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What Is Sciatica?

The back is made up of the bones (vertebrae) of the spinal column, disks between the bones, the spinal cord (which contains nerves), muscles, and ligaments. The sciatic nerve is the longest nerve in the body. It goes from the spinal cord to the hips and down the back of the legs. Sciatica refers to pain that this nerve causes in these areas. Instead of a disorder, it’s a symptom of a problem with the nerve. The pain usually goes away on its own in 4 to 8 weeks.

What Causes Sciatica?

The usual cause is a herniation (bulge) of a disk that presses directly on the sciatic nerve. Disks are pads of a jelly-like substance with a tough, fibrous outer covering. They separate vertebrae and cushion them like shock absorbers, but they can herniate and press on the nerve. Other causes include irritation or inflammation (swelling) of this nerve from degenerative arthritis and rarer causes, such as tumors, muscles, bleeding, infections, and injuries such as pelvic bone fractures (breaks). Spinal stenosis, or narrowing of the spinal canal that puts pressure on the nerve, can cause sciatica. It is often due to degenerative arthritis. Risk factors include age, occupation, prolonged sitting, and obesity.

What Are the Symptoms of Sciatica?

Symptoms include pain, burning, numbness, muscle weakness, or tingling going from the lower (lumbar) back to the buttock and down the back of the leg. Usually only one leg is involved. The toes or part of the foot can be affected. Walking, bending at the waist, sitting for long periods, coughing, or sneezing may make symptoms worse. Lying down may make them better. The pain can be mild and achy, sharp and burning, or extreme. Severe sciatica can make walking hard or even impossible.

How Is Sciatica Diagnosed?

Diagnosis results from taking a medical history and doing a physical. X-ray studies are not usually needed. Computed tomography (CT), magnetic resonance imaging (MRI), and other tests may be done if treatment has not resulted in symptom relief and surgery is being considered.

How Is Sciatica Treated?

Treatment depends on the cause and pain severity. Medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and inflammation. Muscle relaxants, oral antiinflammatory steroids, or epidural steroid injections may be given. Severe pain may need stronger narcotic-containing medicines for a short time. Alternating heat and ice massage may soothe muscles and relieve acute pain.

All medicines have side effects. NSAIDs may cause stomach upset, diarrhea, ulcers, headache, dizziness, difficulty hearing, or rash. Muscle relaxants may cause drowsiness, dizziness, or rash. Narcotic medications are habit forming and may cause constipation and drowsiness.

Physical therapy and exercises may also help reduce the pain.

Surgery may be an option if other treatments don’t work.

DOs and DON’Ts in Managing Sciatica:

  • DO take your medicine as prescribed.
  • DO call your health care provider if you have drug side effects.
  • DO lose weight if you’re overweight.
  • DO back stretching and strengthening exercises daily.
  • DO use good posture when sitting or standing. Use good body mechanics and lifting techniques.
  • DO call your health care provider if you have trouble urinating or lose control of your bowels or bladder.
  • DON’T wait for a drug side effect to go away by itself.
  • DON’T give up. If you don’t feel better, ask your health care provider about starting in a special treatment program.
  • DON’T stop exercising completely.
FOR MORE INFORMATION

Contact the following sources:

  • American Academy of Orthopaedic Surgeons
    Tel: (800) 346-AAOS
    Website: http://www.aaos.org
  • North American Spine Society
    Tel: (708) 588-8080
    Website: http://www.spine.org
  • American Association of Neurosurgeons
    Website: http://www.neurosurgerytoday.org/what/ patient_e/herniated.asp

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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