What is sciatica?
Sciatica—also known as lumbar radiculopathy—is not a condition but rather a term used to describe a series of symptoms that occur when the sciatic nerve is irritated. This large nerve runs from the lower back, past the buttocks, and down each leg.
What causes sciatica?
Sciatica occurs when the sciatic nerve is being pinched (impinged) by something else in the spine. This can be due to a number of common spine issues, including:
- Bone spurs, an overgrowth of bone on a vertebra that can press on the nerve
- Degenerative disc disease (DDD), where weakened spinal discs (the cushions between the vertebrae)
- Disc herniation, which happens when a spinal disc cracks and the center leaks out and presses against the nerve or nerve roots
- Isthmic spondylolisthesis, where one vertebra slips over the other and pinches a nerve root
- Spinal stenosis, a narrowing of the spinal canal that can result in nerve impingement
There are also a number of risk factors that play into potentially developing sciatica. These include:
- Activity level: Patients are less active or sit for long periods of time are more likely to develop sciatica
- Occupation: Jobs that require a lot of twisting, heavy lifting or long periods of sitting may increase the risk of sciatica happening
What are the symptoms associated with the term sciatica?
Along with the pain mentioned above, sciatica can refer to numbness, tingling or weakness that typically only occurs on one side of the body. These symptoms can range from a mild ache to a sharp, intense pain or jolt-like shock while moving.
Symptoms don’t last that long and usually go away within a week or two. However, if they don’t improve, seeing a physician about persistent symptoms is recommended. It’s also important to note that immediate medical attention at a hospital is needed if patients experience any of the following in addition to sciatica:
- Fever with increasing pain that does not get better after taking a fever/pain reducer, such as Tylenol® or Motrin®
These symptoms—though rare—can indicate that there may be serious damage to the sciatic nerve or cauda equine syndrome, a compression of the nerve sac in the lower spine.
How is sciatica diagnosed?
To confirm a diagnosis, a physical exam is done which may include the patient performing tasks that involve testing muscle strength and reflexes, including:
- Lifting the legs while lying flat
- Rising from a squatting position
- Walking on toes or heels
Pain or other symptoms that worsen during these activities are a positive sign that sciatica is the cause.
Diagnostic testing may be recommended to confirm a diagnosis, including:
- A computed tomography (CT) scan to get a better look at the spinal cord and nerves
- A magnetic resonance imaging (MRI) scan for detailed images of the spine and surrounding tissues to see what may be causing the compression
- An electromyography (EMG) test, which measures electrical impulses that nerves produce and muscle response
- An X-ray to reveal any bone spurs that may be pressing on the nerve
How is sciatica treated?
In most cases, sciatica will resolve on its own through self-care (e.g., stretches, over-the-counter pain medication, hold/cold packs). However, should symptoms not improve over time, a physician may recommend other treatment methods.
The following may be prescribed by a physician to relieve sciatic pain:
- Certain anti-seizure medications
- Muscle relaxants
- Tricyclic antidepressants
Aside from oral medications, corticosteroid injections may also be an option for pain relief and are usually administered by a pain management specialist. These injections are inserted near the trouble area to relieve inflammation around the part of the nerve that’s irritated.
After the pain has somewhat subsided, a physical therapist can create a rehabilitation program for patients that can help prevent sciatica from reoccurring in the future. This can include exercises to correct posture, strengthen back muscles and increase flexibility.
In rare cases (e.g., if there is a loss of bowel/bladder control) surgery may be necessary to relieve pressure on the compressed nerve. This can include minimally invasive and open surgical procedures to remove whatever may be causing the nerve impingement, such as a bone spur or herniated disc.
For more information about sciatica or to schedule an appointment with one of our specialists, contact us today.