Sciatica

Definition

The sciatic nerve begins from the lower spine on either side. It travels deep in the pelvis to the lower buttocks. From there, it passes along the back of each upper leg and divides at the knee into branches that go to the feet. Sciatica is an irritation of the sciatic nerve.

Sciatic Nerve Pain

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Causes

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

• Herniated disc —the cushions between the bones of your spine bulge and press on the nerve as it exits the spinal column
• Arthritis in the lower back
• Spinal stenosis —narrowing of the spinal canal in the lumbar area
• 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 piriformis muscle

Risk Factors

Sciatica is more common in men. Other factors that may increase your chance of sciatica include:

Lifestyle and personal health factors, such as:

• Obesity
• Smoking
• History of low back problems
• Anxiety and depression

Occupational factors, such as:

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

Health conditions, such as:

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

Symptoms

Sciatica causes symptoms that can range from mild to severe. Symptoms may include:

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

More serious symptoms associated with sciatica that may require immediate medical attention include:

• Continuing weakness in a leg or foot
• Numbness in groin or the buttocks
• Difficulty walking, standing, or moving
• Loss of bowel or bladder control
• Fever, unexplained weight loss, or other signs of illness

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor will pay particular attention to your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes.

Imaging tests are used to evaluate the affected area:

• X-ray
• MRI scan
• CT scan

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

Treatment

The goal of treatment is to reduce sciatic nerve irritation.

Treatment options include:

Activity

Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Activities may be restricted for a period of time and then resumed as soon as possible. Recovery time may be shortened by staying active and exercising.

Medication

Medications used to treat sciatica include:

• Over-the-counter or prescription pain relievers
• Muscle relaxants for muscle spasms
• Corticosteroid injections in the back
• Antidepressants or antiseizure medications for chronic pain

Physical Therapy

Physical therapy may include:

• Cold packs or heat therapy
• Stretching and strengthening exercises
• Massage
• Ultrasound treatments or electrical stimulation
• Posture education and appropriate lifting instructions

Alternative Therapies

These therapies have not been proven by scientific studies to have an effect on sciatica. However, some people may find some pain relief from:

• Biofeedback
• Acupuncture

Surgery

Surgery may be done to relieve pressure on the sciatic nerve. This is performed in emergency situations or if other treatments fail. Common surgical procedures are microdiscectomy and lumbar laminectomy .

Prevention

Sciatica tends to happen more than one time. To help reduce your chance of sciatica:

• Use proper body movement when playing sports, exercising, or lifting heavy objects.
• Practice good posture to reduce pressure on your spine.
• Begin a safe exercise program with the advice of your doctor.
• If possible, avoid sitting or standing in one position for long periods.
• Consider job retraining if your work requires a lot of heavy lifting or sitting.