The radiating pain of sciatica calls for prompt diagnosis and treatment.
It might start with a dull lower backache, a cramplike twinge in your thigh or tingling in your calf. You take a couple of acetaminophen and forget about it. But several days later those sensations have intensified into pain that radiates from your low back into your buttock and down to your foot. Such is the telltale journey of sciatica.
Common, yet potentially debilitating, sciatica isn’t so much a condition as it is a symptom with several causes. Tending to strike during our most productive years, sciatica is especially problematic for people who spend a lot of time sitting and leaning forward—in other words, people like nail techs. Here’s what you need to know about preventing, recognizing, treating and managing sciatica.
It Strikes a Nerve
The key difference between sciatica and other types of pain is the involvement of the sciatic nerve, which is formed from five nerve roots that join together in the lower back and become one large nerve that runs through the buttock, thigh and lower limb. Every person has two sciatic nerves to serve the left and right sides of the body. When those nerve roots are disturbed in some way, sciatica occurs. Tingling, tightening, numbness, weakness and—most of all—pain, flare up anywhere along the nerve route.
“It started with back pain out of the blue,” recalls Tiffany Nelson, nail tech and owner of A Nail Nirvana in West Valley City, Utah. “Then one night, both of my legs went numb. The pain started in my butt cheek and then moved down the back of my thigh and eventually to my knee and foot. By then it felt like a tight pull from my back down to my knee.”
It’s the leg pain that defines sciatica and tends to cause the greatest discomfort, explains Mark J. Spoonamore, MD, assistant professor
in the department orthopaedic surgery at the Keck School of Medicine of USC in Los Angeles. “Leg symptoms [in sciatica] may manifest as a shooting electric pain down the buttock, back of the thigh and calf, and into the foot,” he says. “There may also be a component of numbness (paresthesia) and/or weakness.” Acute sciatica lasts several weeks and gradually resolves with conventional treatment, but it may recur if triggered, whereas chronic sciatica can stay for years or even a lifetime.
Why Sciatica, Why Me?
To date, the majority of medical opinion states that most cases of sciatica are triggered by spinal discs, spongelike structures sandwiched between our vertebrae that act as shock absorbers. Age, occupation, fitness level, posture and, possibly, genetics and psychological factors may cause a disc to degenerate and/or herniate (bulge). One medical puzzle is that many people whose image tests show herniated discs have no symptoms whatsoever, which is why image testing is not necessarily conclusive when it comes to pinpointing a cause for sciatic pain. However, such tests can detect or rule out other causes, such as disc rupture, spinal stenosis (narrowing of the spinal canal in the lower back), spondylolisthesis (vertebra slippage), infection and spinal tumor.
John Sarno, MD, professor of physical medicine and rehabilitation at New York University and author of numerous best- selling books on pain and the mind- body connection, rejects the mainstream theory that internal structures are largely responsible for sciatic pain. After years of study and clinical experience, Dr. Sarno originated the concept of tension myositis syndrome, a condition wherein a set of emotional issues leads to an oxygen deprivation in muscles, which in turn causes the pain.
Although no one can say for sure why some people develop sciatica and others don’t, medical practitioners note common threads among these patients. Jeffrey N. Katz, MD, MS, professor of medicine and orthopaedic surgery at Harvard Medical School, acknowledges risk factors such as obesity and smoking, but concludes that sciatica mostly seems to occur as a “result of years of bending and sitting for long stretches.”
Karla Sorto Chavez, owner of Karla’s Originail Kolors in Woodland Hills, California, has been a nail tech for eight years, and for the past four of them she has struggled with sciatic pain. “I get sharp pain by my tailbone and it radiates down to my thigh,” reports the tech, who notes that her profession contributes to and exacerbates her symptoms.
“After I’ve worked for a long period, or after many days of back-to-back work, I can barely get up from my seat. It’s the position that I’m in when doing nails that affects it, particularly when I hunch over to do pedicures. I get up with a limp and my leg feels like it’s on fire.”
The pain is scary, but probably not dangerous, says Steven J. Atlas, MD, MPH, associate professor of medicine at Harvard Medical School in his 2017 article for Harvard Health Publishing. “Most people think (understandably) that the worse the pain, the more likely something bad is going on; however, this isn’t true for sciatica,” he says. “The body can reabsorb the disc material that’s causing symptoms, even for those with severe pain.”
Like Sorto Chavez, Nelson has noticed the toll that doing nails is taking on her body. “After my symptoms came to be, it became more and more uncomfortable to sit for long periods,” she says. “And now? Sitting absolutely aggravates my symptoms.” She is quick to add, however, that she doesn’t think that being a nail tech caused her sciatica in the first place.
Take a Stand
Prolonged sitting seems to be the worst thing for sciatica sufferers, and for people in general. When we sit too much, the core muscles responsible for supporting our spine become weak. As noted by David Petron, MD, associate professor in the department of orthopaedics at the University of Utah, in a 2016 interview at the university: “We’re not designed to sit for hours at length. The most common presentation of sciatica I get is when someone goes on a trip and sits on a plane for a long time, then they go to a conference and sit for a long time, then they come back with pain and think it’s because they picked up heavy luggage. Most of the time it’s just prolonged sitting.”
Unfortunately for nail techs, sitting is non-negotiable. But there are ways to manage sciatica symptoms while maintaining your occupation. Sorto Chavez, for instance, schedules clients with time in between to allow for plenty of breaks. She receives acupuncture to reduce flare-ups, takes muscle relaxers on occasion and uses topical products, such as CBD oil.
Medical approaches to sciatica vary from conservative measures (physical therapy, mild pain and anti- inflammatory medication, hot or cold packs, chiropractic treatment, massage, acupuncture and gentle exercises) to more aggressive measures, such as epidural injections and surgery, which is often indicated in cases of tumor, profound nerve root compression, bilateral sciatica and infection. Microdiscectomy, during which a small part of disc material is removed, is a minimally invasive surgical option that has been met with mixed results. Lesser-known treatments for sciatica include lying on an inversion table and the application of a pulsed radiofrequency probe directly to nerve roots. Research is currently being done on a nerve-dulling implant that’s inserted and then dissolves over time.
Like so many ailments, the best way to beat sciatica is to prevent it: Avoid prolonged sitting, do doctor- prescribed stretches and core- strengthening exercises, and manage your stress. If needed, try to lose weight. And if sciatica has already struck, work with your doctor on a treatment and lifestyle regimen that’s doable for you over the long term. The good news is that most cases of sciatica resolve on their own within 6 to 12 weeks, and your odds of developing sciatica drop after age 50. As Dr. Atlas notes, “For most individuals, the body can fix the problem.”
- Approximately 10% of people will report sciatic symptoms in their lifetime.
- Sciatica rarely occurs before the age of 20.
- Men and women are equally likely to experience sciatica.
- Five nerve roots from the lower back join together to form the large sciatic nerve.
- An estimated 5% to 10% of patients with low back pain are diagnosed with sciatica.
Sources: American Chronic Pain Association, theaspa.org; proactivechange.com; National Center for Biotechnology Information; Centers for Disease Control and Prevention; Spine Center of Texas, spinecenteroftexas.com; University of Southern California Spine Center
–by Linda Kossoff