What is Sciatica?

Sciatica is low back (buttock) or leg pain.  This may feel like a bad cramp, or it can be
an excruciating shooting pain that makes standing or sitting miserable.
Sciatica can develop gradually or it can occur suddenly. You can experience a
weakness, numbness, or a burning or tingling sensation down the back of your leg
extending to the toes.

What causes sciatica?
•        A herniated or slipped disc that causes pressure on a nerve root — This is the
most common cause of sciatica.
•        Piriformis syndrome — This develops when the piriformis muscle, a small muscle
that lies deep in the buttocks spasms, which constricts and irritates the sciatic nerve.  
This is common in athletes, after carrying objects (mothers, movers), and by direct
compression (long distance driving with a wallet in the rear pocket).
•        Spinal stenosis — This condition results from narrowing of the spinal canal with
pressure on the nerves either due to our normal aging process or chronic movement.
•        Spondylolisthesis — This is a slippage of one vertebra so that it is out of line
with the one above or below it, narrowing the opening through which the nerve
exits.  This may be caused by trauma or our normal aging process.

How is sciatica diagnosed?
Depending on what your health care provider finds, he or she might need the
following tests:
•        X-ray to look for fractures in the spine
•        Magnetic resonance imaging (MRI) or computed tomography (CT) scan to create
images of the structures of the back
•        Nerve conduction velocity studies, evoked potential testing, or
electromyography to examine how well electrical impulses travel through the sciatic
nerve
•        Myelogram using dye injected between the vertebrae to determine if a
vertebra or disc is causing the pain

How is sciatica diagnosed?
Your primary care physician can provide a referral to the Acute Response Testing
Center for a testing to determine the cause of your sciatica.

How is sciatica treated?
The goal of treatment is to decrease pain and increase mobility. Treatment most
often includes limited rest (on a firm mattress or on the floor), physical therapy, and
the use of medicine to treat pain and inflammation. A customized physical therapy
exercise program might be developed.

Medicine — Pain medicines and anti-inflammatory drugs help to relieve pain and
stiffness, allowing for increased mobility and exercise. There are many common over-
the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They
include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).  Tylenol is
not an NSAID, but is generally used in the older population or in those with known
stomach ulcers or on blood thinning medications.

Muscle relaxants and anti-anxiety medicines, such as Flexeril or Xanax, might be
prescribed to relieve the discomfort associated with muscle spasms.  However, these
medicines may cause confusion in older people. Depending on the level of pain,
prescription pain medicines might be used in the initial period of treatment.

Physical therapy —The goal of physical therapy is to find exercise movements that
decrease sciatic pain by reducing pressure on the nerve. A program of exercise often
includes stretching exercises to improve flexibility of tight muscles and progressive
walking.

The therapist might also recommend exercises to strengthen the muscles of your
back, abdomen, and legs. Massage might help muscle spasms that often occur along
with sciatica.

Spinal injections — An injection of a cortisone-like anti-inflammatory medicine into the
lower back might help reduce swelling and inflammation of the nerve roots, allowing
for increased mobility.

Surgery — Surgery might be needed for people who do not respond to conservative
treatment, who have progressing symptoms, and are experiencing severe pain.

What complications are associated with sciatica?
Chronic (ongoing and lasting) pain is a complication of untreated sciatica. If the
"pinched nerve" is seriously injured, chronic muscle weakness, such as a "drop foot,"
might occur.

What is the outlook for people with sciatica?
Sciatic pain usually goes away with time and rest. Most people with sciatica (80
percent to 90 percent) will get better without surgery. About half of affected
individuals recover from an episode within six weeks.

Can sciatica be prevented?
•        Some sources of sciatica are not preventable, such as degenerative disc
disease, back strain due to pregnancy, and accidental falls.
•        Although it might not be possible to prevent all cases of sciatica, you can take
steps to protect your back and reduce your risk.
•        Practice proper lifting techniques. Lift with your back straight, bringing yourself
up with your hips and legs, and holding the object close to your chest. Use this
technique for lifting everything, no matter how light.
•        Avoid/ stop cigarette smoking, which promotes disc degeneration.
•        Exercise regularly to strengthen the muscles of your back and abdomen, which
work to support your spine.
•        Use good posture when sitting, standing, and sleeping. Good posture helps to
relieve the pressure on your lower back.
•        Avoid sitting for long periods.
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