Sciatica: Causes, Symptoms, and Treatment Options

Sciatica?

Hello, Doctor.
Since the end of 2016, I've been experiencing a feeling of fullness in my left buttock and left thigh after sitting for a long time.
There is some pain when pressure is applied to the buttock.
At that time, I was diagnosed with autonomic nervous system dysfunction, and the doctor suspected it was caused by muscle tension.
However, by mid-2017, I was still uncomfortable, so I underwent a CT scan.
Although there was a herniated disc, it was not compressing any nerves or blood vessels, so the doctor referred me for physical therapy.
Unfortunately, there was no improvement after the therapy.
Recently, I've been experiencing soreness in my lumbar spine, discomfort when pressure is applied to the left buttock, occasional fullness in the back of my left thigh, and sometimes a feeling of fullness behind my left knee, which can cause tingling in my calf when pressed, but this is not a constant occurrence.
I have no issues walking and do not experience pain; it only happens when sitting or lying down, and I feel fine when I’m asleep.
Recently, I visited a physical therapist who mentioned that my vertebrae are very tight, causing tension in the muscles on the left side, possibly due to anxiety and stress.
I have been experiencing dizziness for nearly two years and have undergone numerous tests without finding a cause.
This is the first time someone has mentioned the condition of my vertebrae to me.
I would like to ask the doctor if tight vertebrae can cause dizziness and the symptoms I described above.
Thank you.

Alvin, 40~49 year old female. Ask Date: 2018/01/26

Dr. Shi Guozheng reply Orthopedics

The diagnosis from a computed tomography (CT) scan is quite accurate.
Your symptoms may be related to myofascial pain syndrome.
If the symptoms persist, it is recommended that you consult a neurologist.

Reply Date: 2018/01/26

More Info

Sciatica is a condition characterized by pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. It typically affects only one side of the body. Understanding the causes, symptoms, and treatment options for sciatica can help in managing this condition effectively.

Causes of Sciatica
The most common cause of sciatica is a herniated or slipped disc in the spine. This occurs when the soft material inside a spinal disc bulges out and presses on the sciatic nerve. Other potential causes include:
1. Spinal Stenosis: Narrowing of the spinal canal can put pressure on the sciatic nerve.

2. Degenerative Disc Disease: Age-related changes in the spine can lead to disc degeneration, causing nerve compression.

3. Spondylolisthesis: A condition where one vertebra slips forward over another, potentially pinching the sciatic nerve.

4. Piriformis Syndrome: The piriformis muscle, located in the buttock region, can spasm and irritate the sciatic nerve.

5. Injury or Trauma: Accidents or falls can lead to conditions that compress the sciatic nerve.

Symptoms of Sciatica
Symptoms of sciatica can vary widely but typically include:
- Pain: This can range from a mild ache to a sharp, burning sensation that travels down the leg. It often worsens with prolonged sitting or standing.

- Numbness or Tingling: Many individuals experience numbness or a tingling sensation in the leg or foot.

- Muscle Weakness: Some may notice weakness in the affected leg or foot.

- Difficulty Moving: Pain may make it difficult to move the leg or foot.

Treatment Options
Treatment for sciatica often begins with conservative measures, including:
1. Physical Therapy: A physical therapist can design a program to strengthen the muscles supporting the spine and improve flexibility.

2. Medications: Over-the-counter pain relievers such as ibuprofen or naproxen can help reduce inflammation and alleviate pain. In some cases, prescription medications may be necessary.

3. Heat and Ice Therapy: Applying heat or ice to the affected area can help reduce pain and inflammation.

4. Epidural Steroid Injections: Injections can provide temporary relief by reducing inflammation around the nerve roots.

5. Surgery: If conservative treatments fail and symptoms persist, surgical options may be considered, particularly if there is significant nerve compression.

Addressing Your Symptoms
From your description, it seems that you have been experiencing discomfort in your left buttock and thigh, particularly when sitting or lying down. The fact that you have a history of a herniated disc but without nerve compression is noteworthy. However, muscle tightness and spinal alignment issues can indeed contribute to your symptoms.
Tightness in the spinal muscles can lead to discomfort and may even cause referred pain in other areas, such as the legs. Stress and anxiety can exacerbate muscle tension, leading to a cycle of discomfort. It's essential to address both the physical and psychological aspects of your condition.
In your case, working with a physical therapist who understands the relationship between muscle tension, spinal alignment, and nerve pain could be beneficial. Techniques such as stretching, strengthening exercises, and possibly relaxation techniques to manage stress may help alleviate your symptoms.

If you continue to experience symptoms like dizziness, it may be worth discussing this with your healthcare provider, as it could be related to other underlying issues. Overall, maintaining open communication with your healthcare team and exploring a multidisciplinary approach to treatment may provide the best outcomes for your condition.

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