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Sciatica (neuralgia) Causes, Symptoms and Treatment

The sciatica, commonly known as sciatica, is a sharp pain felt along one of the two sciatic nerves. Located at the back of each leg, they are the largest nerves of the body (see diagram). They join the spine at the lower back, at the level of the lumbar and sacral vertebrae (just above the coccyx).

The pain mainly affects the buttock and thigh, and often extends to the foot. Most often, the pain affects only one side of the body.

Sciatica, lumbago or herniated disc?

In low back, kidney, or lumbago, pain is usually found in the lower back and buttocks. It is of variable intensity and may or may not limit movements.

In case of sciatica , the pain is usually felt on one side of the body, in one buttock and all the way from one leg to the foot; sometimes also at the bottom of the back.

The herniated disc is an abnormal projection of a part of an intervertebral disc of the spine. This is one of the leading causes of low back pain or sciatica.

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Causes of Sciatica (neuralgia)

The sciatica is not a disease in itself. It is a sign that the sciatic nerve is irritated. The majority of cases are attributable to a herniated disc, which compresses one or other of the 5 roots of the sciatic nerve. Symptoms vary slightly, depending on the root affected. (The root is the part of the nerve that joins the spinal cord inside the spine.)

Sciatica can also be due to one or more of the following factors.

  • Narrow lumbar canal (stenosis of the vertebral canal). Narrowing of the canal (where the nerves are inserted) can cause compression of the nerve roots in the lumbar vertebrae region, and sciatica. This occurs mainly in the elderly.
  • Piriformis syndrome. It is caused by the inflammation of a pelvic muscle called piriformis muscle (it has the shape of a pear) or pyramidal muscle. If this muscle is contracted and swollen, it can exert pressure on the sciatic nerve and irritate it. Athletes and people who train poorly are more likely to be involved.
  • Facet syndrome. This syndrome originates in the facet joints, thin joints located at the top and bottom of each vertebra (not to be confused with the intervertebral discs, another structure that allows the articulation of the vertebrae). Poor posture or wrong movement can create a slight misalignment of these facets. Back pain and sometimes sciatica can result.
  • Trauma. A fall, a car accident or any other situation that causes a back stroke can cause damage to the nerve roots.
  • Other causes. Osteoarthritis or metastases that pressure the sciatic nerve can cause back pain and, more rarely, sciatica. Both of these situations occur mainly in the elderly.

Evolution

In most people with sciatic neuralgia, symptoms subside within 4 weeks. However, it often tends to reappear if nothing is done to prevent it. Sciatica can also be associated with chronic low back pain.

When to consult?

When symptoms similar to those of sciatica occur, it is best to consult a doctor to obtain an accurate diagnosis.

If it is a sciatica and the treatments fail to relieve the pain or the pain increases, see a doctor again.

Consult an emergency physician if:

  • the back pain is so intense that it is difficult to tolerate ;
  • the symptoms of sciatica are accompanied by urinary or faecal incontinence (or on the contrary, retention), impotence, loss of sensitivity in the perineal area and inside the thighs or difficulty in standing or climbing stairs;
  • In addition to sciatica symptoms, rapid and unexplained weight loss occurs.

Symptoms of Sciatica (neuralgia)

  • An intense pain triggered in the lower back or buttock, which radiates to the thigh, calf and foot. The pain can occur as an electric shock, or be slight, but constant. It is usually accentuated while sitting, coughing and straining, and relieved when lying down.
  • Of tingling , numbness and muscle weakness in parts of the leg and foot with

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People at risk for Sciatica (neuralgia)

  • People with osteoarthritis or certain forms of arthritis.
  • Pregnant women. The weight of the belly, combined with an increased secretion of a hormone that relaxes the tissues, and the uterus that can compress the sciatic nerve, can cause sciatica.

Risk factors

  • Practice a sport or job that frequently involves lifting heavy loads, bending, or twisting the trunk.
  • Stay several hours in a sitting position.
  • Do little physical activity.
  • To have an excess of weight.
  • Have a bad posture.
  • Have weak abdominal muscles.

The prevention of sciatica (neuralgia)

Basic preventive measures
  • Exercising regularly helps maintain the flexibility and strength of the back and abdomen. The gentle exercises, symmetrical and using stretching is preferred. Note that walking or swimming is excellent for strengthening the muscles of the lower back. For cycling, make sure the seat and handlebars are properly adjusted.
  • Always do some warm-up exercises before performing a demanding physical activity.
  • Be aware of your posture as often as possible: back straight, eyes straight, shoulders backwards.
  • If standing for a long time, use a low stool with feet alternately alternating every 5 to 10 minutes.
  • If sitting for long periods of time, allow rest periods to stretch and stretch, and change position. Make sure you have a chair that supports your lower back.
  • To lift a heavy object, do not tilt the torso forwards and avoid twisting movements. Squat by bending your knees while keeping your back straight, and get up while holding the object close to your body.
  • To catch something behind you, do not twist the trunk. Rotate rather on the feet to turn around.
  • Give priority to backpacks for purses, and use both shoulders to carry the backpack.
  • For a good position at night, choose a comfortable mattress and a pillow that does not create too much angle to the neck.

