Sciatica - Causes

Sciatica is the resulting pain and discomfort that follows a disorder of the lumbar region of the spine in which a pinched sciatic nerve root refers pain from the buttocks down to the toes. Appropriately then, those at risk of lower back injury are more likely to suffer from sciatic pain. For now we will focus on the disorder and underlying cause of your sciatic pain.

1. Herniated disc - A herniated disc of the lumbar vertebra L4-5 through the sacral vertebra S1-3, is the most common cause of sciatic nerve pain. Intervertebral discs serve as cushions between the vertebrae of your spine and act as shock absorbers during activity. The disc is primarily composed of water while the annulus fibrous (outer disc) is tough it has a jelly-like center known as the nucleus pulposus. When a disc bulges or ruptures (herniated) it can place pressure on the sciatic nerve consequently causing pain in the lower back and legs. Once the sciatic nerve has been irritated most people complain of pain in the buttock and back of the leg. However, in more serious cases a herniated disc can irritate the nerve to the point of bladder and bowel problems.

2. Spinal Stenosis - Your spinal cord, which extends from the base of your brain to the upper lumbar (lower back), is contained in the vertebral canal. Spinal Stenosis, a nerve compression disorder, occurs when an area of the spinal canal narrows, placing pressure on the surrounding nerves. When spinal stenosis occurs in the lower-back, it may be the lumbar nerves that are pinched thus creating sciatic-like pain.

3. Spondylolithesis - Most commonly affecting the lumbar spine this disorder occurs when a vertebra is displaced slipping forward over the sub adjacent vertebra. Consequently, the sciatic nerve may be pinched causing lower back pain and leg pain. Spondylolithesis is usually caused by spinal degeneration and physical stress.

4. Degenerative Disc Disease - Firstly, DDD is more appropriately a degenerative process that occurs naturally with age, rather than a disease. Over time the discs that support our vertebrae begin to deteriorate, becoming more rigid, losing their ability to move fluidly and freely.

Associated Sciatic-like Pain

Piriformis syndrome - Piriformis syndrome occurs when the piriformis muscle spasms, irritating the sciatic nerve, which runs beneath the muscle deep in the buttocks. Deep pain is felt in the buttock and is often referred to the hips, lower back and the legs. Often the injury is caused by over-training, running too hard and too frequently for example, but is not limited to athletics. Furthermore, most people complain of increasing pain in a seated position. Technically speaking, piriformis syndrome is not sciatica even though it produces similar pain.

Sacroiliac Joint Pain - The sacroiliac joint is located where the pelvis connects to the spine. It is not a joint with a lot of movement such as the hip, knee, or shoulder, but the SI joint is critical in the transfer of the upper body load to the lower body. Sacroiliac joint pain can be difficult to diagnose for several reasons. For one, the SI (sacroiliac) joint often shows up as normal on diagnostic imaging such as CAT scans, MRIs, X-Rays, and bone scans. It is nearly impossible to isolate the SI joint on tests. In addition, it is difficult to manipulate or palpate the sacroiliac joint.

To further complicate the diagnosing of sacroiliac joint pain, other problems such as sciatica, back pain, hip arthritis, and others can cause the same or similar symptoms.

More generally though, age, occupation, lifestyle and genetics are factors to be aware of when considering back pain, sciatica and your susceptibility to each. Firstly, spinal disc deterioration begins around 30 years of age and most commonly people suffer herniated discs in their 30Õs and 40Õs. Moreover, to make matters worse, men and women in their prime are more likely to work a job that requires twisting, lifting and carrying heavy loads. Conversely, those who lead a less active sedentary lifestyle are more likely to develop sciatica than active people.

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