The Sciatic Nerve and Sciatica
The sciatic nerve is the largest single nerve in the body and is made up of individual nerve roots that start by branching out from the spine in the lower back and then combine to form the “sciatic nerve.” Sciatica symptoms occur when the large sciatic nerve is irritated or compressed at or near its point of origin.
The sciatic nerve runs from the lower back, through the buttock, and down the back of each leg.
Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg—the thigh, calf, foot, and toes.
The specific sciatica symptoms—the leg pain, numbness, tingling, weakness, and possibly symptoms that radiate into the foot—largely depend on where the nerve is pinched. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle.
Sciatica is often characterized by one or more of the following symptoms:
Constant pain in only one side of the buttock or leg (rarely in both legs)
Pain that is worse when sitting
Leg pain that is often described as burning, tingling, or searing (versus a dull ache)
Weakness, numbness, or difficulty moving the leg, foot, and/or toes
A sharp pain that may make it difficult to stand up or walk
Pain that radiates down the leg and possibly into the foot and toes (it rarely occurs only in the foot)
Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.
While symptoms can be painful and potentially debilitating, it is rare that permanent sciatic nerve damage (tissue damage) will result, and spinal cord involvement is possible but rare.
Sciatica rarely occurs before age 20, and becomes more commonplace in middle age. It is most likely to develop around age 40 or 50.
Often, a particular event or injury does not cause sciatica—rather it tends to develop over time.
The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with nonsurgical sciatica treatment.1 For others, however, the leg pain from a pinched nerve can be severe and debilitating.
When Sciatica Is Serious
Certain sciatica symptoms, while rare, require immediate medical, and possibly surgical, intervention. These include, but are not limited to, progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction (cauda equina syndrome). Infection or spinal tumors can also cause sciatica.
Because sciatica is caused by an underlying medical condition, treatment is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually self-care and/or nonsurgical, but for severe or intractable pain and dysfunction it may be advisable to consider surgery.
An MRI study to find out the site at which the nerve is compressed, and the degree of compression. It also helps in finding a serious cause like infection, fracture or tumour.
Common pain killers, special pain killers for nerve pain, vitamins
Transforaminal Epidural Steroid Injection
This injection puts a special type of steroid very close to the site where the nerve is compressedThis is done under X-Ray Guidance, injection is completely safe and there is minimal risk of injury to the nerves. Particulate steroids work within 48-72 to reduce inflammation and the pain relief is vairiable form 3-9 months. We will not repeat this injection within 3 months. If you have any contraindications to steroids then we recommend Non-Steroidal option. We have done hundreds of Transforaminal epidural injections and none of the patients have reported any serious side effects.
Back strengthening exercises should follow the injection for a few months, these will take away the pressure from the disk and put it on back muscles.
Back pain may also be only due to other structures, there may be no nerve compression. A disk may itself be painful, or the facet joints, muscles or ligaments. A thorough examination is needed to diagnose these conditions.
Based on the examination, a small amount of local anaesthetic agent injected at the painful structure will confirm the diagnosis. This is called a diagnostic block and is very helpful in diagnosis.
The treatment options for only mechanical back pain are same, painkillers/injections followed by exercises. But the injections in this case are to the painful structure