Sciatica

What is sciatica?

Sciatica is a general term describing any shooting pain that begins at the spine and travels down the leg.

The most common cause is a herniated or "slipped" disc in the lower spine. This means some of the cushioning material inside the disc has been forced outward, pressing on a nerve root. Bony irregularities of the spine and narrowing of the spinal canal (spinal stenosis) can also cause sciatica.

Shooting leg pain that may begin suddenly or develop gradually is the most common symptom. Additional symptoms may include weakness, numbness, a pins-and-needles sensation in the leg, and, in severe cases, difficulty moving the foot or bending the knee.

Treatment consists of pain medications and exercises. In severe cases, corticosteroid spinal injections and surgery may also be recommended.

You can safely treat this condition on your own. Over-the-counter pain medications such as ibuprofen (Advil) and aspirin as well as muscle relaxants may help. Some people find applying gentle heat or cold on painful muscles is soothing as well. It is important to stay active! Remaining in bed for too long may cause more inflammation.

Sciatica symptoms

Symptoms of sciatica include pain and neurologic symptoms.

Main symptoms

Pain is the defining symptom of sciatica and can be described as:

• Radiating pain: It will travel from the lower spine to the buttocks and down the leg.
• Unilateral pain: It will typically affect one half of the body.
• Varied pain: It will have a quality that varies from aching, to sharp burning, to excruciating.

Other neurologic symptoms

Other symptoms that may occur include:

• Numbness of the skin on the leg
• Abnormal sensations (paresthesia): These can be tingling or "pins and needles" feelings in parts of the leg.
• Weakness of leg or foot muscles

Complications of sciatica

Without treatment, sciatica can result in permanent nerve damage, which can lead to:

• Loss of sensation in the leg
• Weakness in the leg and muscle atrophy
• Difficulty controlling the bowels and bladder

Sciatica causes

Sciatica results from compression of the nerve, where it exits the spinal cord, before traveling down the buttocks and leg. The nerves in the lower back (lumbar spine) are most commonly affected. A variety of back irregularities can lead to nerve compression. These include disk herniation, bony irregularities, and narrowing of the spinal canal.

Intervertebral disk herniation

This is where spinal bones (vertebrae) are separated by discs made of cartilage. Aging or injury can cause part of a disc to slide out of place and compress nearby nerves.

Bony irregularities

These include abnormalities in the bones forming the spine that can irritate nerves as they exit the spinal canal.

• Bone spurs (osteoarthritic osteophytes): These may occur with aging and wear-and-tear, as new small pieces of bone can form that impinge on nerves.
• Slipped vertebrae (Spondylolisthesis): Some people with a common birth defect (spondylolysis) that weakens the vertebrae may suffer from sciatica when a vertebra slips out of place. This most commonly occurs in adolescents and young adults.

Narrowing of the spinal canal (spinal stenosis)

This is when the spinal canal, the space surrounding the spinal cord, can become narrowed due to:

• Arthritis
• Disc degeneration
• Abnormalities of the vertebrae
• Conditions: This includes Paget's disease, rheumatoid arthritis, or ankylosing spondylitis.

Risk factors for sciatica

Conditions that may increase your risk of developing sciatica include:

• Age-related changes: Back pain occurs most frequently in people over 60
• Obesity: This increases stress on the spine
• Workplace activities: Such as heavy lifting or prolonged sitting, may stress the back and may increase your risk of sciatica
• Diabetes: This can lead to nerve damage

Treatment options and prevention for sciatica

Treatment and management of sciatica symptoms are available through home remedies, medications, and procedures, which may include surgery and physical therapy as well as possible alternative methods.

At-home treatments

A few different home remedies can be used to help you find relief from sciatica. This includes:

• Refraining from strenuous activities: Keep in mind that prolonged rest may make symptoms worse. Research has found no benefit in terms of pain relief following bed rest versus continued activity in sciatica.
• Hot and cold packs: If sciatica started following an injury, ice the affected area for 20 minutes, three times per day. Consider alternating cold packs with heating pads at low settings to reduce muscle spasms. Adjust your routine to what seems to help your symptoms most.
• Stretching and gentle exercise: Slow, gentle stretches for your low back muscles can help relieve nerve compression and improve sciatica symptoms. Avoid rigorous or sudden movements that could exacerbate symptoms. Examples of safe stretches can be found here. Gentle exercise like swimming, walking, and yoga can also help.
• Over-the-counter painkillers: Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Aleve) may reduce the pain associated with sciatica, particularly immediately after an injury. Attempted treatment with these medications can continue for up to six weeks. However, these medications have little impact on shooting leg pain associated with sciatica.

Medications for neuropathic pain

Radiating pain associated with weakness and sensory changes is known as neuropathic pain. Medications that particularly help reduce this type of pain include:

• Anti-epileptic medications (anticonvulsants): Medications originally designed to prevent seizures can be helpful in reducing nerve pain. In small studies, gabapentin(Neurontin)has been found more effective than pregabalin (Lyrica) and topiramate (Topamax).
• Antidepressant medications: Medications originally designed to treat depression including tricyclics (TCAs) such as amitriptyline and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), may also be used to help relieve neuropathic pain.

Other medical treatment

A few other medications that may be recommended include:

• Muscle relaxants: Medications such as Baclofen may be helpful for some people.
• Opioid analgesics: For severe pain, opioids such as morphine, Percocet, or Oxycodone may be helpful for short-term use.
• Steroid injections: If symptoms persist for several months, despite trying various treatments listed above, the injection of a corticosteroid in the back may be recommended. Studies have found a small, short-term improvement in leg pain and disability scores following these injections.

When to seek further consultation for sciatica

You should seek medical attention any time that you are experiencing incontinence for unknown reasons, your back pain is severe enough to interfere with your quality of life, or you suffer from an injury.

If you have any problems with your bowels or bladder or numbness in the groin

If you experience urinary retention or incontinence, fecal incontinence, or numbness in the groin, seek immediate medical attention. These could be signs of a severe spinal condition (cauda equina) that could lead to long-term disability if not treated promptly.

If you are unable to walk due to the pain

If you experience pain or weakness so severe that you cannot walk, contact your physician for further evaluation and treatment.

If you experience symptoms of sciatica following a sudden injury

If you develop symptoms following a sudden injury, such as shooting pain and weakness after a traffic accident, seek emergency medical attention.