Sciatica – A detailed breakdown of Causes, Treatment & Prevention

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Let’s be honest, running is an enjoyable personal freedom. All across the world whether done competitively or for leisure, or both, for many it is an awesome feeling of liberation. This relief from stress is an opportunity to reconnect with oneself and the fascinating world around us. Explorers, adventurers, and sightseers the running world is comprised of a multitude of backgrounds, but with this comes an increased risk of encountering various pains which may be the result of running.

 

 

 

Runners quickly become experts at diagnosing their pain. Why? This is likely because it is a by-product of the activity. Many runners experience a myriad of pains throughout their personal growth in the sport. It can be agreed almost unanimously that should the unfortunate case of pain arise during running, especially pain that is mysterious and hard to pinpoint, it seriously hinders or prevents the full experience. Pain during running may result in a decrease in satisfaction, quality of life, and daily living.  As the pain does not magically disappear after a run— talk about a major bummer, but the the point of this article is not meant to discourage. There is a lot of hope in avoiding pain when one is properly educated. So read on as we learn how to address one common source of pain.

 

What is Sciatica?

One common pain that athletes complain of is experienced in their lower back. Think of where the belly-button is, now trace around to the back spine and this will be right around where what is considered the “lower back region” is. While there are numerous causes for experiencing lower back pain, one specifically which will be addressed in this article is called “Sciatica.”

What is this sciatica? Well, breaking it down … Research shows that 4 out of 10 people in the general populace will go through this condition in their lifetime. It commonly affects individuals 30-50 years old, where 60% of these patients have such bad symptoms it results in a disability. It occurs when the sciatic nerve is damaged or impinged, where too much pressure is put on this nerve. 

Hamstring-Tendinopathy-sciatic-nerve

 

 

The sciatic nerve, where the condition derives its name, is the longest nerve in the human body. It originates in the lower spine region— hence being associated with lower back pain. This area of the body is the most vulnerable point of injury due to improper heaving lifting positions. From the lower back the long nerve runs through the pelvis, down through the buttock muscle, into the legs, and all the way down to the feet. With such a long way to travel along the body really any one of these points along the sciatic nerve can be irritated by running activities. During running, muscle strain can result causing discomfort by compressing the nerve, spine misalignment might occur, thus causing sciatica.

 

Symptoms of Sciatica

Several studies have been done on whether or not athletes, in this case runners, experience more symptoms. More studies need to be done to derive conclusive evidence on the subject matter.  For now, most conclusions show that it is not believed runners experience more sciatica than non-runners. Odds are showing that running will actually reduce their chances of getting this condition, pretty cool huh? As with any movement or exercise done in a beneficial manner, it can promote the reduction of inflammation, the conditioning of muscles and body, and create a healthier overall perception of daily living. As previously mentioned, because research studies specifically involving running participants are lacking in prevalence, studies and their conclusions here mostly involve recommendations for the general public.

The symptoms,  where do we start? These generally include:
  • Pain that ranges from a mild ache to severe
  • Sharp or even burning sensations along the lower back, pelvis, and radiating into the legs
  • Numbness, weakness, or tingling sensations
  • Severe pain can lead to loss of proper bowel functioning.

 

 

Commonly it can be described as a “cramp-like” pain. Rare cases are severe enough to cause progressive weakness in the legs, making it difficult to stand for prolonged periods or be involved in activities of daily living. A loss of healthy bowel functioning is also symptomatic when the symptoms are severe. If these symptoms are being experienced already it is recommended to see a medical professional for diagnosis and care.

 

Causes

Photo – http://i.vimeocdn.com/video/447672464_1280x720.jpg



Now that we have discussed the various symptoms,  we can begin to ask the question of how does it happen? Where does it come from? According to studies done it is generally caused by too much pressure or damage on the sciatic nerve which runs along the lower back, pelvis, down the butt and into the legs. So anywhere along these regions are potential points where injury can be sustained. The range of symptoms encompassed by the condition previously mentioned.

