Sciatica is pain and other symptoms resulting from an irritation of the sciatic nerve.Potential sciatica causes include a herniated disc; a bulging disc; spinal osteoarthritis;veterbral body displacement; a narrowing of the spinal canal (spinal stenosis);ligament calcification; muscle spasms (piriformis syndrome); or a tumor, infection, orinjury in the spine. As such, sciatica itself is not a medical condition, but rather a setof symptoms of one of several different conditions, each of which stems from anabnormality of an anatomical component of the spine. In many cases, however, thereis no single obvious cause. This type of uncertainty can be quite frustrating andfrightening to a patient who is experiencing stabbing waves of pain that radiate fromthe lower back down through the back of the thigh.The sciatic nerve is the longest and widest nerve in the body, running from the lowerback, through the buttocks, and down the legs, ending just below each knee. Thisimportant nerve controls the muscles behind the knee and in the lower leg, andprovides sensation to the back of the thigh, lower leg, and sole of the foot. The spinehas a remarkable and complex anatomy, and a traumatic injury, pregnancy, or simplythe culmination of the effects of its weight-bearing and mobility functions over timecan take a considerable toll. Therefore, sciatica causes are generally not preventable,but certain activities are known to accelerate the deterioration of the spinal elements.
What Sciatica Feels LikeIn most cases, sciatica causes pain that originates in the lower back andtravels down through one side of the buttocks and leg. Many patients alsoexperience weakness, tingling, numbness, or a burning sensation in the leg.The pain may be exacerbated by sitting or standing for long periods of time,sneezing, coughing, laughing, or any movement that causes the spine to flex.Some patients also report that their pain intensifies at night.A less common indication of sciatica is a change in gait, or foot drop, which isan inability to properly raise the ankles and toes. The patient may be forcedto drag his toes, or to lift his knee higher than normal in order to be able topropel the body forward. Because foot drop can be a symptom of someserious conditions, such as Parkinson’s disease and multiple sclerosis, theimportance of an early and proper diagnosis cannot be overemphasized.
Treating SciaticaSciatica may serve as a forewarning of several medical conditions, some of which are very severe. Forthat reason, the underlying sciatica causes must be properly identified to ensure a more serious medicalproblem is not overlooked. In making a diagnosis, a physician will generally perform a physicalexamination and discuss the patient’s full medical history and symptoms. Sometimes, X-rays andmagnetic resonance imaging (MRI) studies can be useful in pinpointing the root cause of sciatica so thatit can be treated accordingly.In general, the following suggestions may be helpful in calming the pain and reducing the correspondinginflammation of sciatica:• Alternate the application of an ice pack with the application of a heating pad to the affected area.• Take over-the-counter pain relievers, such as ibuprofen, naproxen, or acetaminophen.• Avoid sitting for long periods of time.• Reduce the level of activity for a few days, and resume it slowly once the pain subsides.• Stay moderately active. Perhaps counterintuitively, bed rest is not usually recommended.• Do not lift heavy objects or perform any movement that twists the back.In addition, if the pain is severe or debilitating, a physician may recommend injections, prescriptionmedications, physical therapy, or surgery.
Protecting the SpineWhile sciatica causes are for the most part unpreventable, the following practices may go a longway toward protecting the health of the spine:• Practice good posture.• Sit in a chair with good back support, arm rests, and a swivel base. Place a small pillow or rolled towel at the small of the back to help maintain its normal curve.• Keep the knees and hips level while sitting, and use a foot rest.• Drive with the seat positioned far forward, and stop to walk briefly every hour.• Incorporate aerobic exercise, stretching, and strength training into a regular fitness routine.• Perform exercises to strengthen the core abdominal muscles and improve the flexibility of the spine.• Maintain a healthy weight.• Do not smoke.• Avoid wearing high-heeled shoes.• When lifting, move straight up and down, bend at the knees, and allow the lower extremities do the work. Never lift and twist at the same time. Better yet: Ask for help!
PrognosisOften, sciatica improves on its own or with conservativetreatment. Nevertheless, a patient who is experiencing backpain is well-advised to seek medical attention, even if the painis mild or intermittent.Not only could this type of pain serveas a warning sign for one of severalserious underlying sciatica causes,but the discomfort may also worsenover time if left unattended. The bestrule of thumb is to see a doctor wheneverthere is any uncertainty involving thehealth of the spine, which plays a crucialrole in guiding some of the most important body systems.