Sciatica

The term sciatica describes the symptoms of leg pain—and possibly tingling, numbness or weakness—that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of each leg.

Warning Signs & Symptoms

Sciatica often is characterized by one or more of the following:

Constant pain in only one side of the buttock or leg (rarely in both legs)
Pain that is worse when sitting
Leg pain that is often described as burning, tingling or searing, versus a dull ache
Weakness, numbness or difficulty moving the leg, foot and/or toes
A sharp pain that may make it difficult to stand or walk
Pain that radiates down the leg and possibly into the foot and toes (it rarely occurs only in the foot)

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms usually are based on the location of the pinched nerve. While symptoms can be painful and potentially debilitating, it is rare that permanent damage will result. Spinal cord involvement is possible but rare.

Possible Risk Factors

Sciatica is not a medical diagnosis in and of itself; it is a symptom of an underlying medical condition. Common lower back problems that can cause sciatica symptoms include a lumbar herniated disc, degenerative disc disease, spondylolisthesis or spinal stenosis.

Tests to Diagnose Sciatica

During a physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.

Your doctor may order:

An X-ray of your spine to reveal any overgrowth of bone (bone spur) that may be pressing on a nerve
An MRI, which uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
A CT scan to view the spine. During the test, you may have a contrast dye injected into your spinal canal before the X-rays are taken. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
An Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. It can confirm nerve compression caused by herniated disks or narrowing of your spinal canal, called spinal stenosis.

Treatment Options

Severe or ongoing flare-ups of sciatic nerve pain can be treated so they do not worsen over time. Nonsurgical remedies and regular exercise will go a long way toward relieving pain for most people. For others, when the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may be the best option for finding relief and preventing or minimizing future pain and/or dysfunction.

One or more of the following nonsurgical treatments are usually recommended in conjunction with specific exercises:

Usually ice or heat is applied for approximately 20 minutes and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.
Over-the-counter or prescription medications are often effective in reducing or relieving sciatica pain. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), or oral steroids can reduce the inflammation that is usually part of the cause of pain. Muscle relaxants or narcotic medications may also be prescribed for the short term (a few days and up to 2 weeks) to alleviate pain.
If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain. While the effects tend to be temporary and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. Most importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.

In addition to standard medical treatments, several alternative treatments also have been shown to provide effective pain relief for many patients. Some of the more common forms of alternative care for sciatica include chiropractic manipulation, acupuncture, cognitive behavior therapy and massage therapy.

For most people, sciatica typically gets better on its own, and the healing process usually will only take a few days or weeks. The majority of episodes of sciatica pain subside within a 6- to 12-week time span. Following initial pain relief, a program of physical therapy and exercise should usually be pursued to alleviate pain and prevent or minimize any ongoing sciatic pain.

Prevention

It’s not always possible to prevent sciatica, and the condition may recur. The key to preventing sciatica is to protect your back:

If you stand for long periods of time, rest one foot on a stool or small box at times.
When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the object close to your body, and avoid lifting and twisting simultaneously. Have someone help if the object is heavy or awkward.
To keep your back strong, pay attention to your core muscles, the muscles in your abdomen and lower back that enable proper posture and alignment. Ask your doctor to recommend specific exercises.
Choose a seat with good lower back support, armrests and a twisting base. Consider putting a pillow or rolled towel in the small of your back to maintain its curve. Keep your knees and hips level.