To put it in a list, the common causes include:

1. Disc Herniation, disc prolapse, slipped disc: is where the soft gel filled disc in between our spinal vertebrae. In rare cases this disc ruptures from torsion, or traumatic injury. Sometimes the disc bulges, pressing on the sciatic nerve, causing a host of pains.

2. Compression or irritation to the sciatic nerve: commonly caused by muscle spasms from overuse or misuse in the lower back region— Runners this might be the most common cause of pain for us. This can include spine misalignment, or malformations such as scoliosis, a condition in which the spine begins to bend in unnatural manner.

3.  Piriformis Syndrome: this is where muscle spasms cause compression of the sciatic nerve travel through the piriformis muscle. It is a small muscle located deep inside the butt which functions to rotate the hip and turn the leg and foot outward. This is a commonly overlooked cause is where most diagnoses jump straight to spine issues. It may be as simple as seeing a physical therapist to do muscle work and relieve this constriction on the nerve.

4.  Aging: degeneration occurs over time with aging in the spine. It is not well equipped to heal itself, especially in the spinal discs in-between the vertebrae due to a lack of blood supply to the region. So it is important to take care of the spine throughout our life to prolong its use. Healthy movements such as yoga has been found improve spine health, even reverse conditions like scoliosis in individuals. Spinal Stenosis is an example of a condition resulting from aging. This is where narrowing of the pathway the nerve uses to travel along the body causes irritation and symptoms as it begins to constrict the conduction of the nerve.

5.  Less Common Causes are: 
Infections: while rare, an infection occurring in the lower back region can affect the sciatic nerve root leading to symptoms.
Tumors: a tumor mass lying near the sciatic nerve can begin to impinge, put pressure on, or even kill the sciatic nerve, resulting in a range of symptoms.

Keep in mind that any situation or injury can potentially cause sciatic nerve damage or impingement with the reality that many causes cannot be accurately diagnosed despite persisting symptoms. It is good to get multiple recommendations from medical professionals of differing expertise and then draw conclusions based on several sources of evidence.



Common Risk Factors

 

 

Risk factors for sciatica vary from person to person. They consist of body posture, positioning, degree of fitness, and overall health factors. In general, runners are in good condition. However, if you are a new runner, sports lover, or only exercise during the weekend, beware of the associated risks with sudden, intense exercise. It is better to go low and go slow. Do not rush, as this is a sport for your lifetime enjoyment. Risk factors include:


Age: the body loses its ability to handle improperly placed stress from daily activities, commonly from bending over and lifting heavy objects.

Pregnancy: this can be a factor because weight increases with pregnancy in areas that the body is not normally used to. It is good to maintain healthy exercise to keep the body conditioned.

Overweight or Obesity: Being overweight can add undue stress to areas that are made weak by overuse or improper form during daily activities. Having a healthy weight will improve the body’s ability to resist stress and heal itself.

Smoking: affects nearly every aspect of body health. The lungs feed oxygen to the blood which is used to transport healing hormones throughout the body, among many other helpful uses. When smoking the lungs are incapacitated, they are unable to fully absorb the amount of oxygen the body needs to sustain homeostasis. As a result, the particulates from cigarettes clog the alveoli, or cells in the lungs and reduce maximal oxygen uptake.

Occupational: j
obs that involve heavy lifting or repeated twisting of lower back. One does not need to be in a primarily manual labor job to injure themselves. Nearly every job out there will at some point require individuals to lift or twist, and move the body. Working at a grocery store for example might seem easy, but many clerks are required to stand for prolonged periods, bend, lift and stock items at the end of the day.

Sitting for prolonged periods: jobs which involve majority computer use may require that one sit at a desk for prolonged periods of time. This can have detrimental effects on the back and body. There are some helpful ways to avoid this, such as taking frequent breaks to stand up, look away, and move.

Recently there have been trends in getting stand up desks as this provides a better mode for movement, posture, and proper blood circulation. Some even have treadmills installed that they can walk on while working. If these are not possible there is no need to worry, actively thinking about and implementing proper posture can be helpful. There are even posture pillows and lumbar supports that can be bought to remind us.

