Lower back pain, which include sciatica, is the leading cause of years living with disability worldwide. And it remains the leading reason for physician consultations among people under 60 years of age in Canada. Estimates of lifetime prevalence of low back pain in the adult general population are variable across studies but have been reported to be as high as 84 per cent.
“The causes of sciatica are multiple and sometimes difficult to pinpoint,” states Kaliq Chang MD of the Atlantic Spine Center in New Jersey. Sciatica is characterized by shooting pain – from mild to debilitating – radiating along the sciatic nerve, the longest single nerve in the body, extending from the lower spine through the buttocks and into the legs. The pain can be persistent or sudden and unpredictable, resulting in a “pins-and-needles” sensation, numbness or weakness in a leg.
The problem initially develops when the sciatic nerve becomes pinched or compressed due, typically, to a herniated or bulging spinal disc in the lumbar (lower) region of the back; lumbar spinal stenosis, a nerve compression disorder affecting older adults; degenerative disc disease like spondylolisthesis; bone spurs – an overgrowth of bone – on the vertebrae; or injury to the lower back.
Some flare-ups, however, are idiopathic in nature and sometimes blamed on carrying heavy loads, prolonged sitting such as at a desk job, driving a vehicle for extended periods, and unusual sleeping positions. “There is a lack of conclusive evidence linking some of these ‘causes’ directly to sciatica,” says Dr. Chang.
He concurs that wear-and-tear on the spine due to advancing age, obesity, which increases pressure on the lower back, and diabetes can increase a person’s risk for the disorder. Shakespeare referred to sciatic pain as a “curse” in one of his plays, and early Germans called it “the witch’s slot” because they believed the pain was linked to demons or devils.
Dr. Chang reassures the disorder is anything but supernatural. It is, instead, he says, a common physical malady affecting approximately 5 per cent of men and 4 per cent of women at some time in their lives and causing a significant number of lost work days.
“Anyone who has experienced episodes of sciatica dreads its potential recurrence,” Dr. Chang says. “The pain is not necessarily disabling but oftentimes serious, difficult to endure and a source of anxiety.”
Mild cases of sciatica clear up within a few weeks, with most doctors recommending self-treatment, including gentle exercises and low-impact aerobics like swimming and limited use of over-the-counter pain-relievers. More severe and chronic sciatica might require prescribed medications, corticosteroid injections, physical therapy or other conservative approaches.
Only if sciatica pain is uncontrolled, worsening or leads to symptoms of concern like bowel and bladder dysfunction or leg weakness will surgery be warranted to correct the source of the pain.
A study published in the May 2018 issue of the journal Pain indicates patients with chronic sciatica have been found with elevated markers for inflammation in their nervous system. The finding, authors say, indicates potential pathways of effective therapy for such patients, including direct treatment of the neuroinflammation in the spinal cord. “This is a great argument for why epidural steroid injections are an excellent treatment for sciatica, at least initially as opposed to surgery,” says Dr. Chang.
Reduce your risk of sciatica
• Exercise regularly to maintain a free range of motion of the spine.
• Ensure proper posture when sitting to avoid putting too much pressure on the back and sciatic nerve. Keep back straight, hips at an approximate 45-degree angle, feet slightly elevated if possible. Avoid crossing legs.
• Use correct body mechanics. When standing for a prolonged time, for example, occasionally elevate a foot by placing it on a small stool or box.
• If overweight, lose the extra pounds.
• Eat a healthy diet.