What is “Sciatica” Pain?
“Sciatica” is a term used to describe the Nerve Pain in the Leg that is caused by the ‘Irritation’ and/or ‘Compression’ of the Sciatic Nerve. Sciatica Pain originates in the Lower Lumbar Back, and radiates deep into the Buttock, and travels down the Leg.
The “Sciatic Nerve” is the largest nerve in the human body and is formed by the union of 5 Nerve Roots (L4, L5, S1, S2 and S3) from the Lower Spine. It passes deep in the buttock and down the back of the thigh all the way to the Heel and Sole of the Foot. The Sciatic Nerve serves a vital role in connecting the Spinal Cord with the skin and muscles of the thigh, leg, and foot.
What Are The Symptoms of “Sciatica” Pain
The Excruciating and Numbing Pain that extends from your Lower Lumbar Spine to your Buttock and down the back of your leg is the main symptom of “Sciatica Pain”. You might feel uneasy almost anywhere along the ‘Nerve Pathway’ as shown in the above diagram.
The Pain may vary widely, from that of a mild aching pain, to one that is of a sharp, burning sensation or excruciating pain. Sometimes it can feel like you just receive a severe jolt or electric shock. It can worsen when you cough or sneeze.
Some patients of Sciatica Pain may experience Pain that range from infrequent and irritating to those more severe cases which may find their Pain both to be severe and debilitating. The symptoms depend on the specific Spinal Nerve Root that is being irritated and/or compressed at the origin of the Sciatic Nerve. One or more of the Nerve Roots may be affected together.
The anatomy of the Sciatic Nerve is shown below:
A combination of 5 Nerve Roots that emerges from the “Spinal Cord” from the inside of the Lower Lumbar Portion and the Upper Sacral Spine—L4, L5, S1, S2, and S3—forms the “Sciatic Nerve”. These 5 Nerves Group, formed together deep in the Buttock, near the front surface of the “Piriformis Muscle”, and combine to form the single large, thick “Sciatic Nerve”. It runs down through the Buttocks and the back of the thigh; above the back of the knee (“Popliteal Fossa”), and it divides into the “Tibial” and the “Common Peroneal Nerve”, both of which serve the Lower Leg and the Foot.
What Are The Most Common Causes of “Sciatica” Pain
“Sciatica Pain” is caused by an irritation, inflammation, pinching or compression of a nerve in the lower back. One of the most common cause may be a “Herniated” or “Slipped Disc” that causes pressure on the Nerve Root. Most people with “Sciatica Pain” get better on their own with time and self-care treatments, although this make takes from 6 weeks up to 12 weeks for pain to ease off.
Some of the most common causes of Sciatica Pain are as follows:
(1) “Bulging” or “Herniated” Disc
The Discs in the Spine serves several functions, including giving the Spine its flexibility, acting as cushions for the vertebrae, and evenly transferring the load placed on the Spine from one Disc to another. “Disc Bulging” and “Herniation” may occur more frequently in the Lower Lumbar Spine simply because that part of the Spine supports the entire weight of the Upper Body as well as whatever objects you may need to pick up.
“Bulging” and “Herniated” Discs are almost the same, but not quite.
A “Bulging Disc” is a “contained” Disc Disorder. The gel-like center of the Disc (Nucleus Pulposus) remains "contained" within the tire-like outer wall (Annulus Fibrosus) of the Disc but can extend the outer wall enough to press on a nearby Nerve or Nerve Root.
A “Herniated Disc” occurs when the Nucleus Pulposus breaks through the Annulus Fibrosus. It is called a “non-contained” Disc Disorder. Whether a Disc bulges or herniates, Disc material can press against an adjacent Nerve Root and compress delicate nerve tissue and causes “Sciatica Pain”. This compression can occur on only one side of the Sciatic Nerve and caused symptoms on only one side of the body or compress it on both sides and give you symptoms on both sides of the body (“Bilateral Sciatica”).
