Table of Contents
Sciatica is a disease of the peripheral nervous system that arises from the compression or irritation of the sciatic nerve. This nerve extends from the lower back down to both legs. Compression of this nerve leads to severe, excruciating pain, accompanied by numbness, paresthesia, and a tingling sensation along its path.
What is sciatica?
To understand sciatica, the anatomy of the sciatic nerve is essential. The sciatic nerve is the thickest and longest nerve in the human body, with a diameter of 2cm. According to Dr. Mikel H-G Hoff, the sciatic nerve is the main nerve of the leg and has 100-1000 beaches. This nerve is formed by the combination of motor and sensory fibres from the spinal nerve route L4-S3. These spinal nerves belong to the most significant nerve group called the lumbosacral plexus. It leaves the pelvis, enters the back of the thigh and leg, and terminates at the foot level. It is considered as the main supply of the leg.
The sciatic nerve plays a vital role in providing motor function to different leg muscles, including hamstring muscles, adductors of the lower extremities, anterior lower leg muscle, calf muscles and intrinsic foot muscle. Moreover, it also provides sensory supply to the posterior and later part of the lower leg and plantar aspect of the foot.
Statistics:
Sciatica affects a broad range of individuals. It has no gender predominance. The condition most frequently affects individuals in the fourth decade of life, with a lifetime incidence reported between 10% to 40% and an annual incidence ranging from 1% to 5%. No significant correlation was found between body height and sciatica, except in individuals aged 50 to 60. It usually does not affect people under 20 years of age unless secondary to the trauma.
Types of Sciatica?
Acute sciatica:
Acute sciatica typically presents suddenly and is characterised by a brief history of symptoms with no prior episodes of sciatica.
Chronic sciatica:
Chronic sciatica is marked by intermittent episodes that persist over extended periods. Patients with this form of sciatica usually have a history of previous sciatic episodes, indicating a recurrent pattern that can complicate long-term management and treatment strategies.
Bilateral sciatica:
It is a rare type of sciatica in which both legs are affected and is usually caused by multiple disc herniation.
Alternative sciatica:
It is also a rare type of sciatica that causes pain in both legs but in an alternative pattern.
Pathophysiology:
The sciatic nerve is formed by the fusion of nerve roots L4 through S3, originating in the pelvic cavity. This large nerve exits the pelvis through the sciatic foramen, travelling posteriorly. It then courses inferiorly and anteriorly to the piriformis muscle and posteriorly to the gemellus superior, gemellus inferior, obturator internus, and quadratus femoris muscles. Moreover, the sciatic nerve enters the posterior thigh, passes through the biceps femoris muscle, and terminates in the popliteal fossa at the knee. Here, it branches into the tibial and common fibular nerves. Sciatica symptoms occur when pathology affects any part of this nerve’s extensive course, including conditions outlined in the differential diagnosis.
Dr. Mikel H-G Hoff states that Inflammation in L2-L4 in the lower back can also induce inflammation of the sciatic nerve because these branches are linked with the femoral nerve and sciatic nerve.
What Causes Sciatica?
There are multiple causes of sciatica. However, the most common causes of sciatica include:
1-Herniation of disc:
Lumbar disc herniation stands as the predominant cause of both sciatica and lower back pain. Typically triggered by trauma or stress to the vertebra, this condition begins when the outer fibrous layer of a disc tears. Following this tear, the nucleus pulposus— the soft, gel-like centre of the disc—protrudes outward. This protrusion exerts pressure on the adjacent nerve, leading to the pain and discomfort associated with sciatica.
2-Degenerative disc disease:
Degenerative disc disease occurs when the cushioning material within the vertebral discs begins to deteriorate. It is often associated with the natural ageing process. This degeneration reduces the disc’s ability to absorb shock and maintain spinal flexibility, frequently leading to discomfort and mobility issues.
3-Spinal stenosis:
Spinal stenosis is characterised by narrowing the spaces between the vertebral bodies, which can exert pressure on the nerves passing through these spaces. This compression often leads to symptoms similar to sciatica, including pain, numbness, and weakness along the affected nerve pathway.
4-Spondylolisthesis:
This medical condition involves displacing a vertebral bone, which slips forward over an adjacent vertebra, deviating from its normal alignment. This displacement can compress surrounding nerves, frequently resulting in back pain and other sciatica-related symptoms.
5-Piriformis syndrome:
This condition arises when the sciatic nerve becomes compressed by the piriformis muscle located in the buttock region. Compression may result from trauma, muscle spasms, or the development of scar tissue within the piriformis muscle, leading to discomfort and pain. It causes pain in the buttock region and upper leg.