 


Diagnosis

Herniated-Disc-x-ray-imaging

Accurately diagnosing sciatica requires the trained medical professional’s discernment. During the diagnosis process a doctor will run a number of tests to make sure the patient is in fact experiencing sciatica. This is helpful to determine what ways it should be treated. When seeing a medical professional for diagnosis here are some common tests that one can expect during their visit:


1. First the doctor will ask for a detailed medical history with the nature and duration of the various symptoms that may be experienced, as well as what actions keep on setting these symptoms. So if during a day job the individual realizes they are improperly lifting heavy loads or hyper extending their backs, it will be good to know this can likely be attributed to the cause of symptoms. In addition,  symptoms may indicate a ruptured vertebral disc that may require more serious treatment such as surgery— try to come prepared by analyzing potential causes beforehand.

2.Next an assessment will be given to check the functioning of an individual’s current neurological strengths, or lack thereof because of nerve impingement. An individual’s reflexes will be checked to make sure all sensation can be felt in the legs and that there are no nerves being cut off by impingement.

3. While rare, if a loss of proper bowel functioning has occurred then a rectal examination may be necessary. This will make sure the muscles in the rectum are maintaining their tone and have sensation, basically still receiving stimulus from the nervous system.

4.If symptoms of sciatica persist for several weeks after initial treatment and care an x-ray may be ordered to further diagnose. The X-ray will be used to assess changes in the bone or spine, and the pelvis. This is important to rule out chances of their being a tumor or an infection causing the sciatica. Note, infections are an incredibly rare source of sciatica as it requires that the infection attack the roots of sciatic nerve in lower back. The presence of a tumor would cause issues if it begins to press and put significant pressure on the sciatic nerve. Thanks to today’s modern technologies it is becoming easier to detect these conditions before they become to detrimental.

5. A Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) may be recommended if symptoms persist several weeks without letting up. These can be used to assess an individual’s nerves, spinal discs, and spine itself in much more detail than initial care can. Electromyography (EMG) can also be used to confirm nerve compression, such that might be caused by spinal stenosis or herniated discs.

During  the diagnosis phase consider asking your health care provider about a referral to a physical therapist or psychiatrist who specializes in physical medicine.



Treatment

 

Hip-Bursitis-Bursae-Inflamed-crutches-treatment

 

Research shows that lower back pain (LBP) is actually one of the most common pain issues experienced by the general public. It is likely that the reader can think of someone in their immediate family who has complained of it. In runners and athletes it can also be a common source of  pain. Sometimes being tough and pushing through the pain is not the answer and usually it worsens the condition.  The problem is that, as pain worsens it begins to become an issue leading to significant time off from training, missed events, and disability during activities of daily living. So, it is important that after diagnosis confirms the presence of sciatica the right treatment is given to the athlete. This must be done in a timely manner, to speed recovery, healing, and prevent the significant loss of training time, and participation.

Here are some common ways to treat sciatica:

1. Hot and Cold Packs:

Research shows that the can help with pain reduction during an episode of sciatica. Heat is a preferred treatment method, where many individuals who experience sciatica may enjoy and benefit from swimming in a heated pool environment.

 

See them here: (Heat and Ice Therapy Packs)



2. Laser therapy,  Low-Level Laser Therapy (LLLT):

 It may sound like science fiction, but laser therapy is a new form of treating sciatica pain. According to recent studies, this shows promising results in relieving symptoms and speeding recovery. It works by using noninvasive light waves that do not produce heat, sound, or vibrations on contact. This therapy is part of a methodology named photobiology or bio stimulation. It has been found to accelerate connective tissue repair, and acts as an anti-inflammatory agent to the site of irritation. Light wavelengths of 632 nanometers to 904 nanometers are used for musculoskeletal disorders.

