Sciatica and Lower Back Pain

Sciatica and lower back pain are two of the most common reasons for visits to the doctor each year. The sciatic nerve runs down the back of the leg from the top of the buttocks down to the feet and so problems in the lower back may cause symptoms far down the sciatic nerve and seemingly unconnected to the back itself. Sciatica is usually experienced only in one side of the body and as a radiating pain throughout the back, buttocks, and leg. The symptoms may arise due to pinched nerve roots in the spine or due to tension in the piriformis muscle in the thigh, meaning that not all sciatica and lower back pain are connected. The sciatic nerve starts at L3 in the lumbar spine, meaning that lower back pain and sciatica often occur together but are not always present simultaneously.

Causes of Sciatica

Sciatic nerve pressure may arise following a muscle strain, spasm, or cramp, in pregnancy as the body changes, with poor posture when working, exercising, or sleeping, or due to carrying excess body weight or wearing high heels. Spine problems such as spinal stenosis may also be the cause of sciatica and lower back pain with disc herniation, vertebral fracture, or spondlyitis (arthritis) causing compression of the spinal nerves. Those who work in professions requiring lots of heavy lifting, twisting, or other strain on the back are at a higher risk of sciatica and lower back pain. Increasing age, general wear and tear on the spine and joints, diabetes, and acute trauma to the spine also increase the risk of sciatic nerve damage. Rare cases of sciatica occur involving a spinal tumor in the lower back that wraps around the spinal cord and causes compression of the sciatic nerve. Systemic inflammatory diseases, such as rheumatoid arthritis, can also cause sciatica and lower back pain as the spinal structures become inflamed more easily and nerve compression can occur.

Spinal Stenosis and Sciatica

Osteoarthritis in the lumbar spine may also trigger sciatica as bone spurs (osteophytes) can form over time and cause nerve compression and spinal stenosis. It may be that patients find that their symptoms are relieved by bending forwards at the waist, usually indicating the presence of spinal stenosis, as this movement opens up the spaces in the lumbar spine and can free the pinched nerves. Sciatic nerve pain may vary day to day with some shooting pains followed by a dull ache and fatigue in the leg. Pain can be chronic or intermittent and can result in numbness, weakness, or acute sharp pain. Sneezing, coughing, and hiccups can cause a bulging disc to herniate, leading to intense pressure on the spinal nerves and acute lower back pain and sciatica. In some cases disc herniation can cause severe spinal nerve damage and loss of bowel or bladder control which requires immediate medical attention.

Coping With Sciatica and Lower Back Pain

Sciatica can make everyday life very difficult for some as they experience sharp pain upon walking, a constant dull ache in one leg or in the buttock, and progressive numbness or weakness in the legs or feet. The sciatic nerve is the longest in the human body and the location of injury or compression of the nerve makes the difference between lower back pain and an inability to extend the big toe properly or keep the ankle stable when walking (foot drop). Treatment of sciatica is usually conservative as symptoms can often be well managed without recourse to back surgery. Improving posture, replacing an old mattress, wearing different shoes, doing back strengthening exercises, and treating underlying causes of inflammation or pinched nerves can all go some way to providing relief from sciatica and lower back pain.

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