Sciatica

*If you are experiencing back pain, see a doctor who can determine the cause. If the pain spreads down your leg or is accompanied by tingling, numbness or weakness, see a doctor immediately. Occasionally, sciatica may be caused by a serious condition that requires immediate surgery.

Sciatica refers to pain along the path of the sciatica nerve. It is usually caused by pressure on the sciatic nerve. Fortunately, most cases of sciatica are not serious and usually resolve within six weeks.

The sciatic nerve branches off nerve roots at the lower end of the spinal cord – it’s two branches run from the lower back through the each side of the pelvis, buttocks, back of leg to the foot. The sciatic nerve is the longest nerve in the body and its diameter is the diameter of a finger

Sciatica Symptoms

Sciatica is a term for pain that radiates along the sciatic nerve, anywhere from the lower back, buttocks, down the back of the leg, to the foot. There may also be weakness, numbness, tingling, particularly in the leg and/or foot. The location of the pain and/or numbness varies according to the location that the sciatic nerve or nerve root is affected. The pain can range from burning to aching and can vary in intensity. The pain may be intermittent or constant. Sciatica usually occurs on only one side of the body. Prolonged sitting or standing, sneezing, coughing or lifting aggravates sciatica. Sciatic pain may be acute but often develops gradually

Causes of Sciatica

Sciatica is caused by inflammation or compression of the sciatic nerve or nerve roots in the lower spine. It may also be caused by damage to nerve roots. Sciatica is not a disease in itself and its causes are various.

*Compression of a nerve is often referred to as a "pinched nerve." A "pinched nerve" in the lower spine causes sciatica.

The most common cause of sciatica is a herniated disc in the lumbar spine (lower back) that puts pressure on the sciatic nerve or a nerve root. A herniated disc can occur suddenly and cause acute pain or it may develop gradually.

Spinal stenosis is a narrowing of the spaces in the spinal column that causes compression of the spinal cord or nerve roots. It can cause sciatica if it occurs in the lower back.

In advanced osteoarthritis of the spine, bits of cartilage may break off and float around inside the spinal joints. This causes irritation and inflammation and if it occurs in the lower back may put pressure on the sciatic nerve.

Spondylolisthesis – when one vertebra slips over another – occurs most often in the lower back – where the misaligned vertebrae may place pressure on the sciatic nerve.

A less common cause of sciatica is Piriformis syndrome, a disorder in which a muscle located in the buttocks (the piriformis muscle) contracts and irritates the sciatic nerve. In this case, the pain starts in the buttocks and radiates down the leg. Piriformis syndrome is generally treated with stretching exercises, massage, and anti-inflammatory drugs.

Something as simple as muscle strain can cause inflammation, which may put pressure on the sciatic nerve.

Sciatica Treatment / Pain Relief

*Always consult a physician to diagnose the cause of sciatica and rule out any serious conditions that may require immediate surgery.

Treatment consists of treating the pain and the condition that is causing it. Anti-inflammatory medication, analgesics, and usually some form of physical therapy are prescribed.

Medications: Non-prescription NSAIDs (anti-inflammatory drugs) such as aspirin and ibuprofen treat both pain and inflammation. Analgesics such as Tylenol treat pain but not inflammation, but may be preferred by some people. In cases of severe acute sciatica, physicians may prescribe codeine preparations and/or muscle relaxants.

An injection of corticosteroids, a powerful anti-inflammatory, into the spinal fluid around the affected area delivers a high dose of medication to the spinal nerves.

Exercise: A couple of days of bed rest may be necessary with acute, severe sciatic nerve pain. Bed rest will not speed up recovery, and it can actually hinder it. Not using the muscles causing them to weaken very quickly. Muscles – back and ab muscles - are what supports and protects the joints of the spine. Exercise also increases circulation and promotes healing.

*Depending upon the cause of sciatic pain, certain exercises may have to be avoided. Always consult a doctor as to the safely of exercises for your particular condition.

Stretching exercises are usually recommended to relieve sciatica. Stretching exercises loosen tight muscles and increase spaces between the vertebrae, allowing more room for the spinal nerves. Stretching muscles in the back and buttocks and even the hamstrings (muscles in the back of the thigh) can relieve sciatica. See Back Exercises.

*A physical therapist can create an individualized exercise program for a patient’s particular condition. Depending upon the cause of sciatic pain, certain exercises may have to be avoided.

Severe Acute Sciatica: Though bed rest does not speed up recovery, in the case of acute sciatica lying down on a firm surface often relieves the pain. Applying ice for the first couple of days of acute sciatica may also help.

Treating Muscles Spasms: Muscles may spasm in a reaction to sciatica, intensifying the pain. Sciatica may also be caused by muscle spasms that irritate the spinal nerves. Massage therapy may be helpful. Stretching exercises also loosen up tight muscles. Heat also relaxes tense muscles. Moist heat may be more effective. See hydrotherapy.

Support/ Posture: Sitting on soft surfaces aggravates sciatica - adequate support is necessary to prevent slouching, which places excessive stress on the lower back. A chair that tilts back slightly shifts your weight onto the backrest of the chair to take stress off the lower back. Support is necessary while lying down too. A saggy mattress causes the lower back to sink into the mattress and can irritate the spinal joints and aggravate sciatica. Any increase or decrease in the normal curve of the lower back increases stress on the spine and aggravates sciatica. See Posture.

Avoid heavy lifting, which places extreme stress on the lower back. Use proper body mechanics. See lifting techniques.

Avoid prolonged sitting or standing, which can aggravate sciatica. (Your lower back supports the majority of the body weight)

Other Pain Treatments: The use of Heat and Cold are often used to relieve pain. Traction is not recommended for acute sciatica but is commonly used to relieve chronic lower back pain, especially sciatica. See Back Pain Treatment and Complementary Treatments for more pain relief information.

Invasive Treatment

Spinal Injections: Before considering surgery, but after conservative, non-invasive treatments have not provided adequate pain relief, an epidural steroid injection may be given. This minimally invasive procedure involves injecting a combination of corticosteroids and a local anesthetic into the epidural space.

Surgery: If conservative treatments do not bring adequate pain relief, surgery becomes a consideration. If there is progressive weakness or difficulty in walking (possible progressive nerve damage) surgery is may be necessary. Immediate surgery is required if there is or loss of bladder or bowel function.

Sciatica Prevention with Exercises:

*If you currently have sciatica, consult a physician who can diagnose the cause and recommend appropriate exercises.

Keeping the back muscles strong and flexible reduces the risk of a herniated disc, the most common cause of sciatica. Low impact aerobics increase circulation and promote healing. Walking, swimming, and riding a stationary bike are good low-impact aerobic exercises. Strengthening the muscles that support the spine (back and abdominal muscles) help maintain proper posture, which takes stress off the spinal joints. Strengthening exercises may cause the muscles to tighten up so stretching exercises are important. Stretching exercises that increase the spaces between the vertebrae and create more room for the discs may relieve pressure on nerves. Exercise can help prevent or slow down age-related degenerative changes in the spine and can help prevent sciatica from recurring.