Understanding Sciatica - 9 Factors Contributing to Sciatic Nerve Pain Or Sciatica

spinal stenosis

What is sciatica? Sciatica is one of the most difficult conditions for medical practitioners, even those experienced in treating back pain and sciatica patients, to identify and treat. Sciatica often presents itself as a tingling and/or numbness, not unlike the feeling one may experience with a pulled hamstring muscle, the biceps femoris at the back of the leg. The sensation may be dull, almost an ache, with periods of tingling and/or numbness occurring during certain activities. The tingling and/or numbness experienced, if not treated, may develop into a full-blown chronically acute phase with pain shooting across the buttocks and radiating down the leg. Sciatica may affect one or both legs, usually one, beginning as a pain radiating from some point in the lower back, the lumbar spine, then across the gluteal muscles (the buttocks), and finally down the back of the leg. In advanced cases, sciatica reaches all the way into the feet and toes, causing discomfort and an eventual loss of feeling.

Interestingly, sciatica is not a specific condition, it is simply a catch-all medical term applied to a constellation of symptoms in order to describe a state the back pain sufferer is in. In this case, sciatica is used to describe a patient's complaint of pain radiating across the buttocks, down the leg, and into the feet and toes...along with the associated tingling and/or numbness. Sciatica may be caused by a number of conditions, from stress and trauma at a specific location on the spine, the lower back or lumbar curvature, to a more generalized condition such as obesity or pregnancy. There are a number of other conditions associated with sciatica, all requiring varying degrees of medical intervention and treatment. Some of the conditions likely to present with sciatica are:

1. Osteomyelitis: An infection of the bone or bone marrow. Osteomyelitis may be debilitating and in extreme cases may even cause death. It is difficult to diagnose and may go undetected for a long time unless appropriate blood tests are ordered and the medical practitioner is well trained in infectious diseases affecting the bones.

2. Tumors on or near the spine: Tumors, particularly tumors or abnormal growth (e.g., scar tissue) affecting the nerves or nerve roots as they exit the spinal canal and intervertebral foramen, will sciatic nerve pain or sciatica.

3. Degenerative Disc Disease: Once again, degenerative disc disease is not a disease any more than sciatic nerve pain, called sciatica, is a specific condition. Degenerative disc disease is a breakdown of the IVDs, the intervertebral discs, and is usually a consequence of aging combined with the any or all of the 5 principal factors affecting the spine as we age.

o Excess weight and/or obesity

o Muscle weakness

o Muscle Imbalance

o Inadequate nutrition and diet

o Inadequate hydration or dehydration

4. Herniated (i.e., ruptured) or bulging disc: This condition may be particularly problematic if the herniated disc or bulging disc is protruding posteriorly (to the back) and into the spinal canal, or impinging on the nerve root at the intervertebral foramen, thus placing pressure on the spine and/or nerve root; and, sciatica is the result in many instances.

5. Piriformis syndrome: We will cover the piriformis syndrome and how it relates to sciatica in depth in a subsequent video and article. Recent research has demonstrated that this little-known syndrome, at least in the lay community, may be a factor in as many as eight out of ten sciatica cases. The piriformis muscle works particularly hard in runners and others who are physically active, often resulting in RMI or repetitive motion injury.

6. Spinal stenosis: This is a narrowing of the spinal canal and/or intervertebral foramen. In fact, any narrowing of a structure can be defined broadly as a stenosis. The stenosis, the narrowing affects and/or obstructs the pathway for nerves, thus exacerbating pain...in this case creating the sciatic nerve pain associated with sciatica.

7. Spondylolysis: In layman's terms, it is a stress fracture at the back of the vertebra, the vertebral body (the front part) breaks away from the back part of the vertebra (everything else). In osteological terms, the break occurs at the pars interarticularis of the vertebra, usually at the fifth lumbar vertebra, the last vertebra before the lumbar spine articulates with the sacrum or tailbone. This is usually associated with spondylolisthesis, the next contributor to sciatic nerve pain.

8. Spondylolisthesis: Usually associated with spondylolysis in younger back pain and sciatica patients but may present without spondylolysis in older adults. Spondylolisthesis is the result of an anterior (forward) shift in the vertebra body, in fact the entire vertebra when spondylolysis is absent, or the vertebral column in relationship to the remainder of the vertebral column below. There are a number of reasons why this condition may occur but in younger patients it is usually found with spondylolysis. We will discuss this condition in depth in a subsequent article and video but suffice it to say that any change in the overall structure of the spine, particularly at the lumbar curvature, will create sciatic nerve pain.

9. Trauma: Trauma and stress go hand in hand when it comes to back pain and sciatica. Trauma may be localized, meaning the spine will take the brunt of the stress at a specific location, or it may be generalized and affect several levels simultaneously. The better equipped we are in terms of muscle strength, muscle balance (or imbalance), and the other factors affecting spine health, the better equipped we will be to handle appropriate levels of stress. The IVDs are remarkably resilient and very strong but if the discs undergo change as a result of any of the 5 factors listed above, or the traumatic event is profound enough, damage to the spine may occur; and, sciatica may be the outcome. In this case, a medical practitioner should always be the first step in any bad back treatment strategy.

In reality, any one of the factors above, or several of the above mentioned conditions together, may cause low back pain and sciatica. Sciatica is, once again, the presentation of a specific type of pain. The actual condition causing the sciatic nerve pain may be any of the above or a number of other conditions not discussed here; these are some of the main ones.

Your medical practitioner may refer to sciatica as radiculopathy, particularly lumbar radiculopathy, because sciatica originates in the lumbar curvature or lumbar region of the spine. This has become a catch-all, in much the same was sciatica has; and, both are used when a more appropriate designation should be applied. But for now, understand that if your medical practitioner refers to sciatica and/or lumbar radiculopathy, he or she is usually referring to pain radiating from the lumbar region of the spine, at times across the buttocks, down the back of the leg, and even into the feet and toes. We will discuss sciatica in much greater depth in upcoming articles and videos.