Sciatica is a neurological condition that mainly arises due to problems in the sciatic nerve. The sciatic nerve is believed to be the largest nerve originating from the spinal nerves L4 to S3. It extends downward from the lower spine into the back of each leg (thighs) right down to the foot. The sciatic nerve acts as a connecting link between the spinal cord and the foot and the leg muscles. People with sciatica often experience a tingling sensation along with a shooting pain radiates downwards from the lower back (mostly the lumbar region) to the back of one of the legs. Some may also experience the sciatic pain down both the legs (rare).

Types of Sciatic Pain:

Sciatica that affects a person can be of two types depending on the severity of the associated symptoms

Acute sciatic pain: In this case, a person experiences a sudden radiating pain which often heals by itself within a week or two. More than often, the pain is triggered by an injury to the spinal joints, nerves, or the disc.
Chronic sciatic pain: This is a more serious condition where the pain may linger for long, often more than three months. The chronic sciatic pain may affect a person with severe Arthritis and nerve injury and damage.
Symptoms associated with Sciatica:

One of the characteristic symptoms of Sciatica is a shooting pain that radiates from the lower back (often the lumbar) to the back of one (or both) of the legs.
In some, the sciatic pain may result in weakness and a tingling sensation down the affected leg.
A person with sciatica may find it difficult to move his/her foot and legs (restricts their movement).
Some people may experience a shooting pain even while they are in a sitting position. In some others, the pain may be at its worst when a person is in a standing position.
Sciatica can also trigger a hip pain.
What triggers sciatica and the associated symptoms?

The disc is a protective shield that prevents any damage or injury to the vertebrae. A degenerative disc problem can interfere with the normal functioning of the disc triggering sciatica.
Spondylolisthesis: In Spondylolisthesis, also known as a Slip Disc, a bone (mostly in the lumbar region) slips over the bone which is located just below it. People with prolonged and untreated spondylolisthesis are often known to suffer from sciatica.
The sciatic pain can also affect a woman during her pregnancy.
Lumbar spinal stenosis: This condition is is characterized by the spinal canal narrowing down in the lumbar region. Lumbar spinal stenosis exerts pressure on the sciatic nerve, giving rise to sciatica.
A muscular strain or spasm in the buttocks can also be a contributing factor.
Proper management and prevention for sciatica are possible. One should be alert and consult a doctor in case they experience the associated symptoms or any discomfort.

Sciatica Pain - What Can Trigger It?

The term Sciatica is used to describe leg pain, tingling, numbness or weakness that travels down the low back via the sciatic nerve to the back of leg. Sciatic nerve arises from each side of lower spine and passes deep in the buttock along the back of thigh and legs. The pain of Sciatica may be irregular/ infrequent or persistent causing severe agony to the patients. The pain of Sciatica may be confined to low back or hips or may extend up to toes. The pain of Sciatica can be excruciating and "not relieved by painkillers".

What causes Sciatica?

Pain in Sciatica is due to irritation or pinching of Sciatic nerve within the spine. This occurs most commonly due to prolapsed intervertebral disc (slip disc) causing nerve compression resulting in pain.

Is surgery the only treatment for Sciatica?

Most patients can be managed with medication/exercises. So surgery is not the only way out. Patients who have severe pain can also benefit from "Epidural Steroid Injection". This treatment has proven to be effective in avoiding spine surgery in such patients.

What is Epidural Steroid Injection?

Epidural Steroid Injection is a procedure done by a Specialist (Interventional Pain) in an Operation Theatre using X-Ray (Image Intensifier) to locate exact level of injection. A drug mixture consisting of Steroid with Local Anaesthetic is injected at the epidural space of affected nerve root. The steroid washes away inflammatory mediators from the epidural space which decreases the pain. Steroid also decreases the inflammatory response of body to the prolapsed disc. As a result the pain arising from nerve inflammation is decreased. This is a day care procedure i.e. the patients are discharged the same day.

How is the possibility of surgery ruled out?

Epidural Steroid Injection is a proven, safe and an effective treatment that works on the concept of Interventional pain management - to provide relief from persistent and chronic pain of Sciatica. Generally, a single injection is sufficient to relieve patients of the pain. The procedure can be repeated for a maximum 3 times in a year, depending on the patient's response. With effective pain relief, surgery is negated.

Non-Surgical Treatment For Sciatica

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatica i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication. Ayurvedic herbs that improve the symptoms of Sciatica are:

1. Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.
2. Guggul is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.
3. Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 
4. Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 
5. Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.
6. Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.
7. Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica.

Ayurvedic Treatment of Sciatica

Ever faced a nagging low back ache that just won't quit? You could be dealing with sciatica. Sciatica or sciatic nerve pain is not a diagnosis in itself, but is a symptom of a deeper problem. Conditions that trigger sciatica include degenerative discs, spinal stenosis, a herniated disc in the lumbar region or   spondylolisthesis. Whether your sciatica pain is persistent or sporadic, it can make routine tasks difficult to perform. The good news is that there are a number of remedies to ease this pain and improve the health of your spine.