Regardless, the consequences of a “Herniated Disc” are worse. Not only does the “Herniated Disc” cause direct compression of the Nerve Root against the interior of the bony Spinal Canal, but the Disc material itself also contains an acidic, chemical irritant (Hyaluronic Acid) that causes Nerve Inflammation. To put it simply: “Disc Herniation” is the Two-for-One deal you really don’t want to experience.
(a) Direct Compression
“Direct Compression” is the classic Sciatica mechanism. When a Disc’s jellylike “Nucleus Pulposus” bulges or bursts through the hard Annulus Fibrosus, that part of the Disc very often presses on a nearby Nerve Root branching off the Spinal Cord and exiting the vertebra. “Herniated Discs” in the Lumbar and Sacral areas of the Spine will often press on one of the Nerve Roots that eventually combine in the buttocks to create the Sciatic Nerve, leading to “Sciatica Pain”.
(b) Chemical Inflammation
With a “Herniated Disc”, the trouble doesn’t stop with “Direct Compression”. The soft inner layer of a Disc, the “Nucleus Pulposus”, is mostly Water and Collagen, but releases powerful chemicals when it punches through the “Annulus Fibrosus”. These chemicals caused inflammation to the immediate area, which will further irritate any Nerve Roots being already being compressed.
(2) Disc Degeneration
Technically, the “Disc Degeneration” is more of a risk factor for “Herniated Discs” than an actual cause of Sciatica, but it leads to Sciatica so often that we’d be remiss if we were to exclude it.
“Disc Degeneration”, or “Degenerative Disc Disease (DDD)”, is an extremely common and almost inevitable part of the normal human aging process. Over time—years and/or decades—the intervertebral Discs undergo a drying out process called “Disc Desiccation”. The water content in the Discs drop, which makes them weaker, more brittle, and more prone to “Herniation”.
Although Degenerative Disc Disease (DDD) is incredibly prevalent and almost unavoidable, there are some lifestyle modifications that you can make to help reduce your risk of or to even slow down “Disc Degeneration”, such as:
- Practicing Proper Lifting Mechanics when trying to lift heavy objects.
- Keeping to a healthy body weight.
- Not smoking and limiting the intake of alcohol.
- Sitting less and moving around more often.
(3) Lumbar Spinal Stenosis
“Spinal Nerve Roots” branches outward from the “Spinal Cord” through passageways made of bone and ligaments called “Neural Foramina”. “Nerve Roots” passes through these openings, and join with each other to become Nerves, and extend out to the rest of your body.
(4) Spondylolisthesis
The word “Spondylolisthesis” (pronounced spohn-di-low-less-THEE-sis) comes from the Greek words “spondylos”, which means "Spine" or "Vertebra," and “listhesis”, which means "Slipping, Sliding or Movement".
“Spondylolisthesis” is a condition involving “Spine instability”, which means the vertebrae move more than they should. A vertebra slips out of place onto the vertebra below. It then may exert pressure on a Nerve, which in turn could cause Lower Back Pain or Leg Pain.
Is “Spondylolisthesis” the Same as “Spondylolysis”?
Both “Spondylolysis” and “Spondylolisthesis” will cause Lower Back Pain. They are related but NOT the same.
(a) Spondylolysis
This “Spine Defect” is a “Stress Fractures” or “Cracks” in the Spine Bones. This may be common in young athletes.
(b) Spondylolisthesis
This condition involves a vertebra slipping out of its place, and resting on the bone below it. “Spondylolysis” may eventually cause “Spondylolisthesis” when a Stress Fracture causes the slipping. Or the vertebra may slip out of place due to a “Degenerative Disc” condition. The Discs between Vertebrae and the Facet Joints (the two back parts of each vertebra that link the vertebrae together) can wear down. Bone of the Facet Joints actually grows back and overgrows, causing an uneven and unstable surface area, which makes the vertebrae less able to stay in place. No matter what is the cause, when the vertebra slips out of place, it puts pressure on the bone below it. Most cases of Spondylolisthesis do not cause symptoms. If you feel Leg Pain, it can also be caused by the “Compression” or a "Pinching" of the Nerve Roots that exit the “Spinal Canal” (the “Tunnel” created by the interlocking vertebrae of the Spine). The “Compression” or “Pinching” is due to the vertebrae slipping out of position and narrowing the needed space for the nerves.