6-Spinal tumours and infection:
Spinal tumours vary widely, with larger tumours exerting pressure on nearby nerves, often leading to symptoms reminiscent of sciatica. These symptoms can include pain, numbness, and weakness in the legs.
7-Cauda equina syndrome:
This urgent medical condition arises when the cauda equina, a bundle of nerve fibres at the lower end of the spinal cord, becomes compressed. Such compression can occur due to traumatic injuries or spinal disc herniation. The syndrome often presents sciatica-like symptoms, including intense lower back pain, leg weakness, and sensory loss. Prompt recognition and treatment are crucial to manage symptoms and prevent permanent damage.
8-Iliotibial band syndrome:
Iliotibial band syndrome can also occur when the tendon (iliotibial band) gets inflamed or irritated due to rubbing against the knee and hip bones. This syndrome has the same kind of radiation as sciatica but on the outward and lateral sides of the legs.
9-Chronic inflammation:
Chronic inflammation of the body, either due to some infection due to trauma or any other illness, can be a source of inflammation in your sciatic nerve.
10- Metabolic abnormality:
Dr Mikel H-G Hoff states that the deranged metabolic profile of the patient weakens its immune system and neuronal oscillations. This weakened immune system induces an inflammatory response that can cause sciatica.
What are the risk factors for sciatica?
Multiple factors increase the risk of sciatica. These factors include the following:
1-Ageing and scoliosis:
Ageing is the primary risk factor for sciatica, as it leads to degenerative changes in the spine. These changes can make individuals more susceptible to conditions like scoliosis, where the spine curves abnormally. As the spine ages, its structures weaken, increasing the likelihood of nerve compression and associated pain.
2-Weight:
Obesity is closely linked with an increased risk of sciatica. In individuals with obesity, the excess body weight can contribute to greater pressure on the spine, thereby elevating the likelihood of nerve compression compared to those of an average weight. This compression often results in sciatica symptoms.
3-Osteoarthritis:
Osteoarthritis contributes to the degeneration of the spine, which can lead to the formation of bone spurs, known as osteophytes. These osteophytes may cause the narrowing of joint spaces, increasing the risk of nerve compression. Consequently, individuals with osteoarthritis are more susceptible to developing sciatica than those without this condition.
4-Diabetes:
People who are chronic diabetics are at greater risk of nerve damage than others who are non-diabetic.
5-Smoking:
Smoking accelerates the degenerative processes of the spine, significantly increasing the risk of sciatica. Daily smokers are more likely to experience this nerve-related pain compared to non-smokers, as the harmful effects of smoking contribute to the deterioration of spinal health.
6-Profession:
Sciatica is also associated with your profession and daily lifestyle activities. People with certain occupations, such as machine operators, truck drivers, and jobs that require physically awkward positions, show a higher predisposition to developing sciatica.
7-Previous history of back pain:
People with a previous history of back pain are at greater risk of having sciatica than others.
8-History of lower back or hip joint surgeries:
Individuals who have undergone lower back surgery or hip joint replacement are at an increased risk of developing sciatica compared to those who have not had these surgeries. These procedures can potentially affect nearby nerves, leading to sciatica symptoms.
9-Pregnancy:
During pregnancy, the risk of sciatic nerve issues can increase due to weight gain and the growing uterus putting pressure on the sciatic nerve. This added pressure can lead to discomfort or pain in the lower back and legs.
What Are the Symptoms of Sciatica?
Pain:
Pain is one of the most common features of sciatica and occurs anywhere along the nerve route from L4 to S3. It is sharp and burning in nature, usually involving one leg. The types of pain that a patient can feel during sciatica are:
- Shock-like pain or shooting pain
- Constant dull pain
- Thrombin or pulsating pain
Areas affected by sciatica:
Sciatica involves the following areas of the body.
- Lower back
- Buttocks
- Back of thighs
- Foot
- The web between the first and second toe
Weakness of thigh, leg and foot muscles:
Numbness:
Paresthesia:
How to prevent sciatica?
Some lifestyle modifications can help to prevent sciatica. These include the following:
- Prevent obesity and take a healthy diet from the nutritionist
- Take strengthening exercises regularly to make core muscles stronger
- Avoid smoking
- Maintain your posture
- Use sitting bathroom
- Avoid lifting heavy objects
What are the differentials of sciatica?
There are some differences between sciatica and other backbone diseases because sometimes sciatica is mixed up with other diseases. The differential of sciatica include:
- Lumbar disc herniation
- Nerve impingement
- Epidural abscess
- Epidural hematoma
- Spinal stenosis
- Pott’s disease
- Spondylolisthesis
What are the complications of sciatica?