1. Hot and cold therapy: Sciatic pain that extends down to the thighs can be relieved by alternating between a heat pack and an ice pack. Each pack can be applied for about 20 minutes at a stretch every two hours. However, this does not treat the sciatic nerve itself.

2. Pain medications and steroid injections: Over the counter pain medication like ibuprofen or muscle relaxants can help alleviate pain and reduce inflammation. In chronic cases, epidural steroid injections may also be prescribed to address the inflammation and pain. Pain relief provided by medication and steroid injections can last for a few days or a few months depending on the person.

3. Yoga: Sciatica patients looking for long term relief often turn towards alternative forms of treatment like yoga. Yoga helps strengthen muscles, increases flexibility and improves posture. This is more beneficial towards preventing sciatica problems from arising than treating ongoing sciatic pain. When practicing yoga with a sciatica problem, it is very important to understand your body's limitations and not over extend your back muscles.

4. Massage: A massage that treats sciatic pain is very different from the usual massage you may get at a spa. A massage to relieve sciatic pain involves putting pressure on the inflamed part of the back and the piriformis muscle. This is the muscle that sits over the sciatic nerve and triggers sciatic pain. In most cases, 3 to 4 massage sessions at intervals of 7 to 10 days can have effective results on sciatic pain.

5. Physical therapy: Sciatica patients often find the slightest movement extremely painful. While lying in a bad is tempting, it can actually worsen the pain. Exercise increases blood flow to the spine and helps flush out toxins. Going for a walk, light aerobics or swimming are ideal ways for a sciatica patient to exercise.

6. Chiropractic manipulation: This involves realigning the spinal column and is an effective way of treating underlying conditions that trigger sciatic pain. These spinal adjustments should only be performed by licensed chiropractors or osteopathic physicians.

Treatments for Sciatica Pain

Acupressure can prove to be extremely effective if you are looking for non-medicinal solutions to treat musculoskeletal problems, such as back pain, sports injuries, arthritis, etc. Acupressure is the application of putting firm pressure on the areas on the body which are swollen, agitated or tense by massaging the acupoints (specific points in the body). Acupressure believes that relieving these areas of pressure reduces the pain.

Here are some musculoskeletal problems that can be healed by acupressure:

    Arthritis: Those who seek acupressure as an alternative treatment for pain are mostly suffering from arthritis (a disease characterised by chronic joint inflammation and cartilage degeneration). Acupressure applies pressure on the inflamed joints.
    Back pain: Back pain is a common problem that can affect anyone irrespective of his or her age. Acupressure acts to relieve the points where the muscles are too tense and helps to tone or support the muscles which have become weak with disuse.
    Chronic pain: Unrelenting pain can stem from many causes. Acupressure focuses on the pain and the pain signals when treating chronic pain. The acupoint of the pain and the nerves are gently massaged to relieve the pain.
    Fibromyalgia: Traumatic injury to the soft tissue, emotional trauma or severe illness can cause fibromyalgia. It is non-inflammatory in nature and often leads to Chronic Fatigue Syndrome (a troublesome disorder with symptoms of deep fatigue, sleeping problems, pain, etc.). Acupressure can greatly improve the fatigue and sleeplessness that fibromyalgia causes.
    Tendonitis: The tendon connects the tissue to the bone, and tendonitis is the condition when the tendon is inflamed. Acupressure helps in reducing the inflammation and easing mobility restrictions.
    Sciatica: The sciatic nerve is the longest nerve in the body, stretching from the lower spine to the back of the foot. So when this nerve is agitated, pain radiates from the lower back to the foot. This condition is called sciatica. The acupoints in sciatica are the lower back and the hip. Acupressure effectively loosens the muscles in these regions and reduces inflammation.
    Sports injuries: Strains and sprains are common sports injuries, which mostly affect athletes. Acupressure has anti-inflammatory benefits that can help heal severely injured tendons, ligaments or muscle. Acupressure also plays a huge role in restoring and retraining the body, especially if you are an athlete and play high-demand sports.
    Carpel Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the pressure increases on the median nerve as it goes through the carpal tunnel, and this causes wrist pain. Acupressure involves the use of directed pressure to specific acupuncture points on the surface of the body.
    Insomnia: Insomnia is a sleep disorder. The Acupressure Points between your heel and anklebones (on both sides) have traditionally been used to relieve and prevent insomnia.
    Migraines: Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common.

Acupressure: The Non Medicinal Solution to Musculoskeletal Problems

Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc.

When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed.

When should you consider undergoing surgery for sciatica?
Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following:

Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock
Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud.
When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy
When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough.
When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues
It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain.
In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc.
In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention.
Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.

Sciatica - When Do You Have To Go For Surgery?

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