Sciatica

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Introduction

What is sciatica?

Sciatica refers to a group of symptoms that occur when either sciatic nerve is compressed, injured or inflamed. The sciatic nerves are the longest nerves in the body. They branch out from the spinal cord in the lower back and run through the buttocks and down the legs. The sciatic nerves and their branches are responsible for both movement and sensation in the legs and feet.

Compression, injury or inflammation of the sciatic nerve results in symptoms that typically include pain anywhere along the nerve path through the buttock, leg and foot on the affected side. Weakness and numbness can also occur. There can be marked variability in the specific combination of motor and sensory symptoms. A common cause of sciatic nerve compression and inflammation is a herniated, or bulging, disk in the lower spine. Sciatic nerve compression can also be due to general wear and tear on the spine and the disks that cushion the vertebrae of the spine.

Sciatica is treatable. Treatment for sciatica varies depending on the severity of your symptoms, the presence of complications, your age and medical history, and the type of work and activities you perform.

Seek prompt medical care if you experience symptoms of sciatica, such as pain that runs down the leg. Early diagnosis and treatment can reduce or eliminate symptoms and complications, such as loss of leg movement and disability. Seek immediate medical care (call 911) if you, or someone you are with, have loss of leg movement or sensation, or loss of bowel or bladder control (incontinence).

Symptoms

What are the symptoms of sciatica?

The type and severity of symptoms of sciatica vary among individuals. Certain activities, such as coughing, sneezing, movement of the back, or sudden movements, can make symptoms worse.

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

Symptoms that might indicate a serious condition

In some cases, the underlying cause of sciatica can be serious. Seek immediate medical care (call 911) if you, or someone you are with, cannot feel or move the lower extremity, or have loss of bowel or bladder control (incontinence).

Causes

What causes sciatica?

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

What are the risk factors for sciatica?

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

Reducing your risk of sciatica

You can lower your risk of developing sciatica by:

  • Maintaining a normal 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

Treatments

How is sciatica treated?

With early diagnosis and treatment, it is possible to reverse the symptoms of sciatica in many cases. Treatment plans use a comprehensive approach individualized to the underlying cause, the severity of your symptoms, your medical history and general health, and other factors. Treatment also includes diagnosing and treating any underlying conditions that may be causing sciatica, such as a spinal tumor, herniated disk, and osteoarthritis.

Medications used to treat sciatica include:

  • Antidepressants, which can help to reduce nerve pain
  • Corticosteroid medications, which reduce inflammation and pain. Corticosteroids are generally given through direct injection into the spine.
  • 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. The use of NSAIDs can cause serious, even life-threatening side effects and adverse events in some people and should only be used as recommended by a physician.
  • Non-opioid pain drugs that work at the opioid receptor (Tramadol) for treatment of chronic sciatic pain
  • Short-term opioids for relief of acute sciatic pain

Depending on the underlying cause of sciatica, a variety of treatments and therapies may be recommended including:

  • Bedrest, a mainstay of treatment in the past (now discouraged)
  • Chiropractic therapies, such as spinal manipulation, electrical stimulation, and trigger-point therapy
  • Physical therapy and prescribed exercise to improve muscle strength in the back and abdomen, increase flexibility and movement, and reduce pain

Surgery to relieve severe pain or to address bowel incontinence, bladder incontinence, or leg weakness. Surgical options include laminectomy or diskectomy, both of which relieve pressure on the sciatic nerve.

What are the potential complications of sciatica?

Complications of sciatica can have a profound effect on the ability to function in everyday life and can be permanently disabling in some cases. You can reduce the risk of serious complications of sciatica by following the treatment plan you and your health care professional design specifically for you. Complications of sciatic 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
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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2019 Jan 5
    1. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study. Spine (Phila Pa 1976) 2012; 37:678
    2. Sciatica. American Academy of Orthopedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00351
    3. Sciatica. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000686.htm
    4. Sciatica Frequently Asked Questions. Sciatica.org. http://www.sciatica.org/piriformis/faq.html
    5. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 2012; 344:e497
    6. Chou R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976) 2009; 34:1066
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