From the Guidelines
The most likely etiology of chronic sciatica that began after sitting in an awkward position on a hard chair for an extended period is lumbar radiculopathy, specifically sciatica, which is pain radiating down the leg below the knee in the distribution of the sciatic nerve, suggesting nerve root compromise due to mechanical pressure or inflammation, as defined by the American College of Physicians and the American Pain Society 1.
Key Points to Consider
- The patient's symptoms of sciatica, which is pain radiating down the leg below the knee, suggest nerve root compromise due to mechanical pressure or inflammation.
- The awkward sitting position likely caused mechanical pressure or inflammation on the nerve root, leading to sciatica.
- Treatment typically includes conservative measures such as NSAIDs like ibuprofen (400-800mg three times daily with food) for pain and inflammation, physical therapy focusing on exercises to relieve pressure on the nerve root, and application of heat or ice to the affected area.
- Patients should avoid prolonged sitting, especially in awkward positions, and may benefit from using a cushion designed to reduce pressure on the affected area.
- If symptoms persist beyond 4-6 weeks of conservative treatment, further evaluation with imaging studies may be warranted to rule out other causes like herniated discs.
Important Definitions
- Sciatica: Pain radiating down the leg below the knee in the distribution of the sciatic nerve, suggesting nerve root compromise due to mechanical pressure or inflammation.
- Radiculopathy: Dysfunction of a nerve root associated with pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution.
- Lumbar radiculopathy: A condition that affects the nerve roots in the lower back, causing pain, numbness, or weakness in the legs.
Recommended Treatment
- Conservative measures such as NSAIDs, physical therapy, and application of heat or ice to the affected area.
- Avoid prolonged sitting, especially in awkward positions.
- Use a cushion designed to reduce pressure on the affected area.
- Further evaluation with imaging studies if symptoms persist beyond 4-6 weeks of conservative treatment.
From the Research
Etiology of Chronic Sciatica
The most likely etiology of chronic sciatica following prolonged sitting in an awkward position on a hard chair can be attributed to several factors, including:
- Herniated lumbar intervertebral disk, which is a common cause of sciatica, although it only accounts for a small percentage of low back pain cases 2
- Lumbar intervertebral disk protrusion, which can cause excruciating pain that can be exacerbated by activity such as sitting down and straining at stool 3
- Other disorders that cause radiating pain, which can mimic sciatica 2
Risk Factors
Several risk factors can contribute to the development of chronic sciatica, including:
- Increasing height and age 4
- Genetic predisposition 4
- Walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving 4
- Prolonged sitting in an awkward position, which can put pressure on the lumbar intervertebral disks and nerves 2, 3
Diagnosis and Treatment
Diagnosis of chronic sciatica typically involves a careful history and examination, and may include imaging studies such as MRI or CT scans 2, 5 Treatment options for chronic sciatica include conservative therapy, such as nonsteroidal anti-inflammatory drugs, brief bed rest, and early progressive ambulation, as well as more invasive procedures such as epidural steroid injections 2, 3, 4