(1) What Are the Various Types of “Spondylolisthesis”?
There are altogether SIX different types of “Spondylolisthesis”: Traumatic, Iatrogenic, Congenital, Degenerative, Pathologic, and Isthmic. These types of Structural Abnormality of the Spine can be found in all regions (i.e. the Cervical, Thoracic, and the Lumbar), but it most frequently occurs in the Lumbar Spine.
(i) Traumatic Spondylolisthesis
“Spinal Fractures” from sudden injuries like vehicular accidents or falls can instantly knock the Spine out of its alignment. When this occurs, doctors usually refer to this type of slipped vertebra as a “TraumaticSpondylolisthesis”.
This distinguishes this type of dislocated vertebra from “Isthmic Spondylolisthesis”, which can occur naturally during the course of childhood.
(ii) Iatrogenic Spondylolisthesis
“Iatrogenic Spondylolisthesis” occurs when a surgical error ‘weakens’ the structural integrity of the Spine, leading to “Spondylolisthesis”. For example, during a “Laminectomy”, a Spine Surgeon removes the Lamina, or bony backside of the Spine, to relieve pressure on the Spinal Nerve Roots. Often, the Surgeon will then need to insert a hardware to help maintain the stability of the Spine. If this crucial last step is missed, then you can develop a “Post-Surgical” complications, like “Spondylolisthesis”.
(iii) Congenital (Dysplastic) Spondylolisthesis
“Dysplastic”, which is also known as “Congenital Spondylolisthesis”; this form of slipped vertebra which results from a defect that is present at birth. This defect can weaken the Facet Joints, the points of articulation where two vertebrae meet to create spinal movement. When this point of connection is vulnerable, everyday movements, like bending or twisting, can knock the vertebrae out of alignment.
(iv) Degenerative Spondylolisthesis
If your “Facet Joints” degenerate from Age, then this form of “Degenerative Spondylolisthesis” can result. In fact, it is a fairly common consequence of Osteoarthritis. This form of disorder can lead to “Spinal Stenosis”, or a narrowing of the Spinal Canal that houses your Spinal Cord. When this occurs, symptoms such as “Muscular Weakness” in the Hamstrings, can arise.
(v) Pathologic Spondylolisthesis
“Pathologic Spondylolisthesis” results from an underlying disease, like Paget’s Disease, Spinal Tumors, or Osteomyelitis, etc. Each of these disorders can weaken the points of attachment that hold the vertebrae together. This can result in a sudden injury to the Spine, like a slipped vertebra.
(vi) Isthmic Spondylolisthesis
“Isthmic Spondylolisthesis” occurs when a “Stress Fracture” develops in the “Pars Interarticularis”, a narrow strip of bone that connects our vertebrae at the “Facet Joints”. Children normally develop this type of fracture between 5 – 7 years of age. However, symptoms are not usually noticed until Adulthood, when the Facet Joints continue to degenerate and the Spondylolisthesis results.
(5) Trauma That Can Result in Spinal Cord Injuries
In some cases, Trauma can directly cause “Sciatica”. Examples include Motor Vehicle Accidents (MVA), falling, and contact sports (e.g., football). The impact may injure the nerves themselves or fragments of broken bone may compress the nerves.
In addition to high-energy traumas like Motor Vehicle Accidents (MVAs), other forms of Trauma that can cause “Sciatica” include “Pelvic Fracture” or “Hip Dislocation (Traction-Induced Sciatica)” that causes nearby Hamstrings to tear and irritate the “Sciatic Nerve”. It can also be the result of objects penetrating the body and cutting/tearing the nerve, such as a bullet or a knife.
(6) Piriformis Syndrome
“Piriformis Syndrome” is named for the “Piriformis Muscle” and the pain caused when the muscle irritates the “Sciatic Nerve”. The Piriformis Muscle is in the Lower Lumbar part of the Spine, connects to the Thighbone, and assists in the Hip Rotation. The “Sciatic Nerve” runs beneath the “Piriformis Muscle”.
