Sciatica

What is it?

Sciatica describes persistent pain felt along the sciatic nerve. This nerve runs from the lower back, down through the buttock and into the lower leg. It is the longest nerve in the body. Pain results when this nerve is compressed or injured. It most commonly results from inflammation, bony enlargement due to arthritis or a displaced (herniated) disk in the lower spine.

Symptoms

Sciatica causes pain that begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain generally will feel dull, aching or burning. Sometimes, it starts gradually, worsens during the night, and is aggravated by motion. Sciatica also can cause tingling, numbness or muscle weakness in the affected leg.

Diagnosis

Your doctor will review your symptoms and your medical history. He or she will want to know if you have low back pain that spreads to the leg and if you have muscle weakness in your leg or foot. Your doctor will also ask questions that might suggest a serious condition, such as a bone fracture or infection. He or she will want to know if you've had:

• any injury that might cause an irritation or injury to the sciatic nerve
• fever
• problems controlling your bowels or bladder
• a history of cancer
• recent weight loss.

Your doctor will examine you, paying special attention to your spine and legs. To look for problems in your spinal column and related nerves, your doctor may ask you to perform a series of tests that will check the sensation in your legs, muscle strength, reflexes, and flexibility.

Your doctor may recommend X-rays, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan. These tests check for problems in the spinal vertebrae (backbones) or discs that may be irritating or compressing your sciatic nerve. These tests are most helpful to rule out other causes of symptoms or if surgical options might be considered.

The diagnosis is based primarily on your symptoms. The physical examination is important to look for abnormalities in the neurologic examination such as weakness, abnormal reflexes or loss of sensation in the leg. The exam might indicate another explanation for the symptoms. However, a normal physical examination is common in people with sciatica. While testing may be important in some cases, the diagnosis can be made even when all test results are normal.

Expected duration

Sciatica usually goes away on its own after a period of rest and limited activities. Most people with sciatica feel better within 6 weeks. Pain that lasts longer than 6 to 12 weeks should prompt a follow up visit to your doctor. If symptoms are severe or prolonged, you may be referred to a doctor who specializes in treating back pain.

Prevention

Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. Your doctor may refer you to a physical therapist to develop a personalized program. Here are some steps you can take in the meantime:

• Practice good posture. Stand up straight with your ears aligned with your shoulders. Align your shoulders with your hips and your buttocks tucked in. Your knees should be bent slightly.
• Do abdominal crunches. These exercises strengthen the abdominal muscles that help to support your lower back. Lie with your back on the floor, hands behind your head and knees bent. Press your lower back to the floor. Lift your shoulders up about 10 inches off the floor and then lower them. Don't go that high if it causes more pain. Repeat 10 to 20 times, once a day.
• Walk/swim. Walking and swimming can help to strengthen your lower back.
• Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back.
• Avoid sitting or standing for extended periods. If you sit at work, take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest. Switch feet throughout the day.
• Use proper sleeping posture. Take pressure off your back by sleeping on your side or on your back. Put a pillow under your knees.
• Stretch. Sit in a chair and bend down toward the floor. Stop when you feel just slight discomfort, hold for 30 seconds, then release. Repeat 6 to 8 times.
• Avoid wearing high heels. Shoes with heels that are more than 1 1/2 inches high shift your weight forward, throwing the body out of alignment.

Treatment

Sciatica usually can be treated successfully by a brief period of resting and limiting activity. Avoid prolonged bedrest that can actually make sciatica worse. Start gentle exercises to improve mobility and strengthen the back as soon as you can. If you are not making any progress, notify your doctor. Physical therapy can be helpful.

To ease inflammation around the nerve, your doctor may recommend that you alternate using hot and cold compresses.

You also may need to take acetaminophen (Tylenol) for pain, or anti-inflammatory drugs, such as naproxen (Aleve, Anaprox), ibuprofen (Motrin, Advil and others) or aspirin for pain and inflammation. Medications used to treat nerve pain may be helpful. They include amitriptyline (Elavil, Endep) or gabapentin (Neurontin).

In severe cases, an injection of a long-acting anesthetic with a corticosteroid medication may provide relief. However, recent studies suggest that corticosteroid injections for back pain and sciatica do not relieve short or long term pain any better than injections that do not contain any steroid. These injections typically are done in centers specializing in pain management.

Other non-medication options, including chiropractic manipulation, acupuncture, massage and yoga can be helpful, though how well they compare to more conventional treatment is uncertain.

Surgery may be necessary if pain cannot be relieved with other therapies or leg weakness persists, especially if it is getting worse. Surgery is most effective when there is a clear disc herniation that is compressing the root of the involved sciatic nerve.

When to call a professional

Contact your doctor if sciatica pain grows worse over a few days, or if it begins to interfere significantly with your daily activities. Call your doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. These symptoms may indicate that nerves leading to the pelvis are compressed. This condition can cause permanent damage if not treated promptly.

Prognosis

The vast majority of sciatica cases can be controlled with simple home care. For most people, basic preventive measures are enough to keep sciatica from coming back although it can be chronic or recurrent. Some people do require surgery for persistent pain or leg weakness.

Additional info

American Academy of Orthopaedic Surgeons (AAOS)
https://www.aaos.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov/