If you develop a pain that starts in your lower back or buttock and radiates down your leg, your problem may be sciatica.
Sciatica is an irritation of the sciatic nerve, which is the largest nerve in the human body. Sciatic nerves originate from several nerves in your lower back. These nerves branch outward from the spine and then come together at each buttock to form the sciatic nerve, which then radiates down each leg. Sciatic nerve pain radiates along the same path.
Sciatica can affect people of almost any age except the very young. The symptoms may get worse with age but they may also get better with age. How one manages their symptoms will play a significant role. One should be able to maintain an active lifestyle such as playing sports when having symptoms of sciatica but the decision regarding restriction of activities should not be made as generalized rule and should always be individualized. Pain is always a good guide but should not be the only guide. Weakness and numbness are two neurological symptoms that should be considered and taken very seriously.
The typical first symptom is pain that radiates from the lower back or buttock region down one leg. The pain feels as if it is coming from the sciatic nerve in the buttocks region because of its location, but the pain almost always originates from an irritated nerve in the lower spine.
Generally, symptoms include:
Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.
Irritation of the sciatic nerve is caused by nerve root entrapment (also known as nerve compression, pinched nerve or entrapment neuropathy). This particular form of entrapment is called lumbar radiculopathy, since the damaged nerves roots are located in the lumbar (lower back) portion of the spine. The nerve compression itself is most commonly irritated from disc tissue that is compressing the nerve, other structures in the spine that can also compress the nerve, or by an inflammatory reaction near the nerve.
Causes of sciatica include:
There are many contributing factors that may increase the risk of sciatica, but one of the most important is improper spine mechanics. This would include how we lift and how we sit.
The animation below illustrates the anatomy of the spine and sciatic nerves and the mechanics of sciatic nerve pain and leg pain.
Mild sciatica can go away on its own. Self-care measures that may help include ceasing all activity that causes pain, performing stretches of your lower back, applying an ice pack intermittently to the area causing pain, and taking NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen.
If rest, icing or other self-care methods have not improved your condition after three days, consult a physiatrist, spine surgeon or your primary care doctor to discuss your symptoms. If you experience severe numbness, tingling or problems urinating, see a doctor as soon as possible. (Find a sciatica specialist at HSS.)
Nonsurgical treatments may include applying cold packs or heat, medications and/or physical therapy. In some cases, epidural steroid injections may also help you return to full activity. Severe cases may require spinal decompression surgery.
When acute symptoms of sciatica occur in the absence of weakness, changes in bowel or bladder function or signs of an infection (such as fevers, chills, night sweats), conservative, nonsurgical methods should be tried first.
Conservative treatment is aimed at pain reduction. It may include:
Physical therapy and chiropractor treatments are two of the common forms of physical treatment. Ergonomic and bio mechanical modifications can be very helpful. Exercise physiologists and occupational therapists also have expertise in these areas. Epidural cortisone injections can also be very effective treatments for significant symptoms of sciatica, but require physicians who have had specialized training and should be image guided. Acupuncture treatments can also be effective for management of symptoms.
In some cases, epidural steroid injections may also help you return to full activity. Most people with sciatica get relief from their symptoms within several months.
For those patients who do not respond conservative care and experience persistent, disabling sciatica, surgery may be warranted. Your doctor will determine whether you are a candidate for surgery based on the duration and severity of symptoms. If your condition is causing cauda equina syndrome (which includes symptoms such as bladder dysfunction, incontinence or severe numbness in the buttocks) may be an indication that you should have immediate surgery.
The surgical treatments include various procedures that fall under the umbrella term spinal decompression surgery. The goal is to remove any disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the back and leg pain and associated symptoms of numbness and weakness.
There are several different decompression surgeries, dependent on which nerve roots are affected. These include:
In general, more than 90% of sciatica surgery patients have successful outcomes.
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