Attention to all bicyclists, long-distance commuters and pregnant and or sedentary individuals. All of you may share a common disorder, resulting in one-sided gluteal pain, radiating down the leg, caused by a variety of different pathologies. The result is one disorder, called sciatica. Essentially, sciatica is a nerve root compression by a variety of causes, of at least one of the five spinal roots (L4. L5, S1, S2, S3), that give rise to the sciatic nerve.
The important point here is to remember sciatica is a syndrome resulting from a variety of different causes and subsequently requiring different treatments. These include conservative management such as alternating hot and cold packs, specific stretching, NSAIDS and muscle relaxers. More advanced treatments include chiropractic adjustments, physical therapy and medical massage. Finally invasive therapy such as epidural steroid injections and as a last resort, surgery may be required if significant pathology is present. After a trial conservative treatment and observation for approximately two weeks, an imaging modality such as CT scan or MRI will help differentiate the causes of sciatica.
Risk factors include age over 40, prolonged sitting, diabetes and pregnancy. Causes of sciatica includes lumbar disc herniation, degenerative disc disease resulting in spinal stenosis, piriformis syndrome (whole sciatic nerve is compressed by an irritated piriformis muscle), and rarely tumors.
Prevention of sciatica includes exercise and active lifestyle, stretching of hip flexors and extenders, proper posture and lifting mechanics, controlled diabetic management and finally avoidance of prolonged sitting. Please remember any severe pain or loss of bladder/ bowel control requires immediate medical attention.