SCIATICA
Sciatica is a shooting pain that begins in the lower back,
radiates into the buttock& down the back of one leg.
- The pain is often caused by pressure on the sciatic nerve from a herniated disc, bone
spurs or muscle strain - Sciatica typically improves with rest, exercise & other self-care measures
- Chronic pain that continues despite treatment may be helped with surgery to relieve the underlying cause
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WHAT ARE THE SYMPTOMS?
Classic sciatic pain starts in the low back & buttocks.
It affects1 leg traveling down the back of the thigh,
past the knee & sometimes into the calf & foot.
- The pain feels worse in the leg than in the back
- It may range from a mild ache to severe burning or a shooting pain
- Numbness or tingling (pins & needles) can occur in your leg & foot
1. This usually isn't a concern unless you have weakness in your leg muscles or foot drop
2. Sitting usually causes the most pain because of the weight this position puts onto the discs
3. Activities, such as bending or twisting, worsen the pain but lying down tends to bring relief
4. Running or walking may actually feel better than sitting or standing for too long - Seek medical help immediately
1. If you have extreme leg weakness, numbness in the genital area, or loss of bladder or
bowel function
2. These are signs of a condition called cauda equinasyndrome
WHAT ARE THE CAUSES?
Sciatica can be caused by a number of conditions
that irritate or compress the sciatic nerve
- Piriformis syndrome: Tightening or spasm of the piriformis muscle can compress the nerve.
- Trauma: A sports injury or fall can fracture the spine or tear a muscle & damage nerves.
- Herniated disc: The gel-like center of a spinal disc can bulge or rupture through a weak
area in the disc wall & compress nerves. - Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord & nerves
- Osteoarthritis: As discs naturally age they dry out & shrink.
1. Small tears in the disc wall can be painful.
2. Bone spurs can form
3.The facet joints enlarge & ligaments thicken. - Spondylolisthesis: A weakness or stress fracture in the facet joints can allow a vertebra
to slip out of position & pinch the nerves.
Leg pain can also be caused by a joint problem in the hip or sacroiliac joint.
This type of referred pain is quite common, but is not sciatica.
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TYPES OF LEG PAIN
Leg pain ranges from mild to severe & can be acute or chronic
Acute sciatic pain
- Occurs suddenly & usually heals within several days to weeks
- The severity relates directly to the amount of tissue injury
- The source of pain may be in the spinal joints, discs, nerves, or muscles & ligaments
Chronic sciatic pain
- Persists for more than 3 months & its source may be hard to determine
- Chronic pain may be felt all the time or worsen with certain activities
- Contributing factors may include nerve damage, tissue scarring, arthritis, or mental effects
of pain - People with chronic symptoms may be referred to a pain specialist
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HOW IS A DIAGNOSIS MADE?
A careful medical exam will attempt to determine the type & cause
of your spine problem & the treatment option.
- A diagnostic evaluation includes a medical history & physical exam
- Sometimes imaging scans (x-ray, CT, MRI) & tests to check muscle strength & reflexes are used.
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WHAT TREATMENTS ARE AVAILABLE
Healing begins with self-care & non-surgical strategies.
The goal is to correct the problem, restore function & prevent re-injury.
- Exercise, strengthening, stretching & ideal weight loss are key elements to your treatment.
- Make these a part of your life-long daily routine.
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SELF CARE
Sciatica often resolves with rest, ice or heat, massage,
pain relievers & gentle stretches.
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Reduce muscle inflammation & pain using an ice pack for 20 minutes several times a day
during the first 48 to 72 hours. - After the ice pack is used, a warm shower or heating pad on low setting may be added to
relax the muscles. - A short period of bed rest is okay, but more than a couple of days does more harm than
good. - If self-care treatments aren't working within the first couple of days, see your doctor.
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MEDICATION
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs),
such as aspirin, ibuprofen or naproxen, can bring relief
- A muscle relaxant may be prescribed for spasms.
- If pain is severe, an analgesic may be prescribed that can be taken with the NSAID or
muscle relaxant. - Steroids can reduce the swelling & inflammation of the nerves.
1. They are taken orally (as a Medrol dose pack) tapered over a five-day period or by
injection directly into the painful area.
2. Steroids may provide immediate pain relief within 24 hours.
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PHYSICAL THERAPY
For most leg pain, we recommend
a nearly normal schedule from when the pain starts.
- Physical therapy can help you return to full activity as soon as possible & prevent re-injury.
- Physical therapists will show proper liftingm, walking techniques & exercises to strengthen
& stretch your lower back, leg & stomach muscles. - Massage, ultrasound, diathermy, heat & traction may also be recommended for short periods.
- Patients may also benefit from yoga, chiropractic manipulation & acupuncture.
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SURGERY
Surgery is rarely needed
- Unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or severe pain that has not resolved after a reasonable course of nonsurgical treatment.
- Surgery for a herniated disc, called a discectomy, removes the portion of the disc compressing the spinal nerve.
- People with stenosis may benefit from a decompression of the nerves.
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