Sciatica

Sciatica is irritation of the sciatic nerve that passes down the back of each thigh. The Sciatica nerve arises from the lower spine on either side and 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 typically causes pain that shoots down the back of one thigh or buttock.

Causes

Anything that causes irritation or puts pressure on the sciatic nerve can cause Sciatica, including:
  • Herniated disc or slipped disc – the cushions between the bones of your spine bulge out of place
  • Disc degeneration, caused by aging or arthritis
  • Spinal stenosis – narrowing of the spinal canal in the lumbar area
  • Spondylolisthesis – slippage of a bone in the low back
  • Sprain or strain of muscles or ligaments in the area
  • In rare cases:
    • Benign or malignant tumors
    • Infections
    • Blood clots
    • Metabolic problems like diabetes
    • Toxins such as excessive alcohol

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Age: 25-45
  • Injury such as:
    • Lifting a heavy object
    • Suddenly moving or twisting
  • Family members with sciatica or low back problems
  • Vibration from vehicles or heavy equipment
  • Lack of regular exercise
  • Obesity
  • Smoking
  • Stress

Symptoms

Sciatica causes symptoms that can range from mild to severe.
Typical symptoms include:
  •  Burning, tingling or a shooting pain down the back of one leg
  • Pain in one leg or buttock that is 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:
  • Progressive weakness in a leg or foot
  • Difficulty walking, standing, or moving
  • Loss of bowel or bladder control
  • Fever, unexplained weight loss, or other signs of illness

Diagnosis

The doctor will ask about your symptoms and medical history, and examine your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes. Other tests may include: X-ray - a test that uses radiation to take a picture of structures inside the body, especially bones MRI Scan – a test that uses magnetic waves to make pictures of structures inside the body CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the body Nerve Conduction Study – a test in which an electrical current is passed through a nerve to determine the health or disease of that nerve

Treatment

The goal of treatment is to reduce sciatic nerve irritation.
Treatment options include:
Bed Rest - resting on a firm mattress or pad on the floor for two-to-three days, getting up only to use the toilet
Medication
  • Pain relievers like acetaminophen (Tylenol), aspirin, or ibuprofen
  • Muscle relaxers for muscle spasm
  • Cortisone pills or injections where the sciatic nerve comes out of the spine
  • Antidepressants for chronic pain
Physical Therapy - at home or at work, which may include:
  • Hot or cold packs
  • Stretching and strengthening exercises
  • Massage
  • Ultrasound treatments
  • Electrical stimulation
Alternative Therapies
  • Relaxation training
  • Hypnosis
  • Guided imagery
  • Biofeedback
  • Acupuncture
Surgery - to relieve pressure on the sciatic nerve. This is performed in emergency situations or if other treatments fail. Common surgical procedures are discectomy and lumbar laminectomy.

Prevention

Sciatica tends to recur. The following steps may help keep it from coming back or, in some cases, from happening in the first place:
  • When lifting, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.
  • Practice good posture to reduce pressure on your spine.
  • Sleep on a firm mattress.
  • Exercise regularly, at least 30 minutes most days of the week. Good hoices include walking, swimming, or exercises recommended by your doctor or physical therapist.
  • Avoid sitting or standing in one position for prolonged periods.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.
  • If you smoke, quit. Smoking can damage your sciatic nerve.