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.
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.
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.
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.
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.
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