“Piriformis Syndrome” can cause “Sciatica” when the muscle spasms or becomes inflamed. The Inflammation can cause the muscle to swell and compress the “Sciatic Nerve” whereas the muscle spasms may impact people whose “Sciatic Nerve” runs through the muscle itself; this is because the “Sciatic Nerve” gets compressed as the muscle contracts.
(7) Spinal Tumors
“Spinal Tumors” are abnormal growths that are either “Benign” or “Malignant (Cancerous)”. “Cancerous Tumors” are usually Metastatic, which means they have spread to the Spine from cancer that had formed somewhere else in the body. “Benign” growths in the Spine that can compress the “Sciatic Nerve” include:
(a) Aneurysmal Bone Cysts (ABC)
“Aneurysmal Bone Cysts (ABC)” are not actually Tumors—as the name dictates— but Cysts that are filled with blood and that tends to expand quickly.
(b) Giant Cell Tumors (GCT)
“Giant Cell Tumors (GCT)” are aggressive “Bone Tumors” that usually attack bones that are close to a Joint, a potentially big problem for the Spine with its 364 Joints.
(c) Osteoid Osteomas
“Osteoid Osteomas” tumors are found in Bone. These tend to be small, and do not grow larger once it’s formed. However, they can cause new, unintended bone to form in the affected area or “Osteoid Bone” to form around the Tumor itself.
When a “Spinal Tumor” develops in the “Lumbar Region”, there is a risk for “Sciatica” to develop as a result of “Nerve Compression”. Fortunately, Spinal Tumors are very rare.
What Are The Less Common Causes of “Sciatica”
The more common causes of Sciatica Pain are usually caused by an ‘Irritation’, ‘Inflammation’, ‘Pinching’ or ‘Compression’ of a Nerve in the Lower Back. There are however, also some less-known causes of Sciatica Pain and these may include:
(1) Endometriosis, which is a growing of Uterine Tissue outside of the Uterus that can
accumulate in areas that surround the Sciatic Nerve or the Sciatic Nerve itself.
(2) Infection in the Spine or the Spinal Column that causes an abscess to form and press on
the Sciatic Nerve or damage to the Sciatic Nerve itself.
(3) Nerve damage caused by Diabetes.
(4) Shifting or growing of a fetus during Pregnancy that can result in Nerve Compression.
(5) Side effects from certain kind of medications.
How Are Sciatica Diagnosed?
During the physical examination, the Doctor may check for your muscle strength and reflexes. You may then be asked to walk on your toes or heels or rise from a squatting position. Pain due to Sciatica will usually worsen during the performance of these activities. Diagnosis can also be done through the assistance of such procedures:
(1) X-Ray
An X-Ray may be requested which will reveal bone overgrowth that may be pressing on a Nerve.
(2) Magnetic Resonance Imaging (MRI)
A “Magnetic Resonance Imaging (MRI)” produces detailed images of bone and soft tissues such as “Herniated Discs”. During this test, you lie down on a table that moves into the MRI machine.
(3) Computer Tomography (CT) Scan
When a “Computer Tomography (CT) Scan” is used to image the Spine, a “Contrast Dye” may be injected into your Spinal Canal before the X-Rays are taken. The Dye then circulates around your Spinal Cord and Nerves, which appear white in colour on the CT Scan.
(4) Electromyography (EMG) Test
The “Electromyography (EMG) Test” measures the Electrical Impulses produced by the Nerves and the response of your muscles. This test can confirm Nerve Compression caused by Herniated Discs or the Narrowing of your Spinal Canal.
What Are The Various Treatment Methods for Sciatica Pain Used by the Western Medical Practitioners
Your Western Medical Doctor may suggest some of the following kind of treatments to treat Sciatica Pain:
(1) Medications
These are the kind of drugs that the Western Medical Practitioners might prescribe for you in order to treat your Sciatica Pain:
· Anti–Inflammatories
· Muscle Relaxants
· Narcotics
· Tricyclic Anti-Depressants
· Anti-Seizure Medications
(2) Physical Therapy
Once the patients’ condition is fine, the Western Medical Practitioner may design a Rehabilitative Program to help prevent future injuries. This usually could include exercises to correct one’s posture and to improve one’s flexibility.
