Sciatica

Definition

Sciatica is an irritation of the sciatic nerve. The sciatic nerve leaves the spine in the low back. There is one on the left and one on the right. The nerve travels deep into the pelvis to the lower buttocks. From there, it passes down the back of each thigh. Then, the nerve divides at the knee into branches that go to the feet.

Sciatic Nerve Pain

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Causes

Sciatica is caused by pressure on the nerve. This can be the result of:

• Herniated disc —the cushions between the bones of the spine bulge and press on the nerve as it exits the spinal column
• Arthritis of the back—swelling in joints of the lower back
• Spinal stenosis —narrowing of the spinal canal in the lower back
• Spondylolisthesis —slippage of a bone in the lower back
• Cauda equina syndrome —nerve roots at the base of the spinal cord are compressed
• Piriformis syndrome—spasm of the piriformis muscle deep in the pelvis/hip

Risk Factors

Things that may raise the risk of this problem are:

Personal health factors, such as:

• Obesity
• Smoking
• A history of low back problems
• Anxiety and depression

Job-related factors, such as:

• Heavy manual labor
• Exposure to vibrations
• A job that requires standing for long periods of time and forward bending

Having other health problems, such as:

• Fractures in the back
• Tumors
• Infections
• Metabolic problems, such as diabetes

Symptoms

Symptoms can range from mild to severe. A person may have:

• Burning, tingling, or shooting pain down the back of one leg
• Pain in one leg or buttock that may get worse with:
  • Sitting
  • Standing up
  • Coughing
  • Sneezing
  • Straining
• Weakness or numbness in a leg or foot

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on the back, hips, and legs.

Images may need to be taken. This can be done with:

• MRI scan
• CT scan

Your nerves may also need to be tested. This can be done with a nerve conduction study.

Treatment

The goal of treatment is to reduce sciatic nerve irritation. Once the irritation is removed the nerve should gradualy return to normal. Care steps may include:

• Supportive care, such as resting the area for no more than 1 to 2 days and avoiding things that may the pain worse
• Medicines, such as:
  • Over the counter and prescription pain relievers
  • Muscle relaxants to ease spasms
  • Corticosteroids to ease swelling
• Physical therapy to improve strength, flexibility, and range of motion

People who are not helped by these methods may need surgery. It can help ease pressure on the nerve. Choices are:

• Microdiscectomy—part of disc between spinal bones is removed
• Lumbar laminectomy —part of spinal bone is removed

Prevention

Some things that may help prevent sciatica are:

• Use proper techniques when playing sports, exercising, or lifting heavy objects
• Practicing good posture
• Exercising regularly
• Not sitting or standing in one position for too long