What is Sciatica?
Sciatica is a condition that causes pain along the sciatic nerve, the longest nerve in your body. It begins at the nerve roots in your lower back and runs through your hips, buttocks, and down each leg [1, 2]. The pain from sciatica can feel sharp, burning, or shooting, and it may also be accompanied by fatigue, numbness, or a tingling sensation. Typically, sciatica affects just one side of the body [1].
What are its causes?
Sciatica happens when the sciatic nerve roots get pinched or irritated. The most common cause is a herniated or bulging disc in the lower back. For older adults, lumbar spinal stenosis (spinal canal narrowing) can also lead to these symptoms. Other factors, like spondylolisthesis, where one vertebra slips out of alignment with another, can cause sciatica, too.
Additionally, muscle spasms or inflammation in the lower back or pelvis may pressure the nerve roots, triggering sciatic pain [2, 3].
Other conditions that can cause sciatica include:
- spinal stenosis,
- degenerative disc disease,
- and piriformis syndrome.
Spinal stenosis happens when the lower spinal canal narrows, putting pressure on the spinal cord and sciatic nerve roots. Piriformis syndrome, which is rare, occurs when the piriformis muscle in the buttocks tightens or spasms, irritating the sciatic nerve and causing pain [4].
In some cases, sciatica can also be caused by factors unrelated to the spine, such as trauma, complications from surgery, gynecologic issues, or even shingles (herpes zoster) [5]. However, these are less common causes.
Can sciatica cause groin pain?
Sciatica is commonly associated with nerve compression or irritation. This nerve extends from the lower spine into the pelvis and the top of the legs. When this nerve is irritated, it can cause pain, numbness, and weakness in your back, groin, and eventually legs.
Treatment for sciatica
Sciatica can be managed with different treatment approaches to relieve pain, reduce inflammation, and improve movement.
Medical methods: Medical treatments are typically the first option for sciatica. These may include a short course of oral nonsteroidal anti-inflammatory drugs (NSAIDs), opioid and nonopioid pain relievers, muscle relaxants, and anticonvulsants for nerve-related pain [2]. If oral
NSAIDs don't provide enough relief, oral corticosteroids may be considered [2].
Costicosteroid injections: In some cases, corticosteroid injections can be given to relieve pain quickly [2, 6]. These are injected into the area around the spinal cord, called the epidural space [4]. However, because of possible side effects, they are only used when needed [4].
Physical therapy: Physical therapy is another key treatment for sciatica. It includes exercises and stretches to strengthen your back and stomach muscles, helping prevent future pain and injuries [4, 7].
Other treatments: Alternative treatments like spinal manipulation, deep tissue massage and acupuncture can also help with sciatica [2, 8, 9].
A chiropractor can adjust your spine to improve its function and reduce pain, while massage can relax tight muscles, easing pain and improving movement and flexibility [8].
In severe cases, surgery may be needed, especially if there is a loss of bowel or bladder control or if other treatments haven't worked [10]. The most common surgeries are discectomy, where part of the disc pressing on the sciatic nerve is removed, and microdiscectomy, a less invasive procedure where the disc is removed through a small incision using a microscope [4].