Sciatica

Sciatica Overview

Sciatica refers to a variety of symptoms including leg pain, tingling, numbness or weakness originating in the lower back and moving through the buttocks to the back of the thigh and into the leg. The pain usually occurs because a herniated disk in the spine is pinching the sciatic nerve. The sciatic nerve is the longest nerve in the body and is made up of various roots that branch out from the spine in the lower back and down the back of each leg.

Wellstar neurologists and neurosurgeons are expert in treating sciatica, including complex cases that may affect other organs and functions.

The impact of sciatica can range from irritating to incapacitating. Sciatica will sometimes heal on its own with sufficient time and rest. In other cases, an injection or surgery may be recommended.

Other causes include:

Slipped disk
Spinal stenosis
Piriformis syndrome
Tumors
A nerve damaged by diabetes

Sometimes a herniated or bulging disk will press on nerves that affect bladder and bowel control. This is typically accompanied by numbness or tingling in the groin or genital area. If you or someone else is experiencing these symptoms you should contact your Wellstar neurologist immediately, as surgery may be required.

Symptoms

Symptoms of sciatica vary according to where the nerve is being pinched. For example an L5 nerve problem (L5 refers to a particular lumbar disk) can result in pain and difficulty extending the big toe and moving the ankle.

Among symptoms of sciatica:

Constant pain in one side of the buttock or leg
Pain that makes it hard to stand or walk
A sharp, cramp-like feeling in the leg
Mild tingling down the leg
Dull ache
Burning sensation
Sharp pain in one part of the leg or hip and numbness elsewhere
Pain that worsens after standing or sitting, at night, when sneezing/coughing/laughing, when bending backward or when walking more than a few yards

Risk Factors

Factors including the following can increase the chance for sciatica:

Age. The disks that make up the spine begin to deteriorate and thin by age 30. With increasing age the disks lose moisture and shrink, which can also contribute to sciatica
Certain occupations. Jobs that require lifting, bending, twisting and vibration (such as long-haul trucking)
Prior problems. Certain low back conditions and injuries in childhood
Psychological problems. Some researchers believe that depression, emotional distress and job dissatisfaction contribute to physical problems including sciatica
Pregnancy. The shifting of organs and redistribution of body weight may increase the chance of sciatica in pregnant women
Obesity. Extra weight puts additional stress on the spine
Excessive sitting. People who sit a great deal are more likely to develop sciatica than others
Diabetes. The risk of nerve damage is increased with diabetes, which affects the body’s use of blood sugar

Sciatica Prevention

While sciatica cannot be prevented, there are a number of things you can do to decrease the chance of having it or other spinal conditions.

Lift correctly at home and at work. Let the legs do the work and avoid twisting and pushing.
Use good posture when standing, sitting and driving.
Exercise regularly to strengthen the muscles that support the back. Ask your Wellstar physician if you are unsure which exercises are smart or safe to do.
Maintain a healthy weight to reduce extra pressure on the back.
Try to sit less and move more.

Sciatica Diagnosis

Your Wellstar physician will start the diagnosis process by taking a complete patient history. You will be asked questions about your pain, other symptoms, occupation and lifestyle.

A physical examination can help pinpoint the irritated nerve root. Your doctor may ask you to squat, rise and walk on your heels and toes in order to identify the source of the problem. The exam will reveal problems like weakness when bending the knee, difficulty bending the foot, abnormal or weak reflexes, loss of sensation, numbness or pain when lifting the leg straight up.

Tools and Tests

Certain imaging tests, including blood tests, X-ray, MRI and CT with contrast dye can help confirm the location of the nerve roots responsible for your sciatica.

Your doctor may also recommend electromyography (EMG) and nerve conduction study (NCS). These diagnostic procedures are used together to record and analyze electrical impulses in the muscles.

Sciatica Treatment

Often sciatica will heal itself within several weeks. Non-surgical treatments include stretching and over-the-counter non-steroidal anti-inflammatory drugs (ibuprofen, aspirin, and muscle relaxants) may help, as well as gentle heat or cold. It is important to move around and not stay in bed, which can cause discomfort from other parts of the body.

In some cases the compression is related to nerve problems rather than lower back pain. These cases should be seen and treated by a neurologist or neurosurgeon.

One treatment option for severe sciatica is an epidural steroid injection to reduce inflammation. The reduction in pain may last from a week to a year depending on the patient. Your Wellstar neurologist will answer your questions about this procedure and if it is right for you. Other medicines and physical therapy may be recommended.

Surgery

When severe sciatica does not respond to non-surgical treatments, surgery may be an option. The goal of the surgery is to remove the herniated disk so that it no longer presses on the nerve. Following surgery you will likely be up and moving quite quickly and will be given exercises to strengthen your back.

Your Wellstar neurosurgeon will discuss surgical options in detail with you to make sure you understand the benefits and risks.

Ongoing Care for Sciatica

People with sciatica often feel better within a few weeks after resting and using conservative treatments. The goal is to continue regular activities by avoid the trigger that set off the pain. Call your Wellstar physician if self-care methods do not help and if pain persists for more than week, becomes severe or worsens.