Definition

Ischialgia, or sciatica, is pain felt along the path of the ischiatic nerve, which branches from the lower back through the hips, buttocks, and down the legs. The pain usually occurs on one side of the body. Ischialgia occurs due to a pinched nerve, abnormal protrusions in the spine, or spinal stenosis, which can exert pressure on the ischiatic nerve. Consequently, pain, inflammation, and numbness or tingling in the affected leg can occur. Certain movements are known to exacerbate symptoms, such as bending, twisting, or coughing. If you experience pain caused by ischialgia, the pain can make it difficult for you to perform activities, especially those involving the legs and lower back.

This pain affects both men and women, with the most common age group being those in their 40s. The pain can last for four to six weeks. Experts estimate that ischialgia can occur in 4 out of 10 people at least once.

Causes

The radiating pain is caused by inflammation or irritation of the nerve. One of the most common causes is a pinched nerve in the spine. Other causes of ischialgia pain include:

• In the elderly, spinal stiffness can cause compression or pressure on the nerve, leading to ischialgia.
• Swelling or inflammation of the muscles around the nerve, which can irritate the nerve fibers.
• Masses in the spine, such as cancer, swelling due to active bleeding in the spinal cord layers, or abscesses (pus accumulation) caused by bacterial infection.
• Causes of ischialgia are not limited to injuries or disturbances around the ischiadic nerve fibers; pain can also be caused by other spinal issues, such as spondylolisthesis (vertebral displacement).

Risk factor

Several risk factors that can make you more prone to experiencing ischialgia include:

• History of injury: Injuries to the spine can lead to ischialgia.
• Age: As you age, your entire body, including the spine, undergoes aging. This can cause shifts in the spine, leading to ischialgia.
• Obesity: Excess body weight increases the load on the spine, contributing to structural changes that can trigger ischialgia.
• Occupation: Jobs involving heavy lifting can make someone more susceptible to ischialgia.
• Diabetes: One of the complications of diabetes is nerve damage due to inflammation, increasing the risk of ischialgia.
• Smoking: Nicotine in cigarettes can damage nerves and accelerate bone damage, weakening the bone structure.

Symptoms

Ischialgia pain can occur suddenly or gradually, depending on its cause. If caused by a pinched nerve in the spine, the pain can appear suddenly, while arthritis may cause pain that develops slowly. Symptoms of ischialgia include:

• Moderate to severe pain in the lower back, buttocks, and legs.
• Numbness, tingling, or weakness in the lower back, buttocks, legs, and feet.
• Pain exacerbated by movement in the innervated area, with some patients reporting difficulty moving.
• Stabbing pain in the legs, feet, and toes.
• Digestive and urinary control issues (if there is pressure on the lower part of the spinal nerve/cauda equina).
• Pain can start as an electric shock feeling in the leg. A characteristic symptom of ischialgia is pain originating in the middle of the buttocks and radiating to the legs. The broad causes of ischialgia mean the pain can recur and worsen.

Diagnosis

A physical examination of the leg muscles is performed to assess reflexes and muscle strength in both legs to diagnose ischialgia. You may be asked to perform certain movements to identify locations and movements that worsen or cause pain. Additional examinations may include:

• X-ray: To assess the condition of the spine.
• CT Scan: Can evaluate soft tissues like the spine and bones in one scan.
• MRI: Uses high-strength magnets to produce detailed images of the body.
• EMG (Electromyography): To measure the speed of electrical impulses in nerve fibers.
• Discogram: Uses contrast to view the discs in the spine.

Management

The main goal of treating ischialgia is to relieve pain and improve the mobility of the affected leg. Home treatments include:

• Apply a cold compress to the painful leg.
• Using over-the-counter pain relievers (paracetamol or ibuprofen).
• Performing stretching techniques to relieve pain and strengthen muscles.

If the pain worsens, a doctor may recommend therapies such as:

• Medications like anti-inflammatory drugs, antidepressants, pain relievers, and muscle relaxants.
• Physiotherapy to relieve nerve pressure.
• Steroid injections into the spine to relieve pain and reduce inflammation.
• Surgery for patients with severe pain and accompanying urinary and bowel issues. Surgery is rarely performed for ischialgia.

Complications

Chronic ischialgia can lead to complications such as foot drop, a condition causing weakness in the leg, preventing normal walking. If nerve damage worsens, the fibers controlling urinary and bowel function may be affected, leading to cauda equina syndrome.

Prevention

Prevent ischialgia by:

• Maintaining good posture, especially when sitting, to alleviate spinal stress.
• Quitting smoking.
• Maintaining a healthy weight.
• Exercising regularly, focusing on low-impact activities.
• Avoiding severe injuries.
• Using proper techniques when lifting heavy objects.

When to see a doctor?

Mild ischialgia symptoms may resolve on their own. See a doctor if symptoms persist for more than a week and do not improve with home treatment. Seek immediate medical attention if:

• Sudden, severe pain causes numbness and weakness in the affected leg.
• The pain results from a serious injury like a car accident.
• Urinary and bowel control issues accompany pain.
• Pain occurs in both legs and worsens.

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