What is sciatica?

Written by Na Hong Wei
Orthopedics
Updated on January 02, 2025
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Sciatica refers to severe pain caused by various reasons that result in the compression and irritation of the sciatic nerve. The typical pain of sciatica radiates from the lower back to the buttock or the back of the thigh and the lateral side of the leg down to the foot. The pain can intensify during coughing or increased abdominal pressure. Additionally, this condition is often accompanied by dullness or numbness, and in a minority of cases, it can cause bilateral sciatica. Generally, there are three main causes of sciatica: The first is chemical irritation, mainly when the disc tissue comes into contact with the sciatic nerve, releasing chemical substances that stimulate and trigger an autoimmune response, resulting in neuritis. The second cause is mechanical compression, primarily from protuberance and nucleus pulposus compression or traction on the already inflamed nerve root, leading to obstructed blood flow and worsening edema. The third cause follows chemical stimulation and mechanical compression, leading to ischemic symptoms in the injured nerve, which then results in pain. Therefore, sciatica typically has primary and secondary causes. The primary cause is sciatic neuritis, while secondary causes are usually associated with lumbar spinal stenosis, lumbar disc herniation, lumbar tumors, and piriformis outlet syndrome.

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Written by Na Hong Wei
Orthopedics
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What is sciatica?

Sciatica refers to severe pain caused by various reasons that result in the compression and irritation of the sciatic nerve. The typical pain of sciatica radiates from the lower back to the buttock or the back of the thigh and the lateral side of the leg down to the foot. The pain can intensify during coughing or increased abdominal pressure. Additionally, this condition is often accompanied by dullness or numbness, and in a minority of cases, it can cause bilateral sciatica. Generally, there are three main causes of sciatica: The first is chemical irritation, mainly when the disc tissue comes into contact with the sciatic nerve, releasing chemical substances that stimulate and trigger an autoimmune response, resulting in neuritis. The second cause is mechanical compression, primarily from protuberance and nucleus pulposus compression or traction on the already inflamed nerve root, leading to obstructed blood flow and worsening edema. The third cause follows chemical stimulation and mechanical compression, leading to ischemic symptoms in the injured nerve, which then results in pain. Therefore, sciatica typically has primary and secondary causes. The primary cause is sciatic neuritis, while secondary causes are usually associated with lumbar spinal stenosis, lumbar disc herniation, lumbar tumors, and piriformis outlet syndrome.

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Written by Na Hong Wei
Orthopedics
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Symptoms of Sciatica

Symptoms of sciatica: First, sciatica often occurs in the lumbar 4 and lumbar 5, or between lumbar 5 and sacral 1 disc herniation. Second, the primary symptom of sciatica is pain, which typically originates in the lower back and can radiate to the buttock, posterior thigh, the lateral side of the calf, and the lateral edge of the foot sole. Pain usually has a triggering factor, such as coughing, sneezing, defecation, etc., basically any activity that increases abdominal pressure can cause radiating pain of the sciatic nerve. Third, the area innervated by the sciatic nerve may become hypersensitive, with some people feeling pain, others feeling heat, and still others feeling cold, until the later stages where it generally becomes numbness and dullness. Fourth, there are limitations in movement of the lower back or limbs, with many patients reporting a feeling as if there’s a shortened tendon at the back of the thigh, restricting movement. These are the primary symptoms of sciatica.

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Written by Lv Yao
Orthopedics
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Which department should I visit for sciatica?

Pain in the sciatic nerve first requires a visit to orthopedics or spinal surgery to look into whether the pain is caused by a herniated disc compressing the nerve root. If examinations or imaging studies find no abnormalities, we might consider the possibility of piriformis syndrome, or other reasons causing the nerve pain. You can then consult the pain management department to determine the cause and receive appropriate treatment, primarily involving orthopedics and pain management.

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Written by Na Hong Wei
Orthopedics
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How to relieve sciatic nerve pain

How to alleviate sciatica pain. First, it is necessary to rest in bed absolutely, especially sleeping on a firm bed. While sleeping on a firm bed, you can also pad a soft pad in the lumbar area and place a soft pillow under the knee joints. The main purpose is to keep the knee and hip joints in a flexed state, allowing the muscles in the lower back to fully relax. Second, you can take some non-steroidal anti-inflammatory painkillers orally. Third, you can use traction therapy. Traction therapy is very effective for relieving sciatica pain as it can reduce the pressure inside the disc and expand the volume of the spinal canal, thus alleviating the stimulation and compression of the nerve roots. Fourth, you can consider undergoing physiotherapy, massage, and manipulation. However, aggressive massage is not recommended. Fifth, you can undergo intradiscal blockade or sacral canal injections. Sixth, you can perform nucleoplasty, which involves injecting collagenase into the intervertebral disc, or between the dura mater and the protruding nucleus pulposus. This often requires the intervention of a pain specialist. Therefore, after the aforementioned treatments, sciatica pain should generally be alleviated. If there is no relief or if symptoms worsen, then surgical treatment may be necessary.

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Written by Na Hong Wei
Orthopedics
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What causes sciatica?

The causes of sciatica generally fall into two categories. The first is primary sciatica, which is usually caused by inflammation of the sciatic nerve and is relatively rare in clinical practice. The second category is secondary sciatica, which occurs when the tissues and structures around the sciatic nerve undergo pathological changes, leading to stimulation and compression of the sciatic nerve, thus causing secondary sciatica. The majority of secondary sciatica cases are associated with lumbar spine disorders, such as lumbar disc herniation, tumors in the lumbar spinal canal, or degenerative joint disease of the lumbar spine, as well as sacroiliitis. A hospital examination is necessary to make a definitive diagnosis.