capsule to inflame and increase in bulk. Degeneration of vertebral bone may cause abnormal bone growths (bone spurs or osteophytes). These abnormally bulky tissues in the lumbar spine may cause compression of one or more nerve roots of the sciatic nerve. Degenerated intervertebral discs may secrete inflammatory proteins, causing inflammation of the sciatic nerve.
Lumbar spinal stenosis.
Spinal stenosis is the narrowing of the spinal canal and is relatively common in adults older than age 60. Research suggests that lateral recess stenosis may be common in causing sciatica in the elderly population.
Spondylolisthesis occurs when a small stress fracture causes one vertebral body to slip forward on another. For example, the L5 vertebra may slip forward over the S1 vertebra. Sciatica may result from nerve compression following the disc space collapse, fracture, and forward slipping of the vertebral body. Spondylolisthesis may cause bilateral sciatica and is more common in younger adults.
Risk factors of sciatica:
Risk factors for sciatica include:
- Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
- Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.
- Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there’s no conclusive evidence of this link.
- Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
- Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.
It’s not always possible to prevent sciatica, and the condition may recur. The following can play a key role in protecting your back:
- Exercise regularly. To keep your back strong, pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Ask your doctor to recommend specific activities.
- Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
- Use good body mechanics. If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
Physical therapy helps improve symptoms of sciatica by increasing flexibility, range of motion, posture, while also improving muscle strength.
This type of therapy is an excellent treatment approach when done alongside other complementary treatments. For example, you may take pain-relieving medications for short-term pain while also undergoing physical therapy to resolve the underlying cause of your sciatica.
Deep tissue massage
Sciatic massage of tender areas may help relieve muscle spasms or contractions and improve the discomfort associated with it.
Massage as a sciatica therapy can also help you relax, decreasing stress and tension.
Nutrition and exercise
Exercise can reduce the pain of sciatica by increasing flexibility and range of motion. Another benefit of regular exercise is the release of hormones called endorphins, which are your body’s natural pain relievers. Yoga and Pilates are both good introductory practices you can modify to your comfort level.
Nutrition and healthy eating are powerful treatments that combat nutritional deficits and control inflammation. In combination with one another, changes to diet and exercise can offer profound sciatic pain relief.
This is a treatment that teaches you how to become aware of involuntary processes inside of the body (such as blood pressure, temperature, and heart rate control).
This method enables you to gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness of one’s body teaches one to effectively relax, which can help to relieve pain.
With this ancient Chinese therapy, small needles are inserted into your skin. These needles cause your body to release hormones called endorphins, which are your body’s natural pain relievers.
Acupuncture can also help you relax, decreasing stress, tension, and muscle spasms.
NSAIDs (ibuprofen-like drugs), acetaminophen, membrane-stabilizing drugs, muscle relaxants, and other analgesics are often used in the management of pain associated with sciatica.
It is important to note that there is no evidence that opioid treatment is effective for sciatica.
Transcutaneous electrical stimulation (TENs)
This pain relief technique is a passive process with no known side effects. Your doctor places patches on your skin in the affected area. These patches deliver a mild electrical current that interrupts the pain signals to the brain. A tingling sensation replaces those pain signals that typically reach your brain.
TENs unit therapy may help to:
- Reduce your perception of pain
- Relax your muscles
- Improve mobility
Epidural steroid injections (ESI)
This procedure involves injecting a medication into the epidural space where the actual irritated nerve root is located.
This injection includes both a long-lasting steroid and a local anesthetic. The steroid reduces the inflammation and irritation and the anesthetic works to interrupt the pain-spasm cycle and nociceptor (pain signal). The combination medicine then spreads to other areas of the spine, reducing inflammation and irritation.
This sciatica treatment usually takes less than 15 minutes. The biggest benefit to this treatment is the rapid relief patients often experience. While this relief is temporary, it can allow them to begin other treatments, such as exercise and physical therapy, that they were unable to do before.
Watch the following video to learn more about this procedure.
Trigger point injections (TPIs)
These can be an effective treatment for muscle spasms that lead to sciatica.
The procedure involves injecting a local anesthetic and steroid into a trigger point. Performing a piriformis injection can be considered a type of TPI.
This procedure involves inserting a small catheter through a needle into the epidural space or directly next to affected nerves.
Local anesthetic and other medicines are often given through the catheter for extended time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long-lasting.
With this procedure, a needle is inserted through the skin into the affected disc. Disc material is suctioned out of the bulging disc and pressure is relieved within the disc.
This treatment is best combined with strengthening exercises to prevent further injury.
Spinal cord stimulation (SCS)
For this sciatica treatment, an implanted electrical device can decrease the perception of pain by interrupting pain signals being sent to your brain. Your doctor will perform a short trial procedure to see if this device will help you long-term.
In the initial trial, your pain physician places a small electrical lead through a needle in the epidural space. A tingling sensation will replace your pain signals. If this does manage your pain, you may opt to have your doctor implant a permanent SCS device.
Why choose Apex Pain Specialists for your Sciatica Pain Doctors in Chandler, AZ?
We are dedicated to making your experience at our Chandler pain management clinic as comfortable and efficient as possible. Your patient experience is of paramount importance to us. Our Doctors specialist in Sciatica treatment in Chandler and have a passion for helping patients live a more pain free life.
Apex Pain Specialists has been picked us the best pain management doctors in Chandler, Arizona. Our clinic faced a rigorous 50-Point Inspection, which includes customer reviews, history, complaints, ratings, satisfaction, trust, cost and general excellence. You deserve the best! We offer a comfortable environment for open discussion about your pain.