Sciatica is caused by a pinching or compression of the sciatic nerve. The nerve travels from the lower back to the buttocks and hips and down the legs. It’s important to understand, that sciatica itself is not a condition. Instead, it is a symptom of an underlying problem.
Several individual nerve roots comprise the sciatic nerve. Sciatica can develop when a segment of the nerve becomes pinched as a result of a bone spur, herniated disk or spinal stenosis. Sciatica is more likely to occur in middle age adults than in younger people.
Symptoms and Natural History
The symptoms of sciatica may vary based on where the nerve is pinched. Symptoms may include pain that starts in your lower back and radiates to your buttocks and down into the back of the leg. In most cases, only one side of the body is affected. The pain may be sharp, burning or searing. Depending on where the nerve is pinched, pain may also radiate into the foot. Numbness or tingling may also develop.
The severity of symptoms can come on suddenly and vary from mild to incapacitating. Although the condition often resolves in a few weeks, it can interfere with daily activities, making even simple tasks difficult. For example, sciatica can interfere with walking, bending and standing. But in some cases, sitting may also make the pain worse. Lying down may be the only thing that reduces pain since it takes pressure off the nerve.
A symptom review by your doctor, along with a physical exam is often enough to make a diagnosis. During an exam, your physician may check your reflexes and determine if you have any weakness in your legs. You may be asked to lift your legs one at a time or walk on your heels to determine if you experience any pain.
If symptoms persist longer than a week or if symptoms are severe, imaging tests, such as an MRI or x-ray may be performed. Imaging tests may be able to determine the underlying cause of sciatica, such as a herniated disk.
Self-Help Treatments for Sciatica
Self-help treatment at home may be sufficient to alleviate symptoms. Applying cold packs for about twenty minutes several times a day may reduce pain. After the first few days of a flare-up, applying heat may also reduce pain. Taking over the counter, anti-inflammatory medication may decrease pain. Performing stretching exercises may ease nerve root compression and reduce symptoms.
Standard Clinical Treatments for Sciatica
When self-help treatments are not enough to treat the condition, additional treatment may be needed. Epidural steroid injections are sometimes recommended to reduce inflammation. Spinal manipulation by a chiropractor is an alternative treatment that may help some people.
Doctors also may recommend physical therapy to decrease symptoms and prevent reoccurrences. Exercises to strengthen muscles, improve flexibility and promote proper posture may be taught. In addition to over the counter meds, prescription medication including muscle relaxants and narcotic pain medication may be used.
When symptoms are severe and other less invasive treatments have failed, surgery may be an option. For example, if a bone spur or herniated disk is causing sciatica, surgery may be performed to treat the problems and reduce compression of the nerve.