Sciatica: Causes, Anatomy, Diagnosis, and Treatment

Introduction

One of the harsh realities of the frail human condition is that most people will suffer from some degree of low back pain at some point in their lives. Even people with relatively sedentary lifestyles 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, a number of evidence-based interventions are available for treating this condition, including pharmacological and psychotherapeutic modalities. The purpose of this paper is to review the relevant peer-reviewed and scholarly literature concerning the common mechanisms of injury, anatomy of the injury, presenting signs and symptoms, diagnostic procedures and special tests, and the basic healing process, rehabilitation, and surgical options needed for an athlete to return to play. A summary of the research and important findings concerning the implications of sciatic injuries for individuals and sports medicine practitioners is provided in the conclusion.

Anatomy and Mechanism of Injury

The anatomy and mechanisms of injuries that can result in sciatica include herniated lumbar discs, which are implicated in chronic back pain and often severe disability. Research to date indicates that the prevalence rate for sciatica ranges from 13% to 43% of the general global population (Onac & Moldovan, 2012). The term for the condition is based on the fact that the pain originates and radiates along the sciatic nerve path, which 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 and both sides can be involved, the disorder typically affects only one side of the body (Sciatica overview, 2018).

The actual causes of sciatica vary but include bone spurs on the spine, spinal stenosis — the narrowing of the spinal canal that compresses a portion of the sciatic nerve — and herniated discs (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, Abitbol (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, fragments of broken bone may compress the nerves" (para. 2). The specific adverse effects of sciatica vary depending on the precise cause and severity of the injuries involved; however, pain, numbness, and inflammation of the affected areas are common (Sciatica overview, 2018).

Regardless of the specific cause or sport involved, a growing body of evidence confirms that the costs 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 expenditure of health care resources does not account for the comorbidities typically associated with chronic lower back pain. 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 existing psychological disorders, making early diagnosis and treatment all the more important.

Signs, Symptoms, and Diagnostic Procedures

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

In any context, the sensation of pain is a highly subjective experience, and accurate diagnosis of sciatica requires careful analysis of the type, location, and severity of pain, numbness, tingling, and other reported symptoms (Sciatica overview, 2018). Because these symptoms can be caused by a wide range of disorders, the special tests used to diagnose sciatica typically proceed in a step-wise fashion 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. Other clinical features — particularly rate of onset, associated neurologic symptoms and signs, and symmetry — further narrow the differential diagnosis and guide additional questions and tests to identify specific causative disorders.
3. Electrodiagnostic studies are conducted as warranted (Sciatica, 2018).

Once a diagnosis of sciatica is confirmed, the next step is to identify the optimal course of action for treatment.

Conclusion

Bipedalism has numerous advantages for humans, and the ability to stand upright as well as to walk, jump, and run has contributed to the survival of the species in virtually every hostile environment on earth throughout the millennia. This ability, however, is countered by the fact that the human spine is vulnerable to all types of insults, including sports-related injuries that can cause sciatica. In fact, the research was consistent in showing that almost any type of physical activity can either cause or exacerbate spinal nerve compression injuries. Although a number of evidence-based interventions are available for the treatment of sciatica, the best medicine for both athletes and health care practitioners is to place a high priority on prevention.

References

Abitbol, J. J. (2018). Six leading causes of sciatica. Spine Universe. Retrieved from

Hamilton, L. (2012, May). Q & A. Dance Magazine, 86(5), 24.

Lau, A. & Han, J. (2010, July). The truth about treating low back pain. Current Psychiatry, 9(7), 38–44.

Onac, I. A. & Moldovan, A. R. (2012, March). Medication, physiotherapy and cognitive behavior therapy for the treatment of chronic back pain: A clinical trial. Journal of Evidence-Based Psychotherapies, 12(1), 23–27.

Sciatica. (2018). Merck Manual. Retrieved from https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/neck-and-back-pain/sciatica.

Sciatica overview. (2018). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435.

Singh, A. & Singh, O. (2013, January–June). A preliminary clinical evaluation of external snehan and asanas in the patients of sciatica. International Journal of Yoga, 6(1), 71–74.