What is Sciatica?

• Age (peak 45-64 years)
• Increasing risk with height
• Obesity
• Smoking
• Sedentary lifestyle

• Strenuous physical activity—for example, frequent lifting, especially while bending and twisting
• Driving, including vibration of whole body

• Disc Herniation/Migration: A herniated or slipped disc is one of the most frequent causes of sciatica. When a disc in the spine bulges or ruptures, the advancing disc material(ie bulging nucleus pulpous)  can impinge  against the nerve roots that constitute the sciatic nerve leading to the symptoms.
• Spinal Stenosis: Spinal stenosis refers to the narrowing of the spinal canal, which can compress the nerves, including the sciatic nerve. This narrowing often occurs due to age-related degeneration or conditions such as osteoarthritis of the facet joints.
• Piriformis Syndrome: The piriformis muscle, located in the buttocks, can sometimes tighten or spasm, irritating the sciatic nerve as it passes beneath or through the muscle. This is known as piriformis syndrome.
• Spinal Injury or Trauma: Accidents, falls, or other traumatic events can cause damage to the spine, leading to inflammation and compression of the sciatic nerve.

• Sharp or Shooting Pain: The pain experienced in sciatica is often described as a sharp, burning, or electric shock-like sensation. It may be intermittent or constant, and its severity may vary.
• Numbness and Tingling: Along with pain, individuals with sciatica may experience numbness or tingling sensations in the buttocks, leg, or foot. This can range from a mild “pins and needles” sensation to complete numbness.
• Muscle Weakness: In some cases, sciatica can cause weakness in the affected leg, making it difficult to move or bear weight. Muscle weakness can affect daily activities such as walking or standing.
• Worsened Symptoms: Activities that involve prolonged sitting, standing, coughing, or sneezing may exacerbate sciatica symptoms, while lying down or walking may provide temporary relief.

1. Symptoms duration >4 weeks
2. Unilateral leg pain radiating below the knee
3. Leg pain worse than, or as bad as, back pain (if present)
4. Positive straight leg raise test OR muscle weakness in one myotome OR loss of sensation in one dermatome
5. No pain in contralateral leg below the gluteal margin

• Conservative Management: Many cases of  sciatica resolve with non-surgical treatments. These may include:
  • Rest and Activity Modification: Avoiding activities that worsen pain and incorporating periods of rest can help reduce symptoms.
  • Pain Medication: Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help alleviate pain and reduce inflammation.
  • Heat or Ice Therapy: Applying heat or cold packs to the affected area can provide temporary relief from pain and inflammation.
  • Physical Therapy: Targeted exercises and stretches can help improve flexibility, strengthen the back and core muscles, and alleviate pressure on the sciatic nerve.
• Epidural Steroid Injections (ESIs): In cases of severe or persistent pain, an ESI may be recommended. This procedure involves injecting a corticosteroid medication directly into the affected area to reduce inflammation and alleviate pain.
• Platelet Rich Plasma and Prolotherapy can also be undertaken in cases of sciatica due to degenerative disc disease to treat the arthritic facet joints and strengthen the ligament bone interface.
• Surgical Intervention: If conservative treatments do not provide relief or the underlying condition is severe, surgery may be considered. Common surgical options include discectomy (removal of a herniated disc). Microdiscectomy and Endoscopic discectomy are two common approaches for a majority of the surgical cases.

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