Medical treatments for sciatica (neuralgia)

Important. In case of sciatica, it is better to stay active, moderately. In the past, it was recommended to keep the bed. Today, we know that it does not bring any therapeutic benefits and that by remaining active; we promote healing (see “Physical Activities” below). That said, if the pain is so important as to have to rest in bed, its fine to do it, but not more than 48 hours. If the pain is not relieved by rest or is unbearable, it is better to consult a doctor again.

The sciatica is usually treatable in the space of a few weeks. When neuralgia is caused by a specific disease, recovery or control with medications usually leads to the disappearance of symptoms.

In pregnant women , sciatica tends to disappear after delivery.

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Pharmaceuticals

Various medications can be used to relieve pain . The first advised is acetaminophen or paracetamol (Tylenol).

Nonsteroidal anti-inflammatory drugs (NSAIDs) available over-the-counter also have a pain-relieving effect, in addition to being anti-inflammatory (eg ibuprofen (Advil, Motrin) and acetylsalicylic acid (Aspirine ). However, they are not more effective than acetaminophen in relieving symptoms, according to studies. Moreover, their usefulness in case of sciatica is in doubt. Indeed, most of the time, inflammation is not involved. That said, if an adequate dosage of acetaminophen does not effectively relieve pain, you can opt for nonsteroidal anti-inflammatory drugs and see if the result is better. Ask about precautions and contraindications .

If the pain is resistant to these medications, muscle relaxants , nonsteroidal anti-inflammatory drugs at higher doses or narcotics prescribed by the doctor may be used.

Local injections of a mixture of analgesics and corticosteroids may also be used . These treatments offer short-term relief, but no long-term benefit.

Some practical tips

– The most comfortable sleeping positions would be on the side, with a pillow between the knees and under the head. You can also lie on your back, with your knees and your head and shoulders slightly raised by pillows.

– During the first 48 hours, applying cold to the painful area may reduce pain. To do this, use an ice pack wrapped in a towel. Affix on the painful area for 10 to 12 minutes. Repeat the application every 2 hours or as needed.

– Thereafter, the heat can be beneficial. It helps to relax sore muscles. Take a bath of hot water is ideal. Otherwise, apply a heat source several times a day (a hot, damp towel or heating pad).

Note . Heat and cold applications on sore muscles have been used for a long time. However, recent studies question their real usefulness in relieving back pain. There is more evidenceto support the use of heat than cold.

Physical activity

It is best not to stop the usual activities more than 24 hours to 48 hours. Studies show that people who stay active recover faster. Staying active helps relieve tension in the muscles and preserve muscle mass. If the pain is severe, resting in bed for 1 day or 2 is acceptable. However, it is necessary to resume gentle activities as soon as possible, as soon as the pain becomes tolerable, because it promotes healing .

When pain is present, it is advisable to limit oneself to daily physical activities and to a few light physical exercises, such as walking . These gentle activities will not make the problem worse. On the contrary, they are beneficial. The exercise stimulates the production of endorphins, hormones that inhibit the transmission of pain messages.

Thereafter, the intensity of physical exercises can gradually be increased. Swimming, stationary cycling or other low impact exercises are usually beneficial.

Physiotherapy

If pain has occurred for more than 4 to 6 weeks , consultation with a physiotherapist is recommended for recovery. Various exercises and stretches to correct posture, strengthen back muscles and improve flexibility are offered. To be effective, the exercises must be performed on a regular basis.

Physiotherapy treatments may also include gentle massage, heat exposure and electrotherapy.

  • Massages . The massages performed are generally superficial, slow and regular maneuvers that soften the painful area.
  • Heat . Different sources are directed to the sore muscles: infrared rays, warm wraps, hot balneotherapy (in Europe, thalassotherapy is often integrated in the treatment of sciatica and back pain).
  • Electrotherapy . Ultrasound, transcutaneous electrical stimulation or TENS, ionization, laser, etc. also relieve pain by scrambling nervous messages.

Surgery

If the pain persists more than 3 months despite the treatments, surgery may be considered. If sciatica is connected to a herniated disc, you should know that surgery is necessary in less than 5% of cases. The surgery will remove the pressure exerted by the vertebral disc on the sciatic nerve.

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