Sciatica: What is it and What Helps?
Sciatic nerve pain, commonly referred to as sciatica, is pain that runs along the pathway of the sciatic nerve. There are two sciatic nerves, one on either side of the body, that run from the lower back to the hip, buttock, and down the leg to the foot. Sciatica is quite common with estimates suggesting that between 5% and 10% of individuals with lower back pain suffer with sciatica. Sciatica often results in debilitating pain that interferes with the ability to perform normal every day activities. Luckily, there are many treatment options available to get sciatica symptoms under control, and most cases of sciatica resolve within a few weeks.
Sciatic Nerve Anatomy
To better understand the impact of sciatic nerve pain, let’s take a look at the anatomy of the sciatic nerve.
The sciatic nerve is the largest nerve in the body, with a diameter up to 2 cm, that is comprised of the L4 to S2 nerve roots.
The sciatic nerve provides motor function directly to the lower extremity adductors and hamstrings, and motor function indirectly to the muscles of the calves, front muscles of the lower leg, and even some muscles of the feet. In addition, it also provides sensation to the back and sides of the lower legs, and the bottom of the feet.
Causes of Sciatic Nerve Pain
Sciatica can be caused by anything that impacts or compresses the sciatic nerve, most commonly a bulging or herniated disc in the lower back. Other conditions that can cause sciatica include:
- Degenerative disc disease.
- Spinal stenosis in the lumbar spine.
- Bone spurs.
- Piriformis syndrome.
- Epidural hematoma.
- Epidural abscess.
Symptoms of Sciatic Nerve Pain
Symptoms of sciatica vary in severity from a mild ache to severe shooting pain, but typically only affects one side. Symptoms may include:
- Radiating pain, often described as “burning”, in the lower back to the buttocks and down the back of the leg.
- Pain that worsens with coughing, sneezing, and/or bearing down.
- Pain that worsens with bending forward and/or twisting.
- Pain that worsens with prolonged sitting and/or standing.
- Numbness and/or tingling in the affected lower extremity.
- Weakness of the affected lower extremity.
Diagnosis of Sciatic Nerve Pain
Diagnosis of sciatica, is clinical, meaning that a detailed history of symptoms and a thorough physical exam including range of motion, muscle strength, reflexes and targeted orthopedic testing including toe walking, heel walking and straight leg raise is crucial. Diagnostic imaging doesn’t provide much value in most cases but may be recommended in certain cases. X-ray may be recommended to evaluate for fracture or spondylolisthesis. Computed tomography (CT) may be recommended to further evaluate for fracture if plain x-rays are negative or inconclusive. Magnetic resonance imaging (MRI) is usually recommended for persistent sciatica symptoms lasting 6 to 8 weeks. If a neurological defect is present, or if a mass such as a malignancy or epidural hematoma is suspected, urgent MRI is needed to rule of cases that require prompt surgery.
Treatment Options for Sciatic Nerve Pain
There are various home treatments to get symptoms under control, including:
- Ice – icing the area for 10 to 15 minutes at a time can help to decrease inflammation and pain in the affected area.
- Heat packs – applying moist heat to the area for 15 to 20 minutes at a time can help to encourage blood flow and soothe aching muscles in the affected area.
- Stretching – lower back and hamstring stretching can help to improve range of motion.
- Avoiding prolonged positions.
- Practicing good posture.
- Avoiding heavy lifting.
- Using proper lifting technique.
If pain doesn’t subside with home treatments, there are a wide array of treatment options available, including:
- Medications – over-the-counter (OTC) pain relievers, such as acetaminophen, and anti-inflammatories including ibuprofen and naproxen may provide some relief. If OTC medications fail to provide relief, prescription strength medications including non-steroidal anti-inflammatories (NSAIDs), muscle relaxants, narcotics, oral corticosteroids, anti-seizure medications, and/or antidepressants may be recommended.
- Corticosteroid injection – injection of corticosteroids into the area may help to decrease inflammation and pain in and around the affected nerve.
- Physical therapy – specific exercises including postural re-education, and stretching and strengthening for the back and core muscles can help to improve function and decrease pain while also helping to prevent future episodes of sciatica.
- Chiropractic care – spinal manipulation can help to improve spinal mobility and restore movement to decrease pain and improve function.
- Massage therapy – deep tissue massage can help to reduce muscle tension and improve range of motion in the affected area.
- Acupuncture – insertion of thin needles into specific points of the body may help to decrease pain.
- Surgery – may be necessary in rare cases when there is significant weakness, loss of bladder or bowel control, of worsening pain that doesn’t improve despite treatment.
While sciatic nerve pain can cause debilitating symptoms, most cases resolve within 4 to 6 weeks. Various home treatments and medical treatments can help to decrease pain and improve function helping to reduce recovery time.
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