Sciatica

When someone experience pain in his lower limbs that starts from the hip or back and radiates down to the leg and has difficulty sitting, standing, or walking or bending forward, it may be due to
nerve compression. In local language this problem has so many names, some called it as sciatica or disc problem. But their as several problems or conditions that mimics sciatica and can cause lower limb pain. Some of You may experience weakness, tingling, numbness, or pain in your hip, leg, and/or foot due to various reasons.

Sciatica

Common causes of radiating pain in lower limb (sciatica)

We here discuss the causes of lower limb pain that originates from hip and radiate down to legs or up to foot. Sciatica is a condition that occurs when the sciatic nerve is entrapped or compressed or damaged.

Prolapsed intervertebral disc or disc herniation

It’s a painful condition occur when due to any reason disc between lumbosacral spine bones bulges outward or inward resulting pressure on a nerve radicles that makes up the sciatic nerve. The most common reason for this disc bulge could be old age, fall from height, lifting heavy weight. Lifting heavy weight is most common reason in young person of disc herniation. In general, disc herniation is not deemed to be a serious matter until n unless it results in nerve compression and cause symptoms of sciatica.

Lumbar Spinal Stenosis
Most common cause for neurological claudication is lumbar canal stenosis. In simple words when patient finds it difficult to walk, tightness in calf or hamstrings muscle of lower limb, needs rest intermittently to walk, it may be due to lumbar canal stenosis. Lumbar canal is the space in your spine through which the nerves pass could narrow because of the disc prolapse of a disc and/or thickening of ligaments that provide support to your spine. This could also lead to nerve compression and pain. Changes that occur to the spine because of aging or degeneration can cause bone outgrowths called osteophytes which irritate/compress the nerves root and causes pain like sciatica.

Spondylolisthesis

Spondylolisthesis is an orthopedical condition wherein the spine loses its alignment and one vertebra is ahead of lower vertebra, mostly seen in lumbosacral spine. This misalignment of spine cause pressure on intervene disc leading to the prolapse or rupture, leading to nerve compression. Degenerative disk diseases, previous spine injuries or surgeries, and physical stress experienced by the spine are also known to cause nerve compression. Weight lifting and obesity can also cause be the risk factor for nerve compression.

Trauma or Injury
Trauma to the lumbosacral spine during road traffic accidents or fall from height or sports injury may lead to the damage to the disc and lead to compression of sciatic nerve.

Piriformis Syndrome
It’s a very interesting condition because symptoms are same as sciatica where patient experience radiating pain in lower limb .The condition is present in approximately 15-20 percent of patients suffering from lower limb pain. Injury, tightness, or stress caused to piriformis muscle in the buttock region compresses the sciatic nerve and causes pain. Piriformis syndrome may resemble this problem, but it is different and, therefore, treated differently.

Spinal Tumours
Spinal tumours can also compress the nerve roots or a nerve that is exiting through the spinal canal and cause pain in the hip, thigh, and groin area. However, spinal tumours are rare and they rarely cause pain below the knee.

Mimics of sciatica

These are those conditions that produce symptoms like sciatica but actually there is no compression or damage to sciatic nerve.

Peripheral vascular disease
Peripheral vascular disease is caused by the narrowing of the arteries in the lower limb which causes decreased blood supply to the lower limb. Resulting person may experience leg muscle cramps and dragging pain which causes difficulty in walking. Along with these patient may have ulcers, cyanosis of affected part.

Peripheral neuropathy
This condition occurs when there is damage to the peripheral nerves, condition causing this are alcoholism, diabetes, drug induced, kidney disease, infections and many other medical conditions As in the case of sciatica, peripheral neuropathy also causes a burning sensation, tingling, pin pricking, jabbing pain, numbness, and tingling in the lower part of the leg and foot.

Peroneal neuropathy
Injury sustained to the common peroneal nerve that extends below the knee along the outer side of the leg can also cause weakness as well as foot drop that sciatica patients sometimes experience.

Pain in lower limb is a vast conditions with so many causes. Its always better to consult a specialist. He will Perform a physical examination, order imaging studies like CT/MRI, as required. In certain cases, your doctor mightrecommend nerve conduction test to pinpoint the source of pain.
When it comes to Treatment of sciatica/low back pain in Indore, at AsianNeuro Centre, the first approach is conservative care, which includes physical therapy and medication. If this is not helpful, doctors might consider spinal injections. Surgery is last asset and very rare and is indicated in only those condition in which pain is not relieved by drugs and injections, patient has weakness of limb, bladder bowel involvement.

Dr. Navin Tiwari
Director, Asian Neuro Centre, Indore and consulting neurologist with more than 10 years of experience.