(3) Steroid Injections
Corticosteroids help to reduce the Sciatica Pain by Suppressing Inflammation around the Irritated Nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited, because the risks of serious side effects increases when injections occur too frequently.
(4) Surgery
Surgeons may remove the “Bone Spur” that’s pressing on the Pinched Nerve. This Surgical Option is generally reserved for when the Compressed Nerve causes significant weakness or when you have Sciatica Pain that progressively worsens or doesn’t improve with other form of therapies.
Who are Those at Risk of Getting Sciatica Pain?
In addition to all of these potential causes of Sciatica, features of your anatomy, your genetics, and your lifestyle can combine to make you more susceptible to Sciatic Nerve Pain. Some of these Sciatica Pain risk factors can include:
(1) Age
Getting older increases your risk of “Herniated Discs” and “Degenerative Disc Disease” which, as you now know, are two of the most common causes of Sciatica Pain.
(2) Obesity
Carrying an unhealthy amount of extra weight stresses the Spine and puts more pressure on your Discs, which can lead to “Disc Herniation” or other damage.
(3) Jobs and Activities
Some jobs are strenuous and physical, involving lots of lifting and twisting. Lifting and twisting unsafely can be a big contributor to Sciatica Pain risk. Conversely, other jobs have you sitting for too long, which can also stress your Discs, especially if that prolonged sitting leads to a weakened core muscles and, therefore, less protection for your Spine and its Discs.
(4) Spine Injury
Previous Spine Injury can weaken Discs and make them more susceptible to “Disc Herniation” and damage.
How can we help you at FU KANG TCM WELLNESS ?
At the FU KANG TCM WELLNESS, our Consultant Therapist, Mr. SIM CHIN SENG who is one of the Best Specialist in this field in the treatment of “Sciatica Pain” cases. He had treated Thousands of successful cases and has decades of practice and experience. A single session treatment of one hour duration is all you need to walk out of our clinic "Virtually" Pain Free.
Our Consultant Therapist uses a very special and unique treatment technique which he devises and pioneered to achieve virtually 100% success in all the “Sciatica Pain” cases that he had treated. The technique involved a completely non-invasive, virtually painless and without much discomfort to the patients. In fact, most of the patients could even sleep through the whole procedure and treatment. The treatment does not involve the use of any Acupuncture needles or any form of drugs or medication. It’s completely natural. You are only required to come back for one to two times (4 days intervals) to change the dressings and replaces the small bamboo sticks which he places on your fingers to allow your “Sciatic Nerve” to calm down and heal by itself. The change of dressings and bamboo sticks are completely free-of-charge.
Call us to book an appointment with our Consultant Therapist today and get that “Sciatica Pain” treated once and for all. A short waiting period may be expected as only a limited number of cases can be treated on each day and there are always a queue and backlog of reservations. Going for Acupuncture and/or Physiotherapy, Steroid injections or Chiropractic adjustments for months after months is absolutely NOT a “CURE” of your condition, it is ONLY at most a “TEMPORARY RELIEF” that requires you to keep going back for more and more sessions. Even then, the Sciatica Pain do not go away completely when you walk out of the clinic.
Call @ 6983 4964 or WhatsApp to @ 81200830 to book your appointment with our Consultant Therapist now. Please expect a short waiting period of few days due to the limited number of patients our Consultant Therapist can treat in a day.
ABOUT THE AUTHOR
Mr. SIM CHIN SENG is the Consultant Therapist in FU KANG TCM WELLNESS. He is an Accomplished Tuina and Pain Management Specialist with decades of practice and experience. He specialises in the treatment of “Frozen Shoulders” cases, Sciatica, Lumbar Back Pain and many other Musculoskeletal Disorders, Trigger Fingers and Carpal Tunnel Syndrome, etc.