Sciatica can cause complications if it remains unaddressed for a long duration because the symptoms of sciatica worsen with time. Complications include:
1-Worsening Pain:
Without intervention, sciatic pain tends to worsen over time, making daily activities increasingly difficult and uncomfortable.
2-Loss of Muscle Strength:
Prolonged compression of the sciatic nerve can lead to muscle weakness in the legs, affecting mobility and stability.
3-Loss of Bowel and Bladder Functions:
In severe cases, untreated sciatica can result in loss of control over bowel and bladder function, indicating significant nerve compression and requiring immediate medical attention.
4-Permanent Nerve Damage:
Long-term compression of the sciatic nerve can cause irreversible damage, leading to chronic pain and impaired function in the affected area.
How do ANF Therapists Diagnose sciatica?
The ANF Orthopedic Therapists diagnose sciatica by taking the patient’s history and conducting a clinical evaluation. The detailed history, along with the examination, helps to make the diagnosis.
History:
Throughout history, the ANF Orthopedic Therapist will ask specific questions, including presenting complaints, the severity of the pain, and medical and occupational history. This includes:
1-Biodata:
Basic personal information for identification and contact purposes.
2-Pain Assessment:
Origin of Pain: Where does the pain start?
- Severity of Pain: Rate the intensity from mild to severe.
- Radiation: Does the pain extend down the leg and into the foot?
- Quality of Pain: Describe the pain (sharp, dull, throbbing).
3- Sensory Symptoms
- Tingling Sensations: Presence of tingling in the legs and feet.
- Numbness: Any areas of reduced sensation?
4-Injury or Trauma History:
Specific incidents of falls or trauma that might relate to the current condition.
5- Medical History:
- Previous Illnesses: Notable past medical conditions, particularly chronic illnesses like diabetes.
- Medication History: Current and past medications, focusing on those related to pain management or conditions that might affect therapy.
6-Lifestyle Factors:
- Smoking History: Current and past smoking habits.
- Occupational history: This includes information about the patient’s job, especially if it involves physical labour or prolonged sitting, which could influence their condition.
Physical examination:
During physical examination, the ANF Therapists will do some clinical examinations to make the diagnosis. The examination includes:
1-Straight leg raising (SLR):
In this test, the patient lies in a relaxed and supine position. After ANF Therapists will lift the patient’s leg by flexing the hip joint and extending the knee joint. If there is pain between 30-70 degrees of flexion, it shows lumbar disc herniation. If there is also numbness and parenthesis, it indicates peripheral nerve compression. If the pain is above 70 degrees, it is considered musculoskeletal pain.
2-Bragged sign:
Positive bragged sign indicates pain during dorsiflexion of the foot during straight leg raising.
3-Naffziger test:
In this test, they will ask the patient to cough. If there is pain during coughing, then this test is positive.
4- Cross straight leg test:
This test is performed in the asymptomatic leg by crossing the leg on each other. If pain is produced in the symptomatic leg at 40 degrees, the cross-straight leg test is positive.
Additional Observations:
Additional observations include checking the movement of the muscles. Weakness of the muscle depends upon the type of nerve root affected.
1-L3 Radiculopathy:
It affects hip adduction and knee extension and causes pain in the anteromedial thigh.
2-L4 Radiculopathy:
It presents with weakness in ankle dorsiflexion and absent patellar reflex.
3-L5 Radiculopathy:
It causes weakness in hip abduction and significant toe extension.
4-S1 Radiculopathy:
Ankle reflexes are absent in S1 radiculopathy.
These tests are critical for diagnosing radiculopathies involving the L4, L5, and S1 nerve roots and assessing nerve irritation or compression.
Neurological examination:
During a neurological examination, the Neuro ANF Orthopedic practitioner does the complete neurological examination to check:
- Which side of the leg is affected?
- Numbness in the leg by applying cotton to the affected area and asking the patient if he feels it or not
- Paraesthesia in the leg (feeling of heavy leg)
- Tingling sensation in the leg (something crawling on the leg)
- Reflexes of the joints (ankle and knee joint)
- Power of the leg
- Tone of the muscles
Managing Sciatica with ANF Therapy®️:
Application of ANF Devices:
Dr. Mikel H-G Hoff emphasises using specialised ANF Devices strategically placed over the affected areas. These are:
Anti-Inflammatory Devices:
These are applied to the gluteus muscle and the lower thigh to mitigate active and chronic inflammation, primarily contributing to sciatica pain.
Antioxidant Devices:
Devices such as AGAL and ACA are used along with anti-inflammatory devices to combat harmful free radicals.
Expected Outcomes of ANF Therapy®️:
Routine follow-up:
Routine visits to the expert ANF Therapist are necessary to check the devices’ efficacy. Because these devices remove inflammation layer by layer, regular follow-up is required to remove all the possible causes of inflammation.
