Sciatica

Sciatica

Overview

Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the buttocks and down each leg.

Sciatica most often happens when a herniated disk or an overgrowth of bone puts pressure on the lumbar spine nerve roots. This happens "upstream" from the sciatic nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be serious, those cases that are caused by a herniated disk can clear up with treatment in a few weeks to months. People who have severe sciatica and serious leg weakness or bowel or bladder changes might need surgery.

Symptoms

Sciatica pain can be almost anywhere along the nerve pathway. It's especially likely to follow a path from the low back to the buttock and the back of a thigh and calf.

The pain can vary from a mild ache to a sharp, burning pain. Sometimes it feels like a jolt or electric shock. It can be worse when coughing or sneezing or sitting a long time. Usually, sciatica affects only one side of the body.

Some people also have numbness, tingling, or muscle weakness in the leg or foot. One part of the leg can be in pain, while another part can feel numb.

Causes

Sciatica occurs when the nerve roots to the sciatic nerve become pinched. The cause is usually a herniated disk in the spine or an overgrowth of bone, sometimes called bone spurs, on the spinal bones. More rarely, a tumor can put pressure on the nerve.

Risk factors

Risk factors for sciatica include:

Age. People ages 20 to 50 are most likely to have herniated disks. Bone spurs develop more commonly as people age.

Obesity. Being overweight increases stress on the spine.

Occupation. A job that requires twisting the back, carrying heavy loads or driving a motor vehicle for long periods might play a role in herniated disks.

Prolonged sitting. People who sit a lot or don't move much are more likely to develop herniated disks than active people are.

Diabetes. This condition, which affects the way the body uses blood sugar, increases the risk of nerve damage.

Complications

Most people recover fully from sciatica caused by herniated disks, often without treatment. But sciatica can damage nerves. Seek immediate medical attention for:

Loss of feeling in the affected leg.

Weakness in the affected leg.

Loss of bowel or bladder control.

Prevention

It's not always possible to prevent sciatica, and the condition can come back. To protect your back:

Exercise regularly. To keep the back strong, work the core muscles — the muscles in the abdomen and lower back needed for good posture and alignment. A healthcare professional can recommend activities.

Keep good posture when sitting. Choose a seat with good lower back support, armrests and a swivel base. For better low back support, place a pillow or rolled towel in the small of the back to keep its normal curve. Keep knees and hips level.

Use your body correctly. When standing for long periods, rest one foot on a stool or small box from time to time. When lifting something heavy, let your legs do the work. Hold the load close to your body. Don't lift and twist at the same time. Find someone to help lift heavy or awkward things.

Diagnosis

During the physical exam, a healthcare professional might check muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position, and lift your legs one at a time while lying on your back.

Tests

People with severe pain or pain that doesn't improve within a few weeks may need:

X-ray. An X-ray of the spine may reveal various mechanical changes that can affect the size of the holes where the nerve roots exit the spine.

MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of the back. An MRI produces detailed images of the soft tissues, so herniated disks and pinched nerves show on the scan.

CT scan. Having a CT scan might involve having a dye injected into the spinal canal before the X-rays are taken (CT myelogram). The dye then moves around the spinal cord and spinal nerves, making them easier to see on the images.

Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of the muscles. This test can confirm how severe a nerve root injury is.

Treatment

For pain that doesn't improve with self-care measures, some of the following treatments might help.

Medications

The types of medicines that might be used to treat sciatica pain include:

Anti-inflammatories.

Corticosteroids.

Antidepressants.

Anti-seizure medications.

Opioids.

Physical therapy

Once the pain improves, a healthcare professional can design a program to help prevent future injuries. This typically includes exercises to correct posture, strengthen the core and improve range of motion.

Steroid injections

In some cases, a shot of a corticosteroid medication into the area around the nerve root that's causing pain can help. Often, one injection helps reduce pain. Up to three can be given in one year.

Surgery

Surgeons can remove the bone spur or the portion of the herniated disk that's pressing on the nerve. But surgery is usually done only when sciatica causes severe weakness, loss of bowel or bladder control, or pain that doesn't improve with other treatments.

Lifestyle and home remedies

For most people, sciatica responds to self-care measures. Although resting for a day or so may provide relief, staying inactive will make symptoms worse.

Other self-care treatments that might help include:

Cold packs. Place a cold pack on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.

Hot packs. After 2 to 3 days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. For continuing pain, try using both warm and cold packs, one at a time.

Stretching. Stretching exercises for the low back might provide some relief. Try to hold the stretch for at least 30 seconds. Avoid jerking, bouncing or twisting during the stretch.

Medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica. Use only as directed.

Type of Doctor Department : Physician