One of the more common health conditions I treat is sciatica. The most prominent symptom of sciatica is leg pain, which typically starts on one side of the lower back and radiates to the buttock and back of the leg on the same side as the back pain. The pain is described as being “deep” or “like a cramp.” Sitting, standing or sneezing may make the pain worse.
You might also notice changes in skin sensation, like numbness or a burning or tingling ("pins and needles"), down your leg, sometimes reaching the foot or toes. In severe cases, there can be weakness that makes it difficult for you to wiggle your foot or your toes.
What causes it?
Sciatica is frequently caused by compression or pinching of the sciatic nerve. It can be caused by several different conditions. The most common cause of sciatica is a slipped disc that causes pressure on the nerve root. Another condition that can cause sciatica is a narrowing of the spinal canal, called spinal stenosis. Finally, there is a condition called spondylolisthesis. In this condition, there is a slippage of one of the backbones (vertebrae) out of line with the bone below, which leads to narrowing of the opening through which the nerve exits.
How will my physician diagnose sciatica?
A complete medical history, including a review of your symptoms and a physical exam, will usually provide your doctor with enough information to determine the likely cause of your symptoms. Often, this is enough for your provider to recommend treatment. However, there are instances in which information you provide during your appointment will lead your doctor to order further testing to help determine the cause with more certainty.
Such testing might include:
- An X-ray of your back to check for problems with the bones
- Magnetic resonance imaging (MRI) or computed tomography (CT) scan to look at the structure of how the bones in your back relate to the nerves – are there areas where the nerve looks to be pinched or crowded?
- Electrical studies of nerves to assess how well electrical impulses travel through the nerves in your legs
How is sciatica treated?
Treatment plans typically include recommendations for limited rest, physical therapy and the use of medication to treat pain and inflammation.
- Medication — Medications may include those to treat muscle spasm, inflammation (such as non-steroidal aspirin, ibuprofen and naproxen or steroidal medications) and medicines designed to treat pain generated by nerves.
- Physical Therapy —The goal of physical therapy is to decrease the pressure on the sciatic nerve by engaging in exercises for that purpose. These programs often include stretching exercises (including yoga) to improve flexibility of tight muscles, as well as aerobic exercise, such as walking.
- Spinal Injections — Injections of a cortisone-like anti-inflammatory medicine into the lower back to reduce swelling and inflammation of the nerve roots are sometimes necessary before patients can begin to engage in more physical activity.
- Surgery — Surgery is usually reserved for patients who do not respond to conservative therapy and who are still in pain or have weakness that interferes with function. Surgical options include things like microdiscectomy and laminectomy. In a microdiscetomy, fragments of the disc that is out of place are removed. In a laminectomy, some portions of the bone around the nerve are removed in order to relieve the pressure off of the nerve.