sciatica

You may have heard people complaining about their sciatica, but what exactly is it? Sciatica is a symptom. It consists of leg pain, which could feel like a bad leg cramp, or it can be an excruciating, shooting pain that makes standing or sitting nearly impossible. If you have ever experienced the radiating pain that shoots from your spine to your bottom and down the back of your leg it is more than likely sciatica. You can feel the discomfort almost anywhere along the nerve pathway but more than likely, it will follow the path from your low back to your bottom and the back of your thigh and calf.

What causes sciatica?

The sciatic nerve is the longest nerve in your body. It is comprised of two branches on either side of the spine. The root of each nerve exits the spine from several locations including the two lowest vertebrae in the lumbar spine. It travels down the back of each leg all the way to the foot and toes. Sciatica could be a symptom of a pinched nerve affecting one or more of the lower spinal nerves. The nerve may be pinched inside or outside of the spinal canal as it passes into the leg. The most common cause of sciatica is a herniated or slipped disc that causes pressure on the nerve root. Other causes include:

  • Piriformissyndrome- this develops when the piriformis muscle, a small muscle in your bottom, becomes tight or spasms which can irritate the sciatic nerve

  • Spinal stenosis- a condition resulting from the narrowing of the spinal canal causing pressure on the nerves

  • Spondyloisthesis- this is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits

 

How is sciatica diagnosed?

A full medical history will be taken and a physical will be given. The doctor may perform a straight leg test in which you lie on your back with your legs straight and then the doctor will slowly raise each leg and note the elevation at which your pain begins. By doing this, the doctor can help pinpoint the affected nerves and determine if there could be a problem with one of your discs. Most patients with sciatica can be treated without the need for further testing but other diagnostic tests may be performed to look for other causes of sciatic pain such as:

  • X-rays

  • Magnetic resonance imaging (MRI) or computed tomography (CT) scan to create images of the structures of the back

  • Nerve conduction velocity studies, evoked potential testing, or electromyography to examine how well electrical impulses travel through the sciatic nerve

  • Myelogram using dye injected between vertebrae to determine if a vertebra or disc is causing the pain

 

How it sciatica treated?

Decreasing pain and increasing mobility is the goal of treatment. Treatment most often includes rest but other treatment options include:

  • Physical therapy—finding exercise movements that decrease pain by reducing sciatic nerve pressure is the goal

  • Spinal injections

  • Medication, including over the counter medications such as asprin, ibuprophen (Motrin, Advil) and naproxen (Aleve, Naprosyn) and muscle relaxers prescribed by a physician

  • Surgery—as a final effort, surgery could be needed for those who do not respond to conservative treatment or for those who have progressing symptoms and are experiencing severe pain

 

When should I seek treatment?

Chronic pain is a complication of untreated sciatica. If the “pinched nerve” is seriously injured, chronic muscle weakness, such as “drop foot” might occur. Mild sciatica can go away given time and patience. If you have tried resting and other self-care measures and nothing has eased your pain or if your symptoms have lasted longer than a week, are severe or becomes progressively worse, seek medical care. Get immediate attention if:

  • You experience sudden, severe pain in your lower back or leg and numbness or muscle weakness

  • The pain follows an injury such as a car accident

  • You have trouble controlling your bowels or bladder

 

At Performance Rehabilitation and Integrated Medicine we have a staff of knowledgeable pain management physicians chiropractors, physical therapists, massage therapists, and acupuncturists who can help get you relief from sciatica. Contact us at 908-756-2424 for an appointment.