What is Sciatica and How Can it be Treated?

By Kristen Willett, DO

If you have ever suffered from pain that radiates
from your lower back into the back of your leg or
foot, there is a good you were experiencing
sciatica. In fact, 40% of the population will
experience sciatica at some point in their life.

What is Sciatica?

Sciatica refers to the symptoms associated with compression or irritation of the sciatic nerve, the longest nerve in the body. The nerve is a collection of fibers from the lower lumbar and upper sacral areas that exits the spine and travels down into the muscles of the buttocks, through the back of the thigh and into the knee. Around the knee, it splits into the nerves that continue down into the calf and foot.

• Sciatica may feel sharp, achy, or burn and may radiate from the back or buttocks into the outside or back of one of the legs.
• It may intensify when standing up from a seated position, or when coughing or sneezing.
• In more severe cases, it may be accompanied by weakness or numbness in the affected leg that could extend as far as the foot.

What Causes Sciatica?

Several things can precipitate sciatica but the most common are:

• A herniated disc—the most common cause.
• Spinal stenosis—a narrowing of the nerve’s passageway that may be due to arthritis and degeneration of the discs.
• Spondylolisthesis—slippage of one vertebrae onto another, causing the nerve to be pinched as it exits the spine.
• Miscellaneous—things such as infection, tumors, and other disorders can very rarely disturb or compress the sciatic nerve.

How is Sciatica Diagnosed?

When symptoms fail to resolve, see your doctor or healthcare professional. They will discuss your symptoms and history, as well as perform a physical exam to help determine your diagnosis. He or she may take X-rays to help with the evaluation. If necessary, advanced imaging studies such as a computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered.

How is Sciatica Treated?

Most cases of sciatica will resolve on their own or with a few simple treatments. Those treatment options may include:

• Anti-inflammatories, such as ibuprofen, when appropriate.
• A physical therapy program may be beneficial to create a customized core strengthening and stretching program, as well as to utilize other modalities that may decrease pain and increase function and range of motion.
• Alternative treatments such as acupuncture and chiropractic care may be appropriate in some cases.

Cases of sciatica that do not rectify with conservative measures such as those listed above may benefit from epidural steroid injections to directly reduce the inflammation around the nerve itself. For those individuals that do not respond well to these treatments or for those who have intractable pain or unresolved neurological symptoms, surgery may be recommended.

How Can Sciatica Be Prevented?

The best way to avoid spine issues, when possible, is to develop a strong exercise program for your core and to maintain flexibility with a stretching routine. It is also beneficial to sustain a healthy weight and to focus on low-impact exercise.

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