 

See more here: (LLLT Therapy)



3. Pharmacology and Medications:

Over the counter medications taken orally can be found to treat symptoms as a short-term solution. Commonly these include:
acetaminophen
aspirin
NSAIDS (Non-steroidal anti-inflammatory drugs) such as:
Ibuprofen
Advil
Motrin
Ketoprofen
Naproxen (Aleve)

 

See more here: (Motrin IB)

Prescription muscle relaxers can also be used to relieve muscle spasms. Certain muscles can be in spasm making symptoms worse by  irritating the site of sciatic nerve damage or impingement. Taking a muscle relaxer will help prevent this, but studies show it is not a significant source of treatment. Antidepressants have been used by patients because the pain can change chemistry in the body; therefore, affect overall outlook on life, and satisfaction of daily living. Although this is not considered a significant source of treatment it has been shown to be effective in some people.  Steroidal injections around the spinal nerve. Research shows a modest reduction in pain using this method when sciatica is caused by a ruptured or herniated disc.



4. Physical Therapy and Body Manipulation

While it may be difficult to remain active with sciatica pain, bed-rest is not a long term solution. Actually, in recent history it was believed that the best way to treat sciatica was with long term bed rest, but today’s research has long since shown that this method will lead to worse symptoms. Physical therapy is a significant source of treatment for sciatica which may be recommended during diagnosis by a doctor. There are many good physical therapists out there to offer an effective treatment plan.  They will help to find the best movements and exercises to practice daily as a means to heal. When done right the proper movements performed will relieve pain and improve daily living conditions. It can even provide conditioning to prevent, or completely remove sciatica in the future. It is very important to do exactly as directed during these sessions as well.



5. Alternative Treatments

Biofeedback: These therapy sessions have been found to help with a person’s pain management. The patient will learn how to control their bodily processes such as heart rate, blood pressure etc. This method is commonly used to treat anxiety and stress related symptoms. The patient is hooked up to various body monitoring instruments and is given the information on a screen to gauge what their current homeostasis is, or body stability. Once they know what their baseline is they can use it to try out different ways of connecting mind and body. Education and teaching people to consciously take control of their body and improve symptoms of anxiety or stress is an effective treatment.

 

See more here: (Biofeedback)



Acupuncture: Acupuncture has been used in traditional Chinese medicine for several millennia. Three thousand years age it was a means of treating pain and a host of other issues. It is generally regarded as a safe effective treatment to relieve pain. Many people who use this treatment have reported significant positive changes. Fine needles are inserted into specific points across the body which are called acupuncture points. According to chinese medicine, these points are along meridians or these channels from which Qi, a vital life energy of the body, flows through. The theory is that pain is felt when one or more of these channels becomes blocked, and the needles are used to restore flow and balance throughout the body.  Scientific studies suggest stimulating these nerve points actually produces beneficial results via the central nervous system. This in turn allows the body to release helpful chemicals that promote regeneration, healing, and overall peace of mind.  A method of acupuncture called analgesia is becoming better known. It has been shown to release a neurotransmitter called 5-hydroxytryptamine, generating a neuropeptide through the electrical stimulation of different frequencies, having a significant effect on pain reduction.

Alternative medicine is considered by many because surgery is expensive and not applicable to all situations, and pharmaceutical drugs have a host of ill side-effects. 

 

 

6. Surgery

Most cases of sciatica can be resolved within 4-8 weeks. When an individual is experiencing unrelenting pain for longer than this period it is recommended to see a medical professional. In some cases,  surgery may be recommended depending on the diagnosis—it may be needed where cases of non-surgical treatment were unsuccessful. Only 5% of individuals actually need surgery to treat sciatica, all other forms of treatment should be exhausted before considering surgery.

Surgery for sciatica typically aims to relieve pressure being put on the sciatic nerve causing the symptoms. A herniated, bulging, or ruptured disc may warrant having surgery. One common procedure to treat back pain is called a discectomy, where part of a spinal disc is removed to relieve compression on the sciatic nerve. Again, if symptoms treated by other treatment options persist longer than 6 weeks it is recommended to see a medical professional.

 

7. Moderate Activity

As mentioned with physical therapy, moderate activity is necessary to prevent the worsening of sciatica, even though an individual might rather stay in bed. This does not mean heavy lifting or exercise, but rather the participation in activities like swimming in a heated pool or walks. Studies have shown that prolonged rest can hinder healing, whereas light physical activity and movement can assist in recovery and reduce inflammation.



