What is Sciatica and How to Manage It?

Sciatica refers to the pain along the large sciatic nerve that runs from the lower back down through the buttocks and along the back of leg.
Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also referred to as a bulging disc, ruptured disc or pinched nerve). The problem is often diagnosed as a “radiculopathy“, meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root).

Symptoms

For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side, and the pain often radiates through the buttock and/or leg.
One or more of the following sensations may occur:
  • Pain in the buttocks and/or leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the buttocks
  • A shooting pain that makes it difficult to stand up
While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most pain syndromes result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.
Symptoms that may constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. These symptoms may indicate cauda equina syndrome and warrant immediate medical attention.
Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica.

Causes

The most common cause is lumbar herniated disc.
  1. Lumbar spinal stenosis
  2. Degenerative disc disease
  3. Isthmic spondylolisthesis
Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these conditions.

Treatment

Normally the pain along the sciatic nerve is going to get better on its own. It will usually do so within a couple of weeks. In fact, the vast majority of this type of back and/or leg pain usually heals on its own within six to twelve weeks.

Conservative Care

During an episode of sciatic pain there are a number of conservative care options available to help alleviate the pain and discomfort.

Treatment With Heat or Ice

For acute pain along the sciatic nerve, heat and/or ice packs are most readily available and can help alleviate the pain, especially in the acute phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

Medications

Over-the-counter or prescription medications may also be helpful. Non-steroidal anti-inflammatory drugs (NSAIDs) or oral steroids can be helpful in reducing the inflammation and pain.

Epidural Steroid Injections

If the pain is severe, an epidural injection can be performed to reduce the inflammation. An epidural is different from oral medications because it injects steroids directly to the painful area to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), an epidural can be very effective in providing relief from an acute episode of pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning program.

Conservative Care Specialists

A visit to a physical therapist, osteopathic physician, chiropractor or physiatrist can be helpful both to alleviate the painful symptoms and to help prevent future recurrences of sciatica. These conservative care professionals can assist in providing pain relief and developing a program to condition the back.

Surgical Treatments

If the pain is severe and has not gotten better within six to twelve weeks, it is reasonable to consider spine surgery. Depending on the cause and the duration of the pain, one of two surgical procedures may be considered: a microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).

Microdiscectomy (Microdecompression)

In cases where the pain is due to a disc herniation, a microdiscectomy may be considered after 4 to 6 weeks if the pain is not relieved by conservative means. Urgent surgery is only necessary if there is progressive weakness in the legs, or sudden loss of bowel of bladder control. A microdiscectomy is typically an elective procedure, and the decision to have surgery is based on the amount of pain and dysfunction, and the length of time that the pain persists.

Lumbar laminectomy (Open Decompression)

Lumbar spinal stenosis often causes pain that waxes and wanes over many years. Surgery may be offered as an option if the activity tolerance falls to an unacceptable level. Again, surgery is elective and need only be considered when there is no improvement after conservative treatments.