Making Sense of Medicine
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Sciatica: A Real Pain

Like other common medical terms, sciatica is not the name of a disease.  Rather, it is a set of symptoms (a syndrome) that includes pain, numbness, weakness or tingling in the lower back, buttocks and parts of the legs, knees or feet. Usually, this happens on one side of the body only.  We give this syndrome the name “sciatica” because of its relation to the sciatic nerve.

Sciatica Can Have Many Causes?

The sciatic nerve is the longest and widest nerve in your body.  It starts in your lower back, runs through your buttocks, divides into two branches in your thighs and runs down each leg to your feet.  Very simply, when the fibers of this nerve are compressed or irritated, it hurts big time.

What's Happening in Your Body?

There are many ways that the sciatic nerve can get in trouble, and depending on the location, we give it a different name.  For example: There is a muscle called the piriformis that goes from your sacroiliac joint (bottom of the spine) to your hip bone.  And alas, the sciatic nerve runs right under the piriformis.  That means that if the piriformis spasms or is just too tight, then you have instant sciatica, but we call it the piriformis syndrome.

Sciatica can result from a herniated (ruptured) disc, a bone spur on the spine or stenosis (abnormal narrowing) of the spinal canal.  The weight of the fetus during pregnancy, and rarely, vigorous coughing or even sneezing, and even more rarely, one vertebra sliding over another can result in sciatica.  Arthritis, osteoporosis, a tumor, blood clot or abscess can be sources of pressure on the nerve, as well.

Herniated Disc.

Between each pair of vertebrae in your spine is a cushioning pad that we call a “disc.”  The disc consists of a tough fibrous outer ring that contains a soft, central portion.  In this most common cause of sciatica—some say 90 percent—that fibrous ring gets torn, allowing the jellylike inside of the disc to bulge out.  This may not only put pressure on nerve fibers, but also release an inflammatory chemical called tumor necrosis factor alpha (TNF) that causes pain even without compression; TNF may also be present if there is stenosis, a narrowing of the spinal canal.

And isn’t it really annoying when your doctor says something like, “You know, Mr. Keller, age is a factor!”  Alas, however, aging, as well as wear and tear, leads to some unfortunate changes in the spinal discs.  Specifically, that soft, cushioning interior becomes a bit stiff, and so more of the load it bears is transferred to the outer ring.  This additional pressure can lead to cracks in the ring, sometimes big enough to allow the inner material to bulge through.

Severe Herniation.

The bad news is that severe herniations may require surgery.  In fact, please seek medical advice if:

         There is sudden, severe pain in your low back or leg and numbness or weakness in your leg

         The pain follows a violent injury.

         You have trouble controlling your bowels or bladder.

Minor Herniation and Other Causes.

The good news is that most minor herniations heal within some weeks.  And in the meantime, to help control the pain, you might try anti-inflammatories like aspirin, ibuprofen or naproxen, perhaps combined with a muscle relaxant (ask your doctor).

Alternative Therapies.

As with many conditions, simple therapies designed to balance your body and nervous system can go a long way toward relieving sciatic pain.  Among the more effective seem to be acupuncture, yoga and the MYK system that I practice. In addition, I often recommend using an ice pack for 20 minutes two or three times a day.

Prevention.

But the best therapy for sciatica is preventing it in the first place, and there are some very simple precautions you can take

         Keep your weight under control, get regular physical activity and don’t sit for extended periods of time.  Also—especially to men—don’t carry your wallet or anything else in your hip pockets, and wear an elastic belt instead of the unforgiving leather that most men use.

         Daily stretching exercises—15 minutes anyway—will keep your piriformis and other gluteal muscles flexible.

         To help head off disc herniations, avoid especially heavy lifting and exaggerated twisting of the torso.

The Metaphorical Side.

In her 1977 book “Illness as Metaphor,” Susan Sontag points out that for centuries diseases that were not well-understood became the subject of often wild metaphorical fantasies about their origin, cause and effect, e.g., cancer as a curse or punishment.  And she goes on to show that once the disease is understood, those fantasies tend to melt away, thus discrediting the metaphorical side of disease.  “Illness is not metaphor,” she says.

But could there yet be some aspects of illness that might beneficially be viewed metaphorically?  Sciatica, for example, produces pain in the buttocks, and so I have found it interesting to receive a positive answer to the question: “Has something in your life become a pain in the butt?”  Or with neck issues: “Is there something going on that’s a pain in the neck?”

It’s not that recognizing the pain in the butt or neck connection is going to cure your problem instantly, but we know that stress and other emotions tend to get locked in the muscles.  And recognizing a possible relationship between pain and other parts of a life can help release those emotions, and open one to new possibilities for healing.

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