What is sciatica?

Written by Na Hong Wei
Orthopedics
Updated on January 02, 2025
00:00
00:00

Sciatica refers to severe pain caused by various reasons that result in the compression and irritation of the sciatic nerve. The typical pain of sciatica radiates from the lower back to the buttock or the back of the thigh and the lateral side of the leg down to the foot. The pain can intensify during coughing or increased abdominal pressure. Additionally, this condition is often accompanied by dullness or numbness, and in a minority of cases, it can cause bilateral sciatica. Generally, there are three main causes of sciatica: The first is chemical irritation, mainly when the disc tissue comes into contact with the sciatic nerve, releasing chemical substances that stimulate and trigger an autoimmune response, resulting in neuritis. The second cause is mechanical compression, primarily from protuberance and nucleus pulposus compression or traction on the already inflamed nerve root, leading to obstructed blood flow and worsening edema. The third cause follows chemical stimulation and mechanical compression, leading to ischemic symptoms in the injured nerve, which then results in pain. Therefore, sciatica typically has primary and secondary causes. The primary cause is sciatic neuritis, while secondary causes are usually associated with lumbar spinal stenosis, lumbar disc herniation, lumbar tumors, and piriformis outlet syndrome.

Other Voices

doctor image
home-news-image
Written by Na Hong Wei
Orthopedics
1min 10sec home-news-image

What to check for sciatica

Sciatica is divided into primary sciatica and secondary sciatica. Secondary sciatica is very common and is mainly due to diseases of the spinal canal, including herniated lumbar discs, lumbar spinal stenosis, or spinal tumors compressing the spinal cord and nerve roots. Another condition is piriformis syndrome, where the sciatic nerve exits; if there is narrowing here, it can also cause sciatica. Therefore, clinically, one starts with secondary sciatica, conducting either a lumbar spine CT scan or an MRI, which can basically clarify the location causing the compression. Another type is called primary sciatica, which is caused by inflammation of the sciatic nerve, and is an internal medicine disease, not an orthopedic disease. This requires an electromyography (EMG). After completing the EMG, the diagnosis can generally be made based on the injured muscle or the muscle with abnormal electromotor conduction. Thus, the routine examinations for sciatica are X-rays, CT, MRI, and the non-routine examination is the EMG.

doctor image
home-news-image
Written by Guan Yu Hua
Orthopedic Surgery
58sec home-news-image

Can sciatica patients walk?

Sciatica can be managed with activities like walking, brisk walking, or jogging. It is best to walk or even walk backwards. It is important to avoid sitting for long periods, bending over, or carrying heavy objects. When the spine is bent, it can increase the pressure on the intervertebral discs, potentially worsening the nucleus pulposus, rupturing the annulus fibrosus, and causing a series of symptoms related to nerve root compression. This compression can cause local swelling, which can press on the nerves to varying degrees. It is recommended to strictly rest on a hard bed, and generally, with about ten days to two weeks of warming up the lower back, recovery is usually achievable. Gradual relief and disappearance of symptoms can occur, and it is advisable to avoid sitting for long periods, bending, or carrying heavy loads. Moderate walking is suitable.

doctor image
home-news-image
Written by Guan Jing Tao
Orthopedics
1min 8sec home-news-image

Is it useful to take calcium supplements for sciatica?

Generally speaking, supplementing calcium has very limited effects on sciatica. Sciatica is typically caused by compression at the location where the nerves deviate, or by herniated lumbar discs, leading to compression of the sciatic nerve. This means that different compression sites require different treatment methods. For sciatica, if it is caused by a herniated lumbar disc compressing the nerve, minimally invasive surgery can be performed when necessary to remove the protruding disc tissue. If the sciatic nerve is compressed near the buttocks or the piriformis, surgery may be required to remove part of the tissue to relieve or loosen the compressed sciatic nerve. In terms of medication, oral nutritional supplements for nerves, anti-inflammatory and blood-activating drugs can be used to improve the condition of the compressed sciatic nerve. This can further alleviate corresponding symptoms such as pain and sensory abnormalities, while the role of calcium supplementation is very limited or ineffective. (The use of medication should be under the guidance of a professional doctor.)

doctor image
home-news-image
Written by Xie Yi Song
Orthopedics
1min 13sec home-news-image

What are the symptoms of sciatica?

Sciatica refers to the pain caused by the sciatic nerve due to various reasons, such as compression from spinal diseases or simply sciatica itself, and it is inherently a symptom. What are the characteristics of this symptom? Sciatica can occur on one side or both sides simultaneously. When it occurs, the pain is usually continuous and can have episodic exacerbations. The pain is often dull, stabbing, burning, or like a knife-cutting sensation. It radiates from the buttocks along the back of the thigh and the outer back of the lower leg toward the foot. Clinically, sciatica is divided into secondary and primary types. Secondary pain is due to compression of the sciatic nerve root, commonly seen in conditions like lumbar disc herniation and other spinal disorders. It often accompanies percussion pain in the lumbar spine, and the pain may worsen with coughing, sneezing, or bending, and severe cases may experience numbness in the skin of the lower limbs. Primary sciatica refers to simple inflammation of the sciatic nerve. This type generally presents pain in the buttocks and back of the thigh and usually does not involve percussion pain in the lumbar spine.

doctor image
home-news-image
Written by Na Hong Wei
Orthopedics
1min 47sec home-news-image

How to treat sciatica

Sciatica typically has two treatment methods. One is non-surgical treatment, which is currently the first and most commonly used approach. The first step is general treatment, meaning that once symptoms of sciatica occur, one should rest on a hard board bed. Second, one can combine this with some heat applications to the lumbar area, physical therapy, and acupuncture; all of these are options. The third is traction therapy, which is very effective for discogenic sciatica, as it can reduce the pressure on the intervertebral disc, thereby increasing the volume of the spinal canal and enlarging the area of the intervertebral foramen, thus reducing stimulation to the nerve. Fourth, one can consider undergoing sacral canal injections, or using papain or collagenase for chemical dissolution of the nucleus pulposus, which usually can also achieve a good effect. The fifth point is that when symptoms are reduced, one should start exercising the lumbar and back muscles to increase their strength and enhance the stability of the lumbar spine, thereby ensuring the stability of the intervertebral disc. It should be mentioned that massage and manipulation are quite effective for herniation of the disc nucleus pulposus, but if there is already obvious osteophyte formation, narrowing of the intervertebral space, or disorder of the facet joints, or even lumbar spinal stenosis, then massage and manipulation are not recommended. If the aforementioned treatments prove ineffective, the condition does not relieve or even worsens, or if there is central herniation of the lumbar disc, or if the patient shows significant cauda equina nerve stimulation symptoms, then surgical treatment is required.