Sciatica

The type and severity of symptoms of sciatica vary from person to person. Certain activities can make sciatica nerve pain and other symptoms worse. Examples include coughing, sneezing, movement of the back, or sudden movements.

Symptoms of sciatica may include:

• Burning, numbness or tingling in the back, buttock, leg or foot

• Pain in the back, buttock, leg or foot. Pain may shoot down from the lower back through the buttock and leg and into the foot. Pain may also occur in only one area of the lower extremity, such as above the knee or below the knee.

• Weakness in the back, buttock, leg or foot

In some cases, the underlying cause of sciatica can be serious. Seek immediate medical care (call 911) for the inability to feel or move the lower extremity, or loss of bowel or bladder control.

Sciatica frequently occurs due to a bulging or herniated disk in the lower spine. This can pinch or put pressure on the sciatic nerve, which is responsible for movement and sensation in the legs and feet.

Other causes of sciatica include:

• Degenerative disk disease (caused by wear and tear and effects of aging on the spine)

• Osteoarthritis

• Pregnancy

• Spinal tumor (rare)

• Trauma to the spine or back

A number of factors increase the risk of developing sciatica. Risk factors include:

• Age older than 40 years

• Back injury

• Contact sports

• Degenerative spine disease

• Obesity and being overweight

• Occupation that includes heavy lifting, bending, or twisting and using improper lifting techniques

• Sedentary lifestyle or occupation, which can weaken the muscles that support the spine

• Smoking

You can lower your risk of developing sciatica by:

• Maintaining a healthy weight

• Not smoking

• Participating in a regular, but moderate, exercise program that includes stretching and core exercises, which strengthen the muscles that support your abdomen and back

• Taking exercise breaks when sedentary, such as walking and stretching every two hours when working all day at a computer

• Using proper techniques and body mechanics when lifting heavy objects, such as lifting with the legs and not the back

To diagnose sciatica and its underlying cause, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor may ask about sciatica include:

• What symptoms are you experiencing, including pain, numbness or weakness?

• When and how did the pain and other symptoms begin?

• Does the pain radiate or travel?

• How would you describe the pain, such as shooting, burning or stabbing?

• What, if anything, seems to make your symptoms better or worse?

• How are your pain and other symptoms affecting your ability to complete daily activities or work?

• How often do you exercise or get physical activity?

• What treatments have you tried so far?

During the exam, your doctor will focus on your muscles and nerves. This includes checking your muscle strength and reflexes. Your doctor may ask you to squat and rise, walk on your toes or heels, and do a straight leg test. This involves your doctor slowly raising your leg while you lie on your back. You will need to let your doctor know when you feel pain.

Depending on the results, your doctor may order testing including:

• Imaging exams, which may include X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) 

• Nerve conduction studies, such as electromyography (EMG), to measure how well your nerves send signals and how your muscles respond to them

With early diagnosis and treatment, it is possible to reverse the symptoms of sciatica in many cases. Doctors base treatment plans on the underlying cause, the severity of your symptoms, your medical history and general health, and other factors.

Medications doctors use to treat sciatica include:

• Antidepressants, which can help reduce sciatic nerve pain

• Corticosteroid injection into the spine, which reduces inflammation and pain

• Muscle relaxants, which ease muscle tension and pain

• Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which help to control inflammation and pain

• Non-opioid pain drugs, such as tramadol (Ultram), for treatment of chronic sciatic pain

• Short-term opioids for acute sciatic pain relief

Depending on the underlying cause of sciatica, doctors may recommend a variety of other treatments and therapies including:

• Chiropractic therapies, such as spinal manipulation, electrical stimulation, and trigger-point therapy

• Complementary therapies, such as yoga, acupuncture, massage and biofeedback

• Physical therapy and prescribed exercise to improve muscle strength in the back and abdomen, increase flexibility and movement, and reduce pain

Surgery may be necessary in some cases. Doctors may recommend it to relieve severe pain or to address leg weakness or bowel or bladder incontinence. Options include laminectomy or discectomy, both of which relieve pressure on the sciatic nerve.

Complications of sciatica can have a profound effect on the ability to function in everyday life. In some cases, it can be permanently disabling.

You can reduce the risk of serious complications of sciatica by following the treatment plan you and your doctor design specifically for you. Complications of sciatica include:

• Abuse and misuse of medications used to treat sciatica

• Adverse effects of treatment

• Bladder incontinence

• Bowel incontinence

• Loss of leg movement

• Permanent disability

• Poor quality of life