Sciatica is a term used to describe pain or discomfort related to the sciatic nerve. This nerve (which is the longest in the body) starts at the lower back, divides in two and runs down the hips, buttocks, legs and feet. Sciatic pain starts as lower back pain and travels the route of the nerve. It is a fairly common disorder, with approximately 40 percent of the population experiencing it at some point in their lives.
Contrary to common belief, sciatica is not a diagnosis. Rather, it is a symptom of another underlying medical issue. These issues typically include degenerative disc disease, lumbar herniated discs, spinal stenosis, spondylolisthesis, piriformis syndrome, pregnancy, nerve impingement (pinched nerve) and injury.
Although there is no way to predict the onset of sciatica, knowing the risk factors can help you prepare if symptoms arise in the future or understand your condition if they currently exist. Common risk factors include:
- Age-related changes in the spine
- Genetics (e.g., inherited abnormalities of the spine)
- High-impact sports/exercise
- Nerve injury
- Occupations which include heavy lifting and/or twisting of the back
- Prolonged sitting
- Psychological factors (e.g., depression, emotional distress)
- Sedentary lifestyle
- Smoking/alcohol consumption
(If you’ll notice, many of the risk factors are related to lifestyle, a fact that has been confirmed by an evaluation of scientific studies. This means that you have significant control over adapting to lifestyle modifications.)
Symptoms of sciatica can be intermittent and/or worsen under certain conditions. They can come on gradually or suddenly. Symptoms include:
- A “pins and needles” sensation
- Buttock pain made worse by sitting
- Lower back, hip, leg and/or foot pain (usually on one side of the body)
- Numbness or weakness of the leg and foot
- Pain that improves lying down or by walking
- Pain that is aching, tingling, burning or stabbing
- Shooting pain leading to difficulty standing up
It’s important to note that symptoms can intensify with sudden movements or when sneezing, coughing, laughing, bearing down during a bowel movement or bending backwards. It’s also important to recognize when symptoms require medical attention.
You should seek medical attention when:
- Symptoms get worse instead of improving
- Symptoms are present in both legs (bilateral sciatica)
- Sciatica onsets following an accident or trauma
- Sciatica develops simultaneously with other symptoms, such as fever or loss of appetite
A visit to your doctor will include a thorough review of symptoms and some basic exams. Keeping track of your symptoms (i.e., writing them down in a diary) can help your doctor identify the cause of sciatica and develop an individualized treatment plan for you.
Initially, a physical exam is conducted. This allows your doctor to observe range of motion, examine posture and pinpoint causes of pain. Your physician may also include a check of your spine for alignment and an exploration of any muscle spasms.
This assessment also includes a neurological exam, during which there is a test of muscle strength, reflexes and any other nerve changes. You may be asked to walk on your heels or toes, lift each leg while lying on your back or rise from a squatting position. Pain generated from these tests is a telltale sign of sciatica.
The final diagnosis is made by a trained specialist using patient history, physical exam and sometimes further diagnostic modalities such as MRI, CT scans and X-ray imaging.
If sciatica is mild, it can resolve on its own. To that end, there are a number of helpful remedies that might provide relief. However, it is important that every patient be assessed for the viability of undertaking any remedies. A well-tailored plan by a medical expert can insure a program that is both safe and useful for each individual.
Cold and heat. Apply cold for 20 minutes several times a day. For prolonged pain, try alternating heat and cold.
Medication. Try over-the-counter pain medications. Speak with your pain management specialist if you feel the need to explore stronger medications available only by prescription.
Physical therapy. This utilizes both passive (e.g., massage, heat/cold therapy) and active treatments (e.g., prescribed exercise).
Yoga, stretching and strengthening. Many exercises can help strengthen muscles, ligaments and tendons in order to support the spinal column. Flexibility leads to relief by taking pressure off of compressed nerve roots.
At Nova Spine & Pain Centers, we encourage anyone with sciatica (either on one side or both) to seek medical attention as even if the symptoms are improving, a treatment plan can be introduced to prevent sciatica from recurring. Among possible treatments, many of our patients find relief with our minimally-invasive techniques, such as epidurals. Our pain management specialists have a unique understanding of the physical and emotional impact of conditions such as sciatica and how to combine a variety of treatments to improve quality of life.