Sciatica

Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body.

Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg, and the sole of your foot. When you have sciatica, you have pain, weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body.

Causes of sciatica include

  • A ruptured intervertebral disk
  • Narrowing of the spinal canal that puts pressure on the nerve, called spinal stenosis
  • An injury such as a pelvic fracture.

In many cases no cause can be found.

Sometimes sciatica goes away on its own. Treatment, if needed, depends on the cause of the problem. It may include exercises, medicines, and surgery.

Prevention varies, depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.

Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot.

Common causes of sciatica include:

  • Slipped disk
  • Spinal stenosis
  • Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
  • Pelvic injury or fracture
  • Tumors

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. Sometimes, your foot gets caught on the ground when walking.
 

The pain often starts slowly. It may get worse:

After standing or sitting
At night
When sneezing, coughing, or laughing
When bending backward or walking more than a few yards, especially if caused by spinal stenosis

The health care provider will perform a physical exam. This may show:

  • Weakness when bending the knee
  • Difficulty bending the foot inward or down
  • Difficulty bending forward or backward
  • Abnormal or weak reflexes
  • Loss of sensation or numbness
  • Pain when lifting the leg straight up off the examining table

Tests are often not needed unless pain is severe or long-lasting. If tests are ordered, they may include:

  • Blood tests
  • X-rays
  • MRIs or other imaging tests

Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated.

In some cases, no treatment is required and recovery occurs on its own.

Conservative (non-surgical) treatment is best in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation:

Apply heat or ice to the painful area. Try ice for the first 48 to 72 hours, then use heat.
Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

Measures to take care of your back at home:

  • Bed rest is not recommended.
  • Reduce your activity for the first couple of days. Then, slowly start your usual activities.
  • Do not do heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
  • Start exercising again after 2 to 3 weeks. Include exercises to strengthen your abdomen and improve flexibility of your spine.
  • Physical therapy may also be recommended. Additional treatments depend on the condition that is causing the sciatica.

If these measures do not help, your doctor may recommend injections of certain medicines to reduce swelling around the nerve. Other medicines may be prescribed to help reduce the stabbing pains due to nerve irritation.

Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options.