Causes and Treatments for Sciatica One of the harsh realities of the frail human condition is the fact that most people will suffer from some degree of low back pain at some point in their lives. Even people with relatively sedentary lifestyle can experience debilitating injuries to their lower back, and the potential for such injuries is exacerbated further when individuals engage in various sports activities. One such lower back and hip problem is sciatica, which is caused by spinal nerve root compression. Fortunately, there are a number of evidence-based interventions available for treating this condition, including both pharmacological and psychotherapeutic modalities. The purpose of this paper was to provide a review of the relevant peer-reviewed and scholarly literature concerning the common mechanisms of injury, anatomy of the injury (which structures are involved), presenting signs/symptoms, diagnostic procedures and/or special tests, and the basic healing process, rehabilitation, or surgery that needs to be done in order for the athlete to return to play. Finally, a summary of the research and important findings concerning the implications of sciatic injuries for individuals and sports medicine practitioners are provided in the paper’s conclusion.

Detailed description of anatomy and mechanism of injury, including common sports associated with the injury

The anatomy and mechanism of injuries that can result in sciatica include herniated lumbar discs which are implicated in chronic back pain and often severe disabilities. The research to date indicates that the prevalence rate for sciatica ranges from 13% to 43% of the general global population for this disorder (Onac & Moldovan, 2012). The term for the condition is based on the fact that the pain caused by sciatica originates and radiates along the sciatic nerve path (see graphics at Appendix A and B) that travels through the lower back to the hips and buttocks and then down both legs (Sciatica overview, 2018). Although every case of sciatica is unique in some fashion and both sides can be involved, the disorder typically only affects one side of the body (Sciatica overview, 2018).

The actual causes of sciatica vary but include bone spurs on the spine, the narrowing of the spine termed spinal stenosis which compresses a portion of the sciatica nerve or herniated disks (Sciatica overview, 2018). While these types of injuries can occur during any type of physical activity, they are especially pronounced during strenuous exercises and sports, particularly contact sports such as football. In this regard, Abitbot (2018) reports that, “Sciatica can result from direct nerve compression caused by external forces to the lumbar or sacral spinal nerve roots [from] football and other sports. The impact may injure the nerves or, occasionally,...

2). The specific adverse effects of sciatica also vary depending on the precise cause of and the severity of the injuries that are involved, pain, numbness and inflammation of the affected areas are common (Sciatica overview,2018).
Regardless of the specific cause of the injury or sports activity involved, a growing body of evidence confirms that the costs that are associated with treating sciatica are staggering, with some estimates indicating that $50 billion is spent each year in the United States alone (Onac & Moldovan, 2012). Furthermore, this enormous amount of health care resources does not take into account the comorbidities that are typically associated with chronic lower back pain. For instance, Onac and Moldovan (2012) emphasize that, “Patients with chronic back pain not only have a much higher emotional distress, but also a higher probability of developing psychiatric symptoms, of which the most common are depression, substance abuse and anxiety disorders” (p. 24). Moreover, left untreated, sciatica can cause or further exacerbate various existing psychological disorders, making early diagnosis and treatment all the more important as discussed below.

The presenting signs/symptoms, diagnostic procedures, and or special tests are relevant to making a diagnosis

Because occasional low back pain and numbness in the extremities are fairly commonplace among the general population, diagnosing sciatica may represent an especially challenging enterprise. It is important to note that the diagnosis of sciatica may include individuals with lower back pain that radiates on one leg or even both legs that involves the sciatic nerve (Sciatica overview, 2018). Two of the main diagnostic criteria for sciatica include (a) burning, lancinating (“piercing pain”), or stabbing pain radiates along the course of the sciatic nerve, most often down the buttocks and posterior aspect of the leg to below the knee; and (b) the loss of sensation, weakness, and reflex deficits (Sciatica, 2018).

In any context, of course, the sensation of pain is a highly subjective experience and the accurate diagnosis of sciatica requires a careful analysis of the type, location and severity of the pain, numbness, tingling and other symptoms that are reported (Sciatica overview, 2018). Since these types of symptoms can be caused by a wide range of disorders, the special tests that are used to diagnosis sciatica typically proceed in a step-wise fashion in order to rule out other potential causes as follows:

1. The distribution of numbness is used to localize the part of the nervous system that is involved;

2. Next, other clinical features—particularly rate of onset, associated neurologic symptoms and signs,…