Prevention


A number of steps can be taken to prevent the onset of sciatica, or the further development of it:

1. Maintaining correct posture during activities, such as walking, standing, sitting.

2. Maintain aerobic fitness, strength, flexibility in the abdominals and spinal muscles.

3.  Practice safe lifting technique:

  • Lift by bending the knees and keeping the back straight
  • The strain should be taken by the legs and hips instead of lower back.
  • Hold the object closer to the body if possible as the further the object is away from the body the more stress it will put on it, and subsequently the lower back region.

4. Ensure lower back is well supported when sitting in a chair. Find a chair that promotes good posture. A lumbar roll or contour cushion can be used to help provide lower back support when seated.

5. Do not smoke. Smoking is a hard habit to quit, but it adversely affects nearly every aspect of health.

Here are steps to begin the process of quitting:

  1. Set a quit date, get accountability by telling friends and family about intentions to quit and be prepared to combat initial cravings.
  2. Know all the reasons support a decision to quit. Write out a list involving health, money, and the impact it will have on others.
  3. Know the personal triggers. What causes the desire to smoke? This can involve physiological addiction, habits, and emotions that need to be resolved using healthy means.
  4. Use patches, lozenges, and gum. There is a number of products created to help with quitting smoking, they contains progressively less doses of nicotine— the main addictive agent in cigarettes— to ease cravings. Not to mention they are much cheaper.
  5. Stay quit. It is helpful to use these 4Ds to deal with desires and cravings: delay, deep breath, do something else, drink water.

6. Maintain a healthy body weight: Maintaining a healthy body weight will help relieve the pressure. In addition, it will improve immune functioning to speed healing and improve perception of life and desires to partake in healthy daily activities. Distance running is a great way to lose body weight as it burns through primary body fuels stored from carbohydrates— primarily found in breads, sugars, and starches— to activate the burning of stored fat as energy. This process is called ketosis.



False Positives

Hip-Bursitis-Bursae-false-positive-stress-fracture

 

There are two main false diagnosis that can mimic the symptoms sciatica.  False or a misdiagnoses include:

Lower back pain is commonly attributed to sciatica

Misalignment of the spinal column

Ruptured, bulging spinal disc

In many cases seeing a physical therapist or chiropractor will address the pain being experienced by an individual in as little as 5 minutes by relaxing deep muscles in the buttock, hips, or legs which may be impinging on the sciatic nerve from overuse, or misuse, and improper stretching.

Keep in mind it is always a possibility for a doctor to make a wrong diagnosis when evaluating a sciatica condition due to human error. The parts of the body comprising the back and spine are numerous and complicated, and even if years of study can be misunderstood. While living in the modern age, with the existence of advanced imaging instruments such as CT Scan, X-Rays, and MRIs, one would think that misdiagnosis would be rare, and perhaps it is becoming rarer. But, even with all of the fancy new equipment misdiagnoses still occurs.

 

Conclusion

Synovitis Hip

 

 

Runners have a likelihood of running straight into the pains of sciatica because of irritation to the nerve via muscles in direct contact with it, or traumatic injury. Running however can be a preventative measure and a form of conditioning the body. One method to avoid sciatica is to regularly exercise. If  this pain that pertains to symptoms regarding sciatica and do not resolve or worsens after 6 weeks of treatment, it is recommended to see a medical professional for diagnosis and care. Overall, the best treatments for this condition involve seeing a physical therapist and psychiatrist that specializes in physical medicines.

In general, it is likely that the cause of sciatica is not a serious issue that would require surgery, such as a herniated, ruptured, or bulging spinal disc. Please note that taking over the counter medication is not a solution and should only be used in situations where they are direly necessitated, as many will actually slow the healing processes.


Sources


Reading this article is not a substitution to seeing a licensed physician for medical diagnoses, especially in trauma situations. Research for this article has been done with reputable sources that have been linked below for the convenience, trust, and cross evaluation of readers. The majority of sources were written by medical professionals or consist of published studies in medical journals, and peer reviewed studies. 

Sources

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