SYMPTOMS AND CAUSES
What causes sciatica?
Sciatica can be caused by several different medical conditions including:
- A herniated or slipped disk that causes pressure on a nerve root. This is the most common cause of sciatica. About 1% to 5% of all people in the U.S. will have a slipped disk at one point in their lives. Disks are the cushioning pads between each vertebrae of the spine. Pressure from vertebrae can cause the gel-like center of a disk to bulge (herniate) through a weakness in its outer wall. When a herniated disk happens to a vertebrae in your lower back, it can press on the sciatic nerve.
- Degenerative disk disease is the natural wear down of the disks between vertebrae of the spine. The wearing down of the disks shortens their height and leads to the nerve passageways becoming narrower (spinal stenosis). Spinal stenosis can pinch the sciatic nerve roots as they leave the spine.
- Spinal stenosis is the abnormal narrowing of the spinal canal. This narrowing reduces the available space for the spinal cord and nerves.
- Spondylolisthesis 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. The extended spinal bone can pinch the sciatic nerve.
- Osteoarthritis. Bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves.
- Trauma injury to the lumbar spine or sciatic nerve.
- Tumors in the lumbar spinal canal that compress the sciatic nerve.
- Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.
- Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.
What are the symptoms of sciatica?
The symptoms of sciatica include:
- Moderate to severe pain in lower back, buttock and down your leg.
- Numbness or weakness in your lower back, buttock, leg or feet.
- Pain that worsens with movement; loss of movement.
- “Pins and needles” feeling in your legs, toes or feet.
- Loss of bowel and bladder control (due to cauda equina).
MANAGEMENT AND TREATMENT
How is sciatica treated?
The goal of treatment is to decrease your pain and increase your mobility. Depending on the cause, many cases of sciatica go away over time with some simple self-care treatments.
Self-care treatments include:
- Appling ice and/or hot packs: First, use ice packs to reduce pain and swelling. Apply ice packs or bag of frozen vegetables wrapped in a towel to the affected area. Apply for 20 minutes, several times a day. Switch to a hot pack or a heating pad after the first several days. Apply for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs – whichever best relieves your discomfort.
- Taking over-the-counter medicines: Take medicines to reduce pain, inflammation and swelling. The many common over-the-counter medicines in this category, called non-steroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen (Advil®, Motrin®) and naproxen (Naprosyn®, Aleve®). Be watchful if you choose to take aspirin. Aspirin can cause ulcers and bleeding in some people. If you’re unable to take NSAIDS, acetaminophen (Tylenol®) may be taken instead.
- Performing gentle stretches: Learn proper stretches from an instructor with experience with low back pain. Work up to other general strengthening, core muscle strengthening and aerobic exercises.
How long should I try self-care treatments for my sciatica before seeing my healthcare professional?
Every person with sciatic pain is different. The type of pain can be different, the intensity of pain is different and the cause of the pain can be different. In some patients, a more aggressive treatment may be tried first. However, generally speaking, if a six-week trial of conservative, self-care treatments – like ice, heat, stretching, over-the-counter medicines – has not provided relief, it’s time to return to a healthcare professional and try other treatment options.
Other treatment options include:
- Prescription medications: Your healthcare provider may prescribe muscle relaxants, such as cyclobenzaprine (Amrix®, Flexeril®), to relieve the discomfort associated with muscle spasms. Other medications with pain-relieving action that may be tried include tricyclic antidepressants and anti-seizure medications. Depending on your level of pain, prescription pain medicines might be used early in your treatment plan.
- Physical therapy: The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. An exercise program should include stretching exercises to improve muscle flexibility and aerobic exercises (such as walking, swimming, water aerobics). Your healthcare provider can refer you to a physical therapist who’ll work with you to customize your own stretching and aerobic exercise program and recommend other exercises to strengthen the muscles of your back, abdomen and legs.
- Spinal injections: An injection of a corticosteroid, an anti-inflammatory medicine, into the lower back might help reduce the pain and swelling around the affected nerve roots. Injections provide short-time (typically up to three months) pain relief and is given under local anesthesia as an outpatient treatment. You may feel some pressure and burning or stinging sensation as the injection is being given. Ask your healthcare provider about how many injections you might be able to receive and the risks of injections.
When is surgery considered?
Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.
How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and you’ve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.
The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.
What complications are associated with sciatica?
Most people recover fully from sciatica. However, chronic (ongoing and lasting) pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.
Pain Care’s approach to pinched sciatic nerve treatment is comprehensive in nature, and we customize each treatment plan to suit the patient’s particular diagnosis and goals. Our board-certified physicians specialize in noninvasive and minimally invasive treatment measures that can often delay or prevent the need for major back surgery. Depending on the patient, our recommended courses of action might include icing the area, performing targeted stretching, taking anti-inflammatory medications, and using other conservative techniques. However, we also offer minimally invasive options for more intense sciatic nerve issues, including:
- Epidural steroid injections – Injecting a numbing agent and cortisone into a precise area of the spine can help alleviate sciatic nerve pain
- Dekompressor discectomy – Removing a portion of a herniated disc may relieve pressure placed on the sciatic nerve, thereby reducing symptoms
If you have sciatica or another chronic pain condition and you live in or around Atlanta, GA, contact Pain Care to learn more about our approach to care. Call us or use our online form to request an appointment – we can usually see patients within 48 hours. We’re here to help you regain life, restore function, and renew hope.