How Does a Doctor Diagnose Sciatica?

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Sciatica is the name for painful syndrome caused due to the compression, at one point or another, of our body’s largest nerve. This giant nerve is formed by the combining of nerves leaving the spinal cord between L4 to S3 segments of the spinal cord or in simple words it is created by combining of several nerves in the lower back. Lower back is one of the most prone areas to strains and sprains due to immense pressure, and high level of movements.

Sciatic nerve provides sensation to most of the leg and is also responsible for the movement of several muscles in the leg. The most common reason for sciatica is the compression of the nerve at the point where it leaves spine either due to herniation of disk or changes in the vertebral bone.

Common symptoms of sciatica

In most cases of sciatica, pain is severe, and there are even changes in bladder and bowel movements. Hallmark of sciatica is the pain that arises in the lower back and radiates through buttocks to the various parts of legs, most commonly to the back of thigh and calf. This typical painful syndrome is diagnostic in most of the cases. In the majority of cases, just one side of the leg is affected, though in some cases pain may be on both the sides.

Pain intensity and type of pain varies among the individuals. Some would say about burning sensation with other may report sharp pain. This variance in pain is due to different kinds of nerve fibers compressed in each case. Usually, pain in the leg would worsen on prolonged sitting. Sneezing or coughing may aggravate the pain.

Factors that increase the risk of sciatica

Apart from the painful syndrome, the doctor would also take into consideration various risk factors. Spine conditions like sciatica are comparatively common in the older generation. Obesity means higher stress on the lower spine, and thus the higher risk of sciatica, certain occupations involving load lifting also increase the risk of sciatica, sedentary lifestyle and diabetes are also risk factors as they weaken spinal bones and supportive muscles.

Clinical diagnosis of sciatica

After taking the patients history, the doctor would carry out a physical examination. It would include testing of various reflexes and strength of muscles. During the investigation, the doctor may ask the patient to walk on toes, heels, do squatting, lift the legs while lying on the back. In sciatica pain would worsen while performing the activities. With history taking and examination doctor would be able to guess the location of spinal compression. However, for exact diagnosis doctor would use modern imaging techniques.

Imaging tests used in sciatica

Usually, people go to the doctor when rest and self-treatment with common painkillers have not helped, and pain has continued to affect the person for days or even weeks. Hence, most doctors would refer a person to the lab for imaging.

  • X-ray: It is one of the oldest imaging methods and is useful in demonstrating the changes in bones, be it the growth of bone or changes in its density (strength).
  • MRI: It is one of the most modern and precise ways of imaging. It uses the radio waves to produce the high-resolution image of bones and even soft tissues. In recent times most doctors may skip the x-ray in favor of MRI since it is far more accurate.
  • CT Scan: Or instead doctor may order CT myelogram, which involves scanning of the spinal cord after injecting contrast material into it.
  • Electromyography (EMG): This test may help to quantify the seriousness of nerve compression as it measures the strength of nerve signal. The highly compressed nerve may produce weaker electrical impulse.

Although doctors can diagnose sciatica in most cases just based on patient’s history and examination, however, they order the imaging and other tests just to exclude some other causes. Imaging also helps to pinpoint the locating of nerve compression and helps to understand the reason. Thus, after the imaging test doctor can say whether sciatica is a result of bone overgrowth, or slipped disc (herniated disc), some local inflammation, or tumor.

Though in most cases sciatic pain would subside with medication treatment, in few cases, there may be a need for surgical intervention.

Prevention is better than treatment

One can decrease the risk of sciatica by making specific changes to lifestyle. In most people sciatica occurs due to the failure of lower back muscles to tackle the stress. Regular exercises to strengthen the lower back and abdomen may help to prevent sciatica.

Quite often sciatica happens after lifting something heavy, and the main reason is the use of the wrong posture while performing physical activities. Maintaining proper position while sitting, lying, and doing physical activities may help to prevent sciatica.

Finally, learn the right way to lift bulky items, without putting undue stress on your lower back. Try to raise the things with back straight, and instead bend the knees. Most importantly avoid lifting and twisting at the same time.

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