Sciatica

What is sciatica?

Sciatica is a pain that runs along the sciatic nerve, a large nerve extending from the lower back and down the back of each leg. Sciatica is a common kind of back pain. Although sciatica can be very painful, it is rare for the disorder to cause permanent nerve damage. Most sciatica pain syndromes result from inflammation and will usually get better within a few weeks.

What are the symptoms of sciatica?

• Pain in the rear or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down the leg. Depending on where the sciatic nerve is affected, the pain might also extend to the foot or toes. For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse.

What causes sciatica?

Any condition that causes irritation to the sciatic nerve can cause the pain associated with sciatica. In many cases, sciatica is caused by pressure on the sciatic nerve from a herniated disc (also called a slipped disc or ruptured disc). Additional common causes of sciatica include:

• Lumbar spinal stenosis (narrowing of spinal canal in the lower back)
• Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
• Spondylolisthesis (a condition in which one vertebra slips forward over another one)
• Pregnancy

Other things that might make your back pain worse include being overweight, not exercising regularly, wearing high heels, and sleeping on a mattress that is too soft.

How is sciatica diagnosed?

In diagnosing sciatica, a doctor will take your medical history and perform an examination of the back, hips, and legs in order to test for strength, flexibility, sensation, and reflexes.

Other tests might include:

• X-rays
• MRI scans
• CT scans
• Nerve conduction studies and an EMG (electromyogram). During these tests, an electrical current is passed through a nerve to determine the health or disease of that nerve.

How is sciatica treated?

Treatment for sciatica focuses on relieving pressure and inflammation. Typical sciatica treatments include:

• Medical treatments for sciatica -- such as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, oral steroids, and epidural steroid injections -- help to relieve inflammation.
• Epidural steroid injections where steroids, with their strong anti-inflammatory effects, are delivered at the origin of the inflamed sciatic nerve roots.
• Physical therapy usually starts after adequate pain control, and has an essential role both for the acute episode as well as long term avoidance of further episodes.
• Surgery for sciatica might be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments. Patients should seek immediate medical attention if they have any symptoms of progressive lower extremity weakness, loss of bladder or bowel control.

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