Sciatica

[This post was written with Jeanne Schulz, RN, MSN]

Sciaticais a symptom. It consists of leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible.

The pain might be worse when you sit, sneeze, or cough.  Sciatica can occur suddenly or it can develop gradually.  You might also feel weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes.  Less common symptoms can include the inability to bend your knee or move your foot and toes.

What causes sciatica?

Sciatica can 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.

Conditions that cause sciatica:

  • A herniated or slipped disc that causes pressure on a nerve root — This is the most common cause of sciatica.
  • Piriformis syndrome — This develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve.
  • Spinal stenosis — This condition results from narrowing of the spinal canal with pressure on the nerves.
  • Spondylolisthesis— 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 complete medical history, including a review of your symptoms, and a physical exam can help the health care provider diagnose sciatica and determine its cause.  For example, he or she might perform a straight-leg-raise test, in which you lie on your back with your legs straight.  The health care provider will slowly raise each leg and note the elevation at which your pain begins.  This test can help pinpoint the affected nerves and determine if there is a problem with one of your discs.

Other diagnostic tests might be performed to look for other causes of sciatic pain.  Depending on what your health care provider finds, he or she might recommend further testing.  Such testing might include:

  • X-ray to look for fractures in the spine
  • 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 the vertebrae to determine if a vertebra or disc is causing the pain

However, most patients with sciatica can be treated without the need for further diagnostic testing.

How is sciatica treated?

The goal of treatment is to decrease pain and increase mobility.  Treatment most often includes limited rest (on a firm mattress or on the floor), physical therapy, and the use of medicine to treat pain and inflammation.  A customized physical therapy exercise program might be developed.

Medicine — Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise.  There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs).  They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).

Muscle relaxants, such as cyclobenzaprine (Flexeril), or Skelaxin, might be prescribed to relieve the discomfort associated with muscle spasms.

Physical therapy —The goal of physical therapy is to find exercise movements that decrease sciatic pain by reducing pressure on the nerve.

Spinal injections — An injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility.

Surgery — Surgery might be needed for people who do not respond to conservative treatment, who have progressing symptoms, and are experiencing severe pain.

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