Sciatica: Causes, Symptoms, and Treatment Options

Pain deep in the buttocks and right thigh?

Hello, doctor.
I am overweight and also have issues with muscle tightness (the therapist mentioned they have never encountered such tight muscles).
Ten days ago, I suddenly rode a motorcycle for 90 minutes (I haven't ridden one in 20 years).
After returning home, I started experiencing pain in my right hip and the inner sides of my right thigh.
The next day, I could barely move; even slight movements were extremely painful.
After visiting a rehabilitation specialist, I was diagnosed with muscle inflammation.
I took anti-inflammatory and pain relief medication for three days, but there was little improvement.
Later, I consulted a neurologist who diagnosed me with sciatica.
I took pain medication and steroids (Kong Su Neng) for a week, and B12, but there was still no improvement.
An X-ray showed a mild disc herniation at the L4-L5 level.
Getting in and out of bed is very difficult and painful; I can only sleep while sitting.
I need to use a commode chair to move around, but I do not experience pain while sitting.
Could this be piriformis syndrome? Which specialty and type of treatment do I need?

Axi, 40~49 year old female. Ask Date: 2020/10/31

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it is important to consider symptoms of nerve compression due to a herniated disc, which may also result from sudden injuries such as twisting the waist, bending to lift heavy objects, or experiencing excessive force, for example, falling from a ladder or landing directly on the spine.
A herniated disc can cause localized inflammatory responses leading to back pain and may compress nerve roots, resulting in radiating numbness and pain extending to one side of the lower limb.

As for piriformis syndrome, it commonly occurs in individuals who sit for prolonged periods at work, especially if they tend to cross their legs, do not use appropriate cushions, or keep their mobile phones in their back pockets, which can lead to prolonged pressure on the piriformis muscle, causing localized swelling and tissue inflammation.
This can result in severe pain in the deep gluteal area, potentially affecting mobility and causing weakness in the leg.
I recommend that you visit a neurologist or a rehabilitation specialist for further examination and follow-up.
Wishing you good health and happiness.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2020/10/31

More Info

Sciatica is a condition characterized by pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Understanding the causes, symptoms, and treatment options for sciatica is crucial, especially given your recent experiences with pain and discomfort.

Causes of Sciatica
Sciatica can be caused by a variety of factors, including:
1. Herniated Discs: The most common cause of sciatica is a herniated or slipped disc in the spine, which can press on the sciatic nerve.

2. Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the nerves.

3. Piriformis Syndrome: This occurs when the piriformis muscle, located in the buttocks, spasms and irritates the sciatic nerve.

4. Spondylolisthesis: This is a condition where one vertebra slips forward over another, potentially pinching the sciatic nerve.

5. Injury or Trauma: Any injury to the lower back or pelvis can lead to sciatica.

Given your description of muscle tightness and the sudden onset of pain after riding a motorcycle, it is possible that your symptoms could be related to muscle strain or irritation of the sciatic nerve due to the position you were in while riding.

Symptoms of Sciatica
The symptoms of sciatica can vary but typically include:
- Pain that radiates from the lower back to the buttock and down the back of the leg.

- Numbness or tingling in the leg or foot.

- Weakness in the affected leg.

- Pain that worsens with prolonged sitting or standing.

- Difficulty moving the leg or foot.

In your case, the pain in your right buttock and thigh, along with the difficulty in movement, aligns with typical sciatica symptoms.

Treatment Options
Treatment for sciatica often involves a combination of approaches:
1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and relieve pain. In some cases, corticosteroids may be prescribed to reduce swelling.

2. Physical Therapy: A physical therapist can design a program to strengthen the muscles supporting your back and improve flexibility. This can help alleviate pressure on the sciatic nerve.

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

4. Epidural Steroid Injections: For severe pain, injections of corticosteroids into the epidural space around the spinal nerves may provide relief.

5. Surgery: In cases where conservative treatments fail and symptoms persist, surgical options may be considered to relieve pressure on the sciatic nerve.

Diagnosis and Further Evaluation
Given your symptoms and the X-ray findings of a mild disc herniation, it is essential to follow up with your healthcare provider. They may recommend an MRI for a more detailed view of the spine and surrounding tissues, which can help confirm the diagnosis and rule out other conditions, such as piriformis syndrome.

Conclusion
While your symptoms could be indicative of sciatica, it is essential to have a thorough evaluation by a healthcare professional, preferably a neurologist or an orthopedic specialist, who can provide a comprehensive treatment plan tailored to your specific needs. Additionally, addressing your weight and muscle tightness through lifestyle changes, including exercise and stretching, may also contribute to long-term relief from sciatica symptoms. Always consult with your healthcare provider before starting any new treatment or exercise regimen.

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