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Sciatica is pain that radiates down the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. Sciatica typically affects only one side of your body.
Sciatica is most commonly caused by a herniated disk, a bone spur on the spine, or a narrowing of the spine (spinal stenosis). This results in inflammation, pain, and numbness in the affected leg.
Although sciatica pain can be excruciating, most cases resolve in a matter of weeks with non-surgical treatments. Patients with severe sciatica who have significant leg weakness or bowel or bladder changes may be candidates for surgery.
WHAT ARE THE SYMPTOMS OF SCIATICA?
Sciatica is characterized by pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg. You may experience pain almost anywhere along the nerve pathway, but it is most likely to travel from your low back to your buttock and the back of your thigh and calf.
The intensity of the pain can range from a mild ache to a sharp, burning sensation or excruciating pain. It can feel like a jolt or electric shock at times. It can get worse if you cough or sneeze, and sitting for an extended period of time can aggravate symptoms. Typically, only one side of the body is affected.
Numbness, tingling, or muscle weakness in the affected leg or foot are also common. You may experience pain in one part of your leg and numbness in another.
WHAT ARE THE CAUSES OF SCIATICA?
Sciatica occurs when the sciatic nerve is pinched, most commonly by a herniated disk in your spine or a bone spur on your vertebrae. Rarely, a tumor can compress the nerve or a disease like diabetes can damage it.
WHAT ARE THE RISK FACTORS FOR SCIATICA?
Sciatica risk factors include:
- Age: The most common causes of sciatica are age-related changes in the spine, such as herniated disks and bone spurs.
- Obesity: Excess body weight can contribute to the spinal changes that cause sciatica by increasing the stress on your spine.
- Occupation: A job that requires you to twist your back, carry heavy loads, or drive a motor vehicle for long periods of time may contribute to sciatica, but there is no conclusive evidence of this connection.
- Long periods of sitting: People who sit for long periods of time or lead a sedentary lifestyle are more likely to develop sciatica than those who lead an active lifestyle.
- Diabetes: This condition, which affects how your body uses blood sugar, raises your chances of nerve damage.
WHAT ARE THE COMPLICATIONS OF SCIATICA?
Although most people recover completely from sciatica, sciatica can potentially cause permanent nerve damage if left untreated. Seek medical attention right away if you have:
- Feeling loss in the affected limb
- Symptoms of weakness in the affected leg
- Deficiency in bowel or bladder function
HOW IS SCIATICA DIAGNOSED?
Your doctor may assess your muscle strength and reflexes during the physical exam. For example, you may be asked to walk on your toes or heels, rise from a squatting position, and lift your legs one at a time while lying on your back. The pain caused by sciatica usually worsens during these activities.
Imaging examinations
Many people have herniated disks or bone spurs that are visible on X-rays and other imaging tests but do not cause any symptoms. As a result, doctors rarely order these tests unless your pain is severe or does not improve within a few weeks.
- X-ray: An X-ray of your spine may reveal a bone spur (overgrowth of bone) that is pressing on a nerve.
- MRI: This procedure creates cross-sectional images of your back using a powerful magnet and radio waves. An MRI generates detailed images of bone and soft tissues, including herniated disks. During the examination, you will lie on a table that will be moved into the MRI machine.
- CT scan: When a CT scan is used to image the spine, a contrast dye may be injected into your spinal canal before the X-rays are taken, a procedure known as a CT myelogram. The dye then circulates around your spinal cord and nerves, making them appear white on the scan.
- Electromyography (EMG): This test measures the electrical impulses produced by your nerves as well as the muscle responses. This test can confirm nerve compression caused by herniated disks or spinal canal narrowing (spinal stenosis).
WHAT ARE THE TREATMENTS FOR SCIATICA?
If self-care measures do not relieve your pain, your doctor may recommend some of the following treatments.
Medications
The following medications may be prescribed for sciatica pain:
- Anti-inflammatories
- Muscle relaxants
- Narcotics
- Tricyclic antidepressants
- Medication for seizure prevention
Physiotherapy
Once your acute pain has subsided, your doctor or physical therapist can devise a rehabilitation program to assist you in avoiding future injuries. This usually consists of exercises to correct your posture, strengthen the muscles that support your back, and increase your flexibility.
Injections of steroids
In some cases, your doctor may advise you to inject a corticosteroid medication into the area surrounding the affected nerve root. Corticosteroids alleviate pain by reducing inflammation around the irritated nerve. Typically, the effects wear off after a few months. The number of steroid injections you can have is limited because the risk of serious side effects rises when the injections are given too frequently.
Surgery
This is usually reserved for when a compressed nerve causes significant weakness, loss of bowel or bladder control, or pain that worsens or does not improve with other treatments. Surgeons can remove the bone spur or the herniated disk portion that is pressing on the pinched nerve.
HOME REMEDIES FOR TREATING SCIATICA
Sciatica, for the most part, responds to self-care measures. Although resting for a day or two may provide some relief, inactivity for an extended period of time will exacerbate your signs and symptoms.
Other self-care treatments that may be beneficial include:
- Cold compresses: Initially, a cold pack applied to the painful area for up to 20 minutes several times per day may provide relief. Wrap a clean towel around an ice pack or a package of frozen peas.
- Hot packs: After two to three days, apply heat to the sore spots. On the lowest setting, use hot packs, a heat lamp, or a heating pad. If the pain persists, try alternating warm and cold packs.
- Stretching: Stretching exercises for your low back can help you feel better and may alleviate nerve root compression. During the stretch, avoid jerking, bouncing, or twisting, and try to hold the stretch for at least 30 seconds.
- Over-the-counter medications: Ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve) are pain relievers that can help with sciatica.
Alternative medicine
Alternative therapies for low back pain that are commonly used include:
- Acupuncture: The practitioner inserts hair-thin needles into your skin at specific points on your body during acupuncture. Acupuncture has been shown in some studies to help with back pain, while others have found no benefit. If you decide to try acupuncture, make sure to find a licensed practitioner who has received extensive training.
- Chiropractic: One type of therapy used by chiropractors to treat restricted spinal mobility is spinal adjustment (manipulation). The goal is to restore spinal movement, which will improve function and reduce pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but it may not be appropriate for pain radiating from the spine.