SCIATICA (PINCHED NERVE) Back Pain

WHAT IS SCIATICA?

Sciatica, radiculopathy, and herniated discs go hand in hand.

Sciatica is not so much a condition but a symptom. It refers to pain that begins in the hip and buttocks and continues all the way down the leg. This symptom is often accompanied by low back pain, which can be more or less severe than the leg pain.

The term sciatica indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition.

True sciatica is a condition that occurs when a herniated disc or osteoarthritic bone spurs compress and pinch one of the contributing roots of the sciatic nerve. This is known as a pinched nerve. This type of lower back pain is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica. The challenge for a physician is to distinguish between radicular pain (also called radiculopathy), which is caused by an inflamed nerve root, and referred pain, which is a result of a musculoskeletal sprain or strain.

WHAT IS RADICULOPATHY?

Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals to the rest of the body at each level along the spine. This term comes from a combination of the Latin words radix, which means "roots of a tree," and pathos, which means "disease."

This disease is often caused by direct pressure from a herniated disc or degenerative changes in the lumbar spine that cause irritation and inflammation of the nerve roots. Radiculopathy usually creates a pattern of pain and numbness that is felt in your arms or your legs in the area of skin supplied the by sensory fibers of the nerve root, and weakness in the muscles that are also supplied by the same nerve root. The number of roots that are involved can vary, from one to several, and it can also affect both sides of the body at the same time.

WHAT IS A HERNIATED DISC?

Herniation describes an abnormality of the intervertebral disc that is also known as a "bulging," "ruptured," or "torn" disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis). This tear in the annulus fibrosis causes pain in the back at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve. Between each vertebra in the spine is a pair of spinal nerves, which branch off from the spinal cord to a specific area in the body. Any part of the skin that can experience hot and cold, pain or touch, refers that sensation to the brain through one of these nerves. In turn, pressure on a spinal nerve from a herniated disc will cause pain in the part of the body that is served by that nerve. Most disc ruptures occur when a person is in their 30s or 40s when the nucleus pulposus is still a gelatin-like substance.

WHAT ARE THE SYMPTOMS OF A HERNIATED DISC/PINCHED NERVE?

Usually, a person’s main complaint is back pain. In some cases, there may be a previous history of episodes of localized lower back pain, which is present in the back and continues down the leg that is served by the affected nerve. This pain is usually described as a deep and sharp pain, which gets worse as it moves down the affected leg. The onset of pain with a herniated disc may occur out of the blue or it may be announced by a tearing or snapping sensation in the spine that is thought to be the result of a sudden tear of part of the annulus fibrosis.

A person with a herniated disc will usually complain of lower back pain that may or may not radiate into different parts of the body. They will often have limited range of motion when asked to bend forward or lean backward, and they may lean to one side as they try to bend forward. Sometimes, they walk with a painful gait, flexing the affected leg so as not to put too much weight on the side of the body that hurts.

HOW IS A HERNIATED DISC/PINCHED NERVE TREATED?

The treatment for the vast majority of people with a herniated disc does not normally include surgery. Many patients will respond to non-surgical treatments. The primary element of non-surgical treatment is controlled physical activity. Usually, treatment will begin with avoidance of exacerbating activities followed by a gradual return to normal activities. Sitting is bad for this condition because the sitting posture puts a large amount of stress and pressure on the lumbar spine, which may increase the pressure on the affected nerve root. The appropriate use of medications is an important part of non-surgical treatment. This can include anti-inflammatory drugs, analgesics, muscle relaxants, or tranquilizers. Physical therapy is also important.

Surgical treatment and chronic pain therapies are reserved for people who have not had success with non-surgical treatment options and a sufficient period of time has passed to indicate that they may need to have surgery in order to help them to get better.