Benefits of ANF Therapy®️:
Pain and Inflammation:
Significant reduction of pain and inflammation, often leading to a pain-free lifestyle.
Muscle and Nerve Recovery:
Reduces muscle spasms and strengthens weakened nerves.
Holistic Health Promotion:
Supports overall health without requiring invasive surgeries or medications that can disrupt gastrointestinal health.
Treatment Duration:
The treatment length varies, typically several days to a month, based on individual patient conditions and responsiveness.
Principle and Advantage of ANF Therapy®️:
Neuro Frequency Modulation:
It operates by correcting impaired bodily frequencies, directly targeting the underlying causes of pain and dysfunction.Non-Invasive approach:
Unlike surgical approaches, ANF Therapy®️ is non-invasive, avoiding post-surgical complications and promoting a natural recovery process.Join ANF Therapy®️ To Upskill Your Clinical Practice
ANF Academy offers clinical training for medical professionals to provide them with detailed knowledge about frequency medicine. It mainly focuses on neurological oscillations, neurobiochemical processes and their functions in the body, advanced palpation skills, and techniques to assess the neurological system. The ANF Clinical Training Program provides expertise on the ANF methodology for managing injuries and inflammation effectively, aiming for optimal patient outcomes.
Training Highlights Include:
- Mastering advanced clinical skills and techniques for neurological examinations.
- Techniques for identifying the differences between healthy and inflamed nerves.
- Methods to investigate the physical effects (signs and symptoms) of disrupted neurological oscillations.
- Strategies to pinpoint and treat the underlying causes of pain, injury, or pathology, focusing on addressing root causes rather than merely symptoms.
The ANF Clinical Training Program:
- It starts with developing the ability to locate, palpate, and evaluate nerves and the level of inflammation.
- Enhances advanced clinical skills to discover the interconnections among different body systems and the underlying causes of symptoms.
- It provides education on the various stages of treatment using ANF Neurotech Devices tailored to match the healing phases of injured tissues.
References:
1. Davis, D., Maini, K., Taqi, M., & Vasudevan, A. (2024, January 4). Sciatica. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK507908/
2. Sciatica / Sciatic nerve pain: Causes, symptoms, treatments. (n.d.). Hospital for Special Surgery. https://www.hss.edu/condition-list_sciatica.as
3. Mba, J. C. M. (n.d.). Low Back Pain and Sciatica: Overview, Pathophysiology, Characteristics of Pain-Sensitive Structures. https://emedicine.medscape.com/article/1144130-overview?scode=msp&st=fpf&socialSite=google&icd=login_success_gg_match_fpf&form=fpf
About Authors
Writer:
Dr. Shahzaib Nasir
Dr. Shazaib Nasir, MBBS, RMP, is a medical writer at ANF Academy. He graduated from Multan Medical and Dental College, Pakistan. He works as a medical officer in the Oethpaedics department at Ibn-e-sina Hospital and Research Institute, Multan. He deals with patients suffering from chronic orthopaedic problems and pain. He is passionate about healthy eating and exercising. Moreover, he believes that frequency medicine can be the future of Orthopaedics.
Editor:
Dr. Shama Nosheen
Dr. Shama Nosheen, MBBS, RMP, is a skilled medical editor and writer at ANF Academy, specializing in medical communications. For 5 years, she has been working with renowned international healthcare companies as a medical writer, aiming to bridge the gap between patients and doctors. She is a graduate of Nishtar Medical University Multan. She grabbed American Board certification (ABAMS) in Aesthetic Medicine after graduation. Working with ANF Academy, she has developed a thorough understanding of ANF Therapy®️ that works on the principles of frequency medicine.
Reviewer:
PT. Irina Heinisuo Berná
Her background includes a Degree in Physiotherapy and a Master’s in Innovation and Research in Health Sciences, enriching her expertise in holistic health care. At ANF Academy, she seamlessly integrates clinical practice, academic teaching, and research into her daily activities to shape the future of ANF Therapy®️. Irina’s work symbolizes integrating education and compassionate care to improve global health outcomes.
Final Reviewer:
Dr. Mikel H-G Hoff
Dr. Mikel H-G Hoff, Founder of ANF Therapy®️, holds a bachelor’s degree in medicine and a Ph.D. in biochemistry, specializing in the bio function of the human body, specifically the neurological system. He is a manual therapist and sports psychologist. He is committed to revolutionizing healthcare by educating medical professionals and directly treating patients to enhance their quality of life. His extensive background in sports injury therapy, manual therapy, and various medical specializations, including biochemistry and nerve system signalization, empowers him to deliver pain-free solutions and lasting patient outcomes.
