What Is Sciatica And Where Does It Come From?

What Is Sciatica And Where Does It Come  From

Sciatica is a common problem for many adults. The sciatic nerve is a major nerve; it’s also the largest nerve in the human body. It consists of nerve roots that emerge from the spine, travel down to the back and the thigh, and then divide into two nerves just above the knee.

Rather than being a condition, sciatica is actually a symptom of nerve irritation that does not necessarily involve the back. Any condition that irritates the sciatic nerve and causes pain and discomfort can be classified as sciatica. Most of the time, a compressed nerve root in the lower spine is to blame.

How Do I Know If I Have Sciatica?

If you have pain, numbness and tingling in your lower back, buttocks, thigh, back of the leg and/or foot, you may have sciatica. In most cases, this symptom begins as a pain in your lower back that extends all the way down to your foot. You may develop stiffness in the affected leg and find yourself unable to bend your knee, move your foot, or even wiggle your toes.

Sitting down or standing up for any length of time can make the discomfort worse. The pain can become so intense that standing up or sitting down becomes impossible.

Leg and foot pain caused by sciatica can be mild or severe. It can develop suddenly or gradually. It can be experienced as anything from leg weakness or a severe leg cramp to piercing, burning and shooting pain in the leg and foot. The pain can be worse when you sneeze or cough.

What Causes Sciatica And Who Gets It?

The most common cause of sciatic pain and discomfort is when the nerve roots in the spine that connect to the sciatic nerve become irritated. The irritation can be caused by a ruptured, slipped or bulging spinal disc. Irritation might also be caused by a herniated disc that’s putting pressure on the nerve roots that connect to the sciatic nerve.

Pain can develop because of other spinal conditions as well. It may result from the presence of bone spurs; it can also be caused by arthritis. It can indicate that one or more of the spinal nerves located either inside or outside of the spinal canal and situated in the lower spine are being pinched as they pass into the leg.

Sciatica symptoms can be caused by spinal stenosis. Spinal stenosis occurs when the spinal canal narrows and exerts pressure on the nerves. Another possible reason for sciatica is nerve root compression that was caused by an injury.

Piriformis syndrome is sometimes to blame. The piriformis nerves situated in the buttocks can tighten or spasm. This, in turn, can irritate the sciatic nerve. Sciatic nerve problems might also develop when a vertebra slips out of place and loses its alignment with the vertebra above it. This slippage can make the opening through which the nerve must pass too narrow; this, in turn, causes pain. Other possible causes for sciatic discomfort might be tumors or pregnancy.

How Is Sciatica Diagnosed? Are Medical Tests Necessary?

A diagnosis will be made based on a thorough medical history, a complete physical exam and a consideration of symptoms. Your doctor may perform what’s called a straight-leg test to locate the painful nerves and to find out whether the pain is being caused by one of the discs.

Your healthcare provider may want to perform additional tests. X-rays can reveal spinal fractures; a myelogram can reveal whether the pain is being caused by a disc or a vertebra. An MRI or a CT scan may be performed to study the structures on the back, while a nerve conduction velocity test will examine the electrical impulses that pass through the sciatic nerve.

How Is Sciatica Treated? Do The Treatments Always Involve

The least invasive treatment procedures will generally be applied first. Your doctor may prescribe any or all of the following applications to increase mobility, reduce pain and relieve stiffness:

• Physical therapy
• Bed rest
• Pain medication
• Stretching exercises to relax tight muscles
• Exercises to build strength in the back, legs, and abdominal muscles
• Aerobic activities such as walking to improve flexibility and loosen tight muscles
• Limited rest on a flat surface
• Non-steroidal anti-inflammatory medications to relieve pain and reduce inflammation
• Muscle relaxant medications to reduce muscle spasms
• Spinal injections

What Are Spinal Injections? Do They Really Help?

Your physician may administer an injection of anti-inflammatory medication directly into your lower back to relieve pain, decrease inflammation and reduce swelling in the nerve roots. For some patients, spinal injections are very effective at relieving symptoms.

Are There Alternative Treatments For Those With Sciatica?

Some patients report that acupuncture and yoga help to relieve leg pain. Massage therapy can be helpful for relieving muscle spasms, whereas biofeedback can relieve stress and help with pain management.

What Is The Prognosis For Someone Who Is Diagnosed With

Ignoring these symptoms can result in long-term pain. Pinched nerves that are seriously injured can result in muscle weakness and other conditions such as “drop foot.”

On the upside, many people who are diagnosed with and treated for sciatica symptoms find that pain and discomfort decrease over time with physical therapy and self-care. Eighty to 90 percent of people who suffer from sciatic discomfort will be able to treat this symptom without surgery. Fifty percent of those who suffer from sciatica will experience relief from their symptoms within one or two months after the initial symptoms first appeared.

Is Sciatica Preventable?

Sciatica caused by degenerative disc disease, by slips and falls, or by the back strain that sometimes occurs with pregnancy cannot be prevented. The best way to protect yourself from sciatica and reduce the risk of injury is to take good care of your back. Here are some steps you can take right now to decrease the probability of developing sciatica in the days to come:

• Exercise every day. Working out and exercising on a regular basis will make your back muscles stronger. Physical activity will also strengthen the abdominal muscles that support your spine.

• Quit smoking. Cigarette smoking increases the probability of disc degeneration.

• Practice lifting objects properly. When lifting any item, lift it while keeping your back straight. Use your hips and legs to lift yourself up, and hold what you are lifting close to your chest.

• Practice good posture at all times. Good posture supports the spine and reduces pressure on the lower back.

• Move around regularly. Don’t remain in a sitting position for long periods of time. If you must sit all day, be sure to get up periodically to move around and stretch your muscles.

Although sciatic symptoms can be uncomfortable, painful and inconvenient, they do clear up for most people over time without back surgery. Most physicians will prescribe a regimen of nonsurgical and noninvasive treatments before considering a surgical procedure.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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