Taking the “Ouch” out of Sciatica
Back pain is one of the top 3 reasons that people seek medical care. Back pain is one of the most common reasons for Americans to miss work and one-half of all Americans admit to having back pain symptoms each year. One of the most common types of ‘back problems’ is sciatica. Studies have reported that a person’s risk of experiencing sciatica is somewhere between 13-40% in their lifetime.
What is Sciatica?
Sciatica is a term used to describe pain radiating down the leg along the course of the sciatic nerve. This term has been in use since the 15th century and is still commonly used today. The term sciatica is a general description of a symptom. Just like the term “headache” implies someone’s head is hurting, “sciatica” implies radiating leg pain. These terms are helpful descriptors but do not fully identify the source of the symptoms.
What causes Sciatica?
Just as headaches can have many causes (tension, migraine, caffeine withdrawal, tumor, aneurysm, etc), sciatica also has many potential causes. The most common cause of sciatica is irritation of a nerve root in the low back; often by a bulging or herniated disc, narrowing of the spinal canal (spinal stenosis), or slipping of the disc (spondylolisthesis). Other common causes of sciatica include piriformis syndrome, sacroiliac joint dysfunction, facet/zygapophyseal joint pain, or vascular problems. There are even rare cases where sciatica is caused by conditions such as infections, autoimmune problems, and cancers. Seeking medical advice for sciatica is important so that your treatment can be tailored to the root cause of your pain. In the rare instance that you are suffering from one of the more serious conditions, it can be addressed quickly.
How is Sciatica Diagnosed?
Sciatica can present in several different ways. Patients typically complain of shooting pain that runs down the back of their thigh or in other parts of the leg. Some patients compare the nerve pain to that of a toothache, while others will describe it as a sharp/stabbing pain, or say that their leg feels burning, numb, or tingling. Occasionally, patients will describe weakness in their legs or feet as well.
The best way to diagnose sciatica is to see a physician who will get a history of your symptoms and perform a physical exam. There are certain physical exam tests that can reproduce the sciatica symptoms, indicating a particular source for the problem or a neurological deficit that corresponds with a particular nerve distribution. These exam maneuvers can inform your physician of the most likely source for your sciatica and help guide the next steps of your treatment. The physician will determine if additional tests such as X-Ray, CT Scan, MRI, or EMG need to be performed.
How is Sciatica Treated?
The treatments chosen should be tailored to the underlying cause of sciatica. Fortunately, most causes for sciatica typically respond well to conservative treatments. These conservative treatments include – ice, heat, stretching, home exercises, physical therapy, spinal manipulation/chiropractic, medications (NSAIDs, acetaminophen, steroids, or nerve pain medications such as gabapentin), and occasionally acupuncture or massage.
Physical therapy for sciatica typically involves a mechanical assessment that allows the therapist to customize the treatments based on which motions aggravate or alleviate the symptoms. The most common type of mechanical assessment for sciatica is called the McKenzie method. Medications can be prescribed to decrease the patient’s pain and disability by reducing inflammation, pain, and muscle spasms, while still encouraging normal function. Narcotics/opioids are often avoided and used only for a very short and limited period when absolutely necessary due to the risks of sedation and other undesirable side effects.
When a patient is not responding adequately to a trial of conservative treatment, injections specific to the source of their symptoms are offered and often provide improvement in the patient’s condition. The most common types of injections are called epidural steroid injections. Other injections such as sacroiliac injections, piriformis injections, and facet injections can also be used depending on the underlying source of the symptoms. The relatively few patients who do not respond well to any of the conservative treatments or injections will be referred for surgical treatment. In these patients, if underlying disc problems are causing their sciatica, surgery can be a reliable and safe way to accomplish pain relief and return to normal function.
How to Prevent Sciatica?
Living a healthy active lifestyle is one of the most important ways to prevent sciatica. This includes eating a well-balanced diet and maintaining ideal body weight. Smoking can also have a negative impact on your spine due to the effects on blood flow.
It is also important to exercise regularly, always remembering to warm up and stretch before working out or doing yard work. A critical tip is to use good body mechanics while lifting (let your legs do the work, keep your back straight and chest up, bend only at the knees, hold the load close to your body). It is also good to avoid lifting and twisting at the same time. When something is heavy, always find a partner to help you lift it. While the risk to your back with lifting may seem obvious, it is also important to use proper body mechanics while seated. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. When seated for work, use a chair with lower back support, armrests, and always keep your knees and hips level.
Who Should I see for Sciatica?
The Spine Center at OrthoNC provides a comprehensive array of services dedicated to treatments of the spine. Our personable staff (Dr. Derek Watson and Dr. Adedayo Ashana) have specialized training and extensive experience in treating the entire scope of spine conditions including sciatica. We aim to provide excellence in conservative, interventional, and surgical treatment in a warm and welcoming environment. We would be happy to see you in consultation regarding sciatica or any other problem that could be related to your spine.