Like a modern skyscraper, the human spine defies gravity and defines us as vertical bipeds.
It forms the infrastructure of a biological machine that anchors the kinetic chain and transfers biomechanical forces to coordinated functional activities.
Lumbociatica is the pain located near the lower back and along the sciatic nerve that carries messages from the brain through the spinal cord to the legs.
The spinal column acts as a conduit for neural structures and possesses the physiological ability to work as a crane for lifting and a crankshaft for walking.
Undergoing aging, the spine adjusts to the wear and tear of gravity and biomechanical load through compensatory structural and neurochemical changes, some of which can be maladaptive and cause pain, functional disability, and altered neurophysiological circuits.
Some compensatory reactions are benign; however, some are destructive and interfere with the body’s ability to function and cope.
Spinal pain is multifaceted and involves structural, biomechanical, biochemical, medical, and psychosocial influences resulting in such complex dilemmas that treatment is often difficult or ineffective.
Lumbociatica describes pain in the legs in the distribution of one or more lumbosacral nerve roots, generally L4-S2, with or without neurological deficit.
However, doctors often refer to pain in the legs of any lumbosacral segment as sciatica. The descriptive phrase “nonspecific root pattern” has been recommended when the dermatomal distribution is unclear.
When initially evaluating a patient with back and leg pain, the physician must first determine that the pain symptoms are consistent with activity-related spinal disorders from the wear and tear of the excessive biomechanical and gravitational load that some traditionally describe as mechanics.
The lumbar syndromes mechanical typically aggravated by static loading of the spine.
For example, prolonged sitting or standing, from long lever activities, such as vacuuming or working with arms raised and away from the body, or lever postures, such as forward bending.
Pain is reduced when the spine is balanced by multidirectional forces (e.g., walking or constantly changing position) or when the spine is unloaded (e.g., reclined).
Mechanical conditions of the spine, including disc disease, spondylosis, spinal stenosis, and fractures, account for up to 98% of low back pain cases, with the remainder due to systemic, visceral, or inflammatory disorders.
Sciatica is defined as an experience of pain due to nerve injury or irritation. Lumbociatica is explicitly used when the origin comes from nerve irritation that begins near the vertebrae and when pain is felt along the nerve.
Symptoms of lumbociatica
In the case of lumbociatica, the patient feels pain that affects one side of the body, radiating from the lower back to the buttocks and the back of the leg to the foot. Sensations of electric shocks or burns may be felt.
In case of S1 root infringement, the pain begins in the buttock and back of the thigh, runs through the knee and leg before affecting the heel, and finally touches the outer edge of the foot up to the little toe.
Lumbociatica symptoms are often worse when sitting or coughing and may be accompanied by numbness or tingling in the leg.
When discussing lumbociatica, it is essential to understand the underlying medical cause, as effective treatment will focus on addressing the cause of pain and relieving acute symptoms.
The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures found between the bones of the spine.
If the outer edge of the disc is torn, usually due to normal pressure on the lower back, the internal jelly-like material can come out and pinch or inflame the nearby nerve. Lumbociatica is most common in people ages 30 to 50.
Muscle tension: In some cases, inflammation related to lower muscle tension and muscle spasm can put pressure on the nerve root and cause sciatic pain.
Spinal tumor: Tumors may originate in the spine, but more commonly, spinal tumors develop as cancer from a different part of the body metastasizes and spread to the spine.
Fracture: If a fracture occurs in a lumbar vertebra, symptoms may include lumbociatica.
Most fractures occur due to severe trauma (such as a car accident or a fall) or because the bone has been weakened due to osteoporosis or another underlying condition or medication.
Ankylosing spondylitis: This condition is characterized by chronic inflammation in and around the spine. Symptoms often appear first in the sacroiliac joints, causing sacroiliitis, and symptoms may include lumbociatica.
Lumbociatica that occurs after an accident or trauma, or if it develops in conjunction with other worrisome symptoms such as fever or loss of appetite, also causes prompt medical evaluation. Patients should seek medical attention immediately if they feel there is cause for concern.
The key to diagnosing lumbociatica is a complete history and a focused exam. Examination of the patient is the first step in characterizing the location of pain and the mode of occurrence.
A clinical exam looks for the initial location of the pain in the back, then the precise route. A Lasegue test triggers pain while the patient’s leg is passive and then gradually as they stand up.
The diagnosis can be confirmed by a spinal X-ray, MRI, or CT scan, which shows the location of nerve pain and sometimes identifies a cause.
Unfortunately, many patients wait for an X-ray or MRI, and clinicians, who often face time constraints, request one even though they know that imaging tests don’t help better treat early lumbociatica.
A physical exam can confirm that the sciatic nerve is involved, and the doctor will look for weakness or decreased reflexes in the legs suggesting that someone needs an early referral to a specialist.
This does not happen often. The doctor can make an initial diagnosis and begin treatment with this information.
Pain management begins with pain relievers and non-steroidal anti-inflammatory drugs. Total rest is not prescribed for lumbociatica; on the contrary, the doctor advises slight movements with physical therapy.
I am dealing with pain … and managing expectations.
Many people think (understandably) that the worse the pain, the more likely something wrong is happening. However, this is not true for lumbociatica.
The body can reabsorb the disc material that is causing symptoms, even for those with severe pain.
Therefore, treatment focuses on managing pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods may help, but prolonged rest does not.
So once the pain subsides, patients are told to get up and start walking short distances. Since sitting increases the pressure on the discs in your lower back, I recommend avoiding prolonged position or driving.
Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches can help alleviate typical low back pain, they are less helpful for low back pain.
Over-the-counter pain relievers, such as ibuprofen and naproxen, can be helpful. The short-term use of more potent prescription pain medications may be recommended when they don’t.
The good news is that symptoms improve within a few weeks for most people (about three out of four). On rare occasions, weakness will be found on examination, such as a foot drop, and will be referred for immediate surgical evaluation.
Surgery is an option for those who do not improve after six weeks. We know that surgery can speed recovery, but between six and 12 months, people who have surgery generally do just as well as those who decide to simply give the body more time to heal on its own.
The surgery involves removing the disc material that is affecting the nerve. It is a very safe procedure, and although complications are rare, they can occur. Also, 5% to 10% of people who have surgery will not get help or may have worse pain afterward.
Patients often ask about spinal injections, where injected steroid medications into the affected area. It is worth considering for those with intractable pain or persistent and bothersome symptoms who wish to avoid surgery.
The injections can provide a remedy in a short time. Like any procedure, it has rare risks, including more pain, and it doesn’t seem to lessen the need for future surgery.
For most lumbociatica patients, it is worth seeing your primary care physician.
They want relief, and rightly so, they want it now. That’s the appeal of surgery and injections, but I also know that most will get better with time, and you can avoid even the rare risks of these procedures.