Sciatica is a disease caused by pressure on the sciatic nerve which causes pain or soreness in the back and radiates down to one or both the legs. This pressure is usually caused by bulging of the spinal disc. Other causes can be due to the presence of tumors or cysts.
What are the risk factors of sciatica?
With growing age, there is an increase in the degeneration of bones and wasting of muscles which weakens the spine and causes the ill alignment of the spinal curvature.
Studies have shown taller people (more than 180 cm) are at greater risk of having sciatica compared to shorter individuals,
Overweight and improper balance of weight can put a lot of pressure on the spine causing lower back pain and sciatica. People with a sedentary lifestyle are also more prone to the risk of having sciatica.
Occupations involving heavy manual work, exposure to vibrations, constant bending, prolonged standing can all heavily lead to sciatica.
It is a weak risk factor predisposing sciatica. It can be due to improper blood circulation supplied to the back.
Stress creates tension in the muscles which can impinge the sciatic nerves and cause sciatica.
Although environmental factors are the biggest factors for sciatica but in some cases, it has been identified that genetic factors may also predispose to this disease. (Younes Mohamed, et.al., 2006)
What are the symptoms of sciatica?
Symptoms vary widely for sciatica
- It starts with acute pain starting in the lower back and spreading down to the hip and legs right to the soles and toes of the foot.
- It may cause mild burning and dull ache lasting for hours.
- It causes numbness and weakening of legs.
- Redness and swelling on the back are also seen in a few cases.
- All these factors cause improper walk, muscle spasm, and in some cases weight loss.
- The pain is often worsened by sneezing or coughing.
- The patient also complains of pain on lying down which causes sleepless nights.
How to identify sciatica?
- Patient history: History of the persistence of back radiating down to one or more leg along with predisposition of any of the risk factors is the most identifying sign of sciatica.
- Physical examination: Physicians may check for tensed muscle, pain response, refluxes, and examine the presence of any cysts or tumors.
- Plain radiography: X-ray may reveal the narrowing of disc gaps or bone growth impinging the sciatic nerve.
- Computed tomography: It reveals the course of the sciatic nerve and shows where it is congested. It also shows disc herniation (bulging), disc protrusion, degenerative facet joint disease, and tumors or cysts.
Why is my sciatica worse when I lie down?
Sciatica is caused due to pressure on the sciatic nerve which in some cases can be worsened on lying down. On lying down on the back, the spinal curvature is ill aligned and this can cause pinching of the nerve. On lying on one side, the rotation of hip can inflict pain on the back, and on lying on the stomach the spine hyperextends giving rise to pain.
What is the best position to sleep with sciatica? How do you sleep with sciatica?
Patients with sciatica is usually advised bed rest but it is recommended to sleep on the side they are most comfortable with. Most comfort is achieved when knees are slightly elevated and the spine is properly integrated causing relief to the spinal gaps thus avoiding pinching of the nerves.
This can be achieved by placing a pillow under the knees for patients sleeping on their backs. Patients sleeping on their sides can use a pillow between their legs and patients sleeping on their stomachs can place a pillow on their lower abdomen or their pelvis. Although studies have found out that not much difference is seen in healing with people taking bed rest and people performing day to day activities (Hagen KB, et.al., 2004). But it does give temporary relief by taking any pressure of their back.
How long will sciatica take to heal?
The healing process depends if the sciatica is acute or chronic. Acute sciatica lasts for four to eight weeks while chronic can persists from 6 months to a year. The prognosis is usually good for most of the patients but few people do take more than a year to heal too.
Dr. Lekh has commented on this that, “The healing process of sciatica depends on the prognosis and compliance of patient towards the treatment. It can usually depend from a month to years.”
Treatment for sciatica
Few self-care treatments can be done to treat sciatica.
- Alternate heat and cold treatment.
- Cold pack to reduce the swelling
- Regular exercise and stretching to ease the back and leg muscles. Avoid lifting heavy objects to eschew from putting pressure on the spine.
- Maintain good posture while standing and sitting to retain the spine in proper alignment.
- Proper sleep posture is essential. The use of a pillow is recommended to keep the spine in alignment and avoid hip rotation. Use of medium-firm mattress is recommended.
- Lumbar support devices are helpful to maintain the posture stability.
- The use of high heels should be prevented.
- Walking and swimming can also help with strengthening the back
- Physiotherapy is highly essential to treat patients with sciatica (Manish Kumar, et.al., 2011)
Dr. Lekh highly advises physiotherapy as it helps with mobility and further abnormalities. The use of medication can only be of help with the pain.
What can you do for unbearable sciatica?
In the case of unbearable sciatica, the pain medication should be prescribed by the doctor. They only suppress the pain temporarily and can’t treat the disease completely. Common medication prescribed are analgesics, NSAIDs, muscle relaxants, anticonvulsants, steroids.
In severe cases, narcotics can be prescribed as they are powerful pain relievers. All these medications are only to be taken under doctors’ recommendations. Patients who fail to improve even after months by non-surgical treatment, imaging is used to check the herniation of the disc and nerve compression. Surgical intervention is done for removal of disc herniation. (Manish Kumar, et.al., 2011)
Leg pillow for lower back pain
Lower back pain is the most common symptom of sciatica. Other causes of lower back pain include muscle spasm, ligament strain, disc prolapse, arthritis, skeletal irregularities, osteoporosis, pregnancy, and menstrual syndrome. The use of a leg pillow can be very helpful to relieve the pain and prevent the curving of the spine. These pillows are medium-firm resilient made of memory foam. There are different shapes of leg pillow i.e. hourglass curvature pillow, wedge pillow, and cylindrical/bolster pillow.
- The hourglass pillow is used to place between the legs when sleeping on the side as it prevents hip rotation,
- The wedge pillow is used to place under the knees when sleeping on the back as it aligns the back, hip, and the waist,
- The bolster pillow is used to place below the waist or under the thigh when sleeping on the back or on the stomach.
Manish Kumar, Gaurav Garg, L. R. Singh, Talever Singh, and L. K. Tyagi. Epidemiology, Pathophysiology and Symptomatic Treatment of Sciatica: A Review. International Journal of Pharmaceutical & Biological Archives 2011; 2(4): 1050-1061
Younes, Mohamed; Béjia, Ismail; Aguir, Zouhour; Letaief, Mondher; Hassen-Zrour, Saoussen; Touzi, Mongi; Bergaoui, Naceur (2004). Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia. Joint bone spine, Vol: 73, Issue: 5, Page: 538-42 ISSN: 1778-7254 https://doi.org/10.1016/j.jbspin.2005.10.022