Sciatica

Overview

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

Sciatica most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases clear up with treatment in a few weeks. 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 can feel 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.

When to see a doctor

Mild sciatica usually goes away over time. Call your primary care provider if self-care measures don't ease symptoms. Also call if pain lasts longer than a week, is severe or gets worse. Get immediate medical care for:

• Sudden, severe pain in the low back or a leg and numbness or muscle weakness in a leg
• Pain after a violent injury, such as a traffic accident
• Trouble controlling bowels or bladder

Causes

Sciatica occurs when the sciatic nerve becomes pinched. The cause is usually a herniated disk in the spine or an overgrowth of bone, sometimes called bone spurs, form on the spinal bones. More rarely, a tumor can put pressure on the nerve. Or a disease such as diabetes can damage the nerve.

Risk factors

Risk factors for sciatica include:

• Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
• 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 sciatica.
• Prolonged sitting. People who sit a lot or don't move much are more likely to develop sciatica 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, 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 health care provider 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 health care provider 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. Pain from sciatica will usually get worse while doing these moves.

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 an overgrowth of bone that can be pressing on a nerve.
• MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of the back. An MRI produces detailed images of bone and 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 drugs that might be used to treat sciatica pain include:

• Anti-inflammatories
• Corticosteroids
• Antidepressants
• Anti-seizure medications
• Opioids

Physical therapy

Once the pain improves, a health care provider 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.

Alternative medicine

Alternative therapies often used for low back pain include:

• Acupuncture. The practitioner inserts hair-thin needles into the skin at certain points on the body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner.
• Chiropractic. Chiropractors can make spinal adjustments (manipulation) to restore spinal movement and decrease pain. Spinal manipulation appears to work and to be as safe as standard treatments for low back pain.

Preparing for an appointment

Not everyone who has sciatica needs medical care. If your symptoms are severe or last for more than a month, make an appointment with your primary care provider.

What you can do

• Write down your symptoms and when they began.
• List key medical information, including other conditions you have and the names and doses of medications, vitamins or supplements you take.
• Note recent accidents or injuries that might have damaged your back.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
• Write down questions to ask your provider.

For radiating low back pain, some basic questions to ask include:

• What's the most likely cause of my back pain?
• Are there other possible causes?
• What tests do I need?
• What treatment do you recommend?
• Should I have surgery? Why or why not?
• Are there restrictions I need to follow?
• What self-care measures should I take?
• What can I do to keep my symptoms from coming back?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Do you have numbness or weakness in your legs?
• Do some body positions or activities make your pain better or worse?
• How much does your pain limit your activities?
• Do you do heavy physical work?
• Do you exercise regularly? If yes, with what types of activities?
• What treatments or self-care measures have you tried? Has anything helped?