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Sciatica Or Slipped Disc? Doctor Explains Why They Are Not The Same Thing
Low back pain is the most common complaint for which patients see a doctor. Among these conditions, two terms which are often mistaken for each other are sciatica and slipped disc. Despite them being related, both are not the same. This distinction is essential since it is only through correct diagnosis that treatment can be done effectively. It is true that one can have sciatica from having a slipped disc, but not all sciatica comes from this problem.
Sciatica Is a Symptom, Not a Diagnosis
Sciatica is defined as pain following the sciatic nerve, which is the biggest nerve in the body. Sciatic pain usually originates in the lower back or the buttocks, and then goes down the leg, usually on one side of the back of the leg or one side of the foot. This pain is often accompanied by tingling, numbness, burning, and weakness in the leg involved. It generally involves just one side of the body. It is important to know that sciatica defines where the pain travels, not what is causing the problem.
Several different things can cause irritation or compression of the nerve roots of the sciatic nerve, such as spinal stenosis, degenerative disc disease, piriformis syndrome, spondylolisthesis, or a slipped disc.
What Is a Slipped Disc?
The phrase “slipped disc” is the most popular one used when speaking about herniated or prolapsed discs. The spinal column consists of vertebral bodies separated from each other by the discs that serve as shock absorbers. Each disc consists of a soft core covered by a hard shell. If the shell is damaged, the core pushes outwards and presses on the nerve endings located nearby. Contrary to the popular opinion, the disc does not “slip,” but bulges out.
If the herniated disc does not pinch a nerve, it does not produce any symptoms. Moreover, MRI scans have revealed that many people have bulging discs but do not feel pain due to that fact.
How The Symptoms Differ
One of the major distinctions is the nature of the pain itself.
Individuals suffering from simple lower back pain because of the herniation of the disc have a pain that is in their lower back and stiffness when bending or lifting. In the case where there is compression of a nerve root by the herniated disc, the symptoms are completely different. The pain starts to travel below the knee accompanied by tingling, numbness, or weakness. At this point, the individual has sciatica because of the disc problem.
Sciatica, no matter what the cause, is often characterised as sharp, electrical, shooting, or burning. It often gets worse with prolonged sitting, coughing, sneezing, or straining due to increased pressure on the nerve.
Not Every Leg Pain Is Sciatica
Just because the pain moves down into the leg does not mean that the patient has sciatica. Hip arthritis, sacroiliac joint disease, vascular problems, muscle strain and nerve diseases may all give symptoms like those of sciatica.
Also, pain localised to the buttocks may be due to piriformis syndrome and not any spine issue. This is the reason why a clinical assessment is more useful than symptoms presented on the internet.
How Doctors Confirm The Diagnosis
A diagnosis starts with a complete history and physical examination. Tests for muscle strength, reflexes, sensation, gait, and special manoeuvres such as the Straight Leg Raise are done to diagnose nerve root irritation.
The use of Magnetic Resonance Imaging (MRI) is indicated only in cases where there are severe symptoms, unresponsive symptoms even after conservative management, or neurological deficit. Nevertheless, results from the MRI should always be correlated with symptoms since there are degenerative changes of the disc that occur with ageing and are not always indicative of one’s pain.
Treatment Depends On The Cause
Most cases of sciatica due to disc prolapse can be treated conservatively within a few weeks. Management of pain, physiotherapy, alteration in activity level, and spinal stabilisation and flexibility exercises are the core of the treatment. Absolute bed rest is not advised anymore since long inactivity can hinder the process of recovery.
Surgery is indicated in case of progressive muscle weakness, significant neurological deficit, loss of bowel or bladder control or continued pain despite adequate conservative treatment.
When Should You Seek Immediate Medical Attention?
Some symptoms cannot be overlooked. Weakness in the foot, an inability to move the toes, numbness in the groin or saddle, or even loss of bladder and bowel control can be symptoms of a severe nerve impingement problem.
While sciatica and slipped discs have strong connections, they are not one and the same thing. The term “slipped disc” implies structural problems with the spine, whereas “sciatica” is the consequence of sciatic nerve irritation. It is crucial to know the difference since correct diagnosis of the root cause of the nerve compression will determine the kind of treatment a patient requires. Instead of attributing each instance of leg pain to the slipped disc, proper examination can help in differentiating among the range of diseases with similar symptoms.
(By Dr Yogesh K, Senior Consultant – Arthroscopy and Sports Injury, Aster Whitefield Hospitals)
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