Many people suffer from sharp, electric-shock-like pain and numbness that runs from their buttocks down to their toes. While you may have heard the term sciatica, it's surprisingly little known that sciatica is not a disease. Sciatica pain is a sign from your body asking for help.
This article provides a detailed explanation of how to identify the underlying cause of pain, stretches you can do at home, and treatment methods to eliminate pain completely.
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What is sciatica? What are the underlying causes?
What is sciatica?
The sciatic nerve is the thickest and longest peripheral nerve in the body, about the thickness of a finger. It originates from the lower part of each vertebra on either side of the body, passes through the buttocks (behind the hip joint), down the back of the thigh, through the calf, and down to the toes. When any part of the long sciatic nerve is compressed or damaged, pain and numbness occur. This is sciatica. In other words, sciatica is not the name of a disease, but rather the name of a symptom, just like a headache or stomach ache.
Source: Japanese Orthopaedic Association | Orthopedic Series "Sciatica"
Source: Japanese Society for Clinical Orthopedic Surgery | Sciatica Source: Japanese Society of Pain Clinics | Treatment Guidelines 5th Edition "Diseases and Pain of the Lower Limbs"
Diseases that can cause sciatica
There are many diseases that can cause sciatica, but the most common are those affecting the lumbar spine. We will explain the diseases that cause sciatica, categorized by the part of the nerve that is affected.
lumbar region
The following conditions are caused by problems around the lumbar vertebrae (lower back bones):
- Lumbar disc herniation: The outer layer of the intervertebral disc, a cushion between the vertebrae of the lumbar spine, tears, and the nucleus pulposus inside protrudes, compressing the nerve root.
- Lumbar spondylolisthesis: This condition occurs when the bones at the back of the spine separate due to strenuous sports activities in youth, and the resulting bone and tissue compress the nerves.
- Lumbar spinal stenosis: As we age, the bones and ligaments thicken, narrowing the nerve passageway (spinal canal) and compressing the nerve roots and cauda equina.
Sciatica often develops due to the accumulation of bone deformation caused by aging and the effects of past strenuous exercise, making it a common cause of sciatica in middle-aged and older adults.
Sciatic nerve area
This pattern involves problems in the nerve pathways around the buttocks and thighs, after the nerves have emerged from the lumbar spine (backbone).
- Piriformis syndrome: This condition occurs when the piriformis muscle in the buttocks hardens and compresses the sciatic nerve that runs beneath it.
- Shingles: A virus infects the sciatic nerve, causing severe pain followed by a rash.
If no abnormalities are found in the lumbar spine itself, this is where we suspect.
No nerve damage
Pain can occur even if there is no abnormality in the nerve itself. Similar pain may occur as referred pain from conditions such as osteoarthritis of the hip, or it may be due to diabetic neuropathy, or in cases where the cause cannot be identified.
Source: Japanese Orthopaedic Association | Orthopedic Series "Sciatica"
Symptoms that warrant immediate medical attention and reasons why they cannot be ignored
It is absolutely forbidden to dismiss sciatica as "just pain" and leave it untreated. In some cases, nerve damage can progress rapidly, and if left untreated, it can result in lifelong paralysis.
Symptoms that require immediate medical attention
In addition to pain, are you experiencing any of the following symptoms?
- Symptoms of muscle weakness: Symptoms such as "slippers easily slipping off" and "tripping over nothing" may indicate "foot drop," a condition where the ability to lift the ankle and toes weakens.
- Suspected bladder and bowel dysfunction (cauda equina syndrome): Symptoms such as "numbness when wiping the buttocks" and "difficulty urinating or leakage" can be serious conditions that may require emergency surgery.
- Severe sensory impairment: "No sensation when touched," "Unable to determine skin temperature."
If you experience signs of muscle weakness or sensory numbness, do not hesitate to seek medical attention.
Reasons why it cannot be left unattended
Once nerve cells completely die, it is difficult to reverse the damage even with modern medical technology (irreversible change). Ignoring the problem, thinking "it's just pain, I can just endure it," can lead to further nerve compression and the risk of permanent paralysis. It is crucial to seek a diagnosis from a specialist before it's too late.
Stretches and lifestyle habits to relieve pain
This section explains stretches and lifestyle habits that can be done at home to alleviate pain.
Stretching (at the office or at home)
Loosening the muscles in the buttocks (piriformis muscle) can sometimes alleviate pressure on the nerves.
[Stretches you can do while sitting in a chair]
- Sit lightly on a chair and place the ankle of the painful side on the knee of the opposite side (forming a "figure 4" shape with your feet).
- Keeping your back straight, slowly bend your upper body forward.
- Hold the position for 20-30 seconds at the point where you feel a "pleasantly painful" sensation deep inside your buttocks.
The key is to keep breathing and to relax.
On the other hand, there are also stretches you can do while lying down.
[Stretches you can do while lying down]
- Lie on your back with your knees bent.
- Place one ankle on the other knee.
- Hold the thigh of the leg that's underneath with both hands and pull it towards your chest.
Hold the position while feeling the stretch in your gluteal muscles.
Should I cool it down or warm it up? | Differences between the acute and chronic phases
Whether you should apply cold or heat depends on whether you are in the acute phase with severe pain or the chronic phase where the pain has subsided.
During the acute phase (from the onset of pain to a few days later), apply cold. If you experience severe pain and the affected area is hot, inflammation is present. Overheating during this period, such as by taking a bath, can spread the inflammation and worsen the pain. The correct approach is to cool the area with an ice pack or cold compress to reduce inflammation.
During the chronic phase (when the pain has subsided to when it persists), apply warmth. When the peak of severe pain has passed and a dull ache or heaviness continues, poor blood circulation is one of the causes of the pain. Warming the affected area with a bath, heat pack, or warm compress will promote blood circulation, which will relax muscle tension and alleviate the pain.
Treatment methods for sciatica | To treat the root cause of the pain
While waiting for natural healing with conservative treatment is one option, if the condition does not improve over a long period, it is necessary to consider a direct approach to the underlying disease (such as a herniated disc or spinal stenosis) rather than using painkillers.
Symptomatic treatment (painkillers)
Commonly prescribed painkillers and nerve block injections are symptomatic treatments that block pain transmission or temporarily suppress inflammation. They do not address the underlying cause.
Fundamental treatment utilizing tissue repair capabilities | Regenerative medicine
In recent years, regenerative medicine (private medical treatment) has been gaining attention as an alternative to surgery. In regenerative medicine, stem cells and components extracted from the patient's own fat or blood are directly administered to the affected area, such as the damaged intervertebral disc or nerves. The cytokines (growth factors) released by the stem cells are expected to soothe chronic nerve inflammation and promote the repair of damaged tissue. Because it does not require hospitalization and places little burden on the body, it is a treatment method that is chosen by busy people.
summary
Sciatica can have a variety of causes, making accurate differential diagnosis essential. Many people hesitate to undergo surgery for a complete cure, citing reasons such as "I can't take time off work," "I'm scared of going under the knife," or "I'm worried about recurrence." However, a new option, regenerative medicine, has emerged. If you are currently managing your pain temporarily with massage or chiropractic treatment, why not consider having the cause identified at a medical institution and exploring a long-term, fundamental treatment?
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Supervised by: Yuzo Terakawa (Board-certified Neurosurgeon)
