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An Overview: Sciatica

back pain

Dr. Joseph Feinberg, Physiatrist-in-Chief, offers his expertise on sciatica.

Sciatica is the term typically used to describe the symptoms of radiating pain, usually from the buttock region down the 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. The nerve in the spine can be irritated from disc tissue that is compressing the nerve, other structures in the spine that can also compress the nerve, or an inflammatory reaction near the nerve. 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.

When acute symptoms of sciatica occur in the absence of weakness, changes in bowel or bladder function or signs of an infection (i.e. fevers, chills, night sweats), applying ice, taking over the counter medications like an anti-inflammatory or acetaminophen when anti-inflammatories are contra-indicated are good first steps. Although, bed rest has been historically recommended, we often now recommend modification of activities. The degree of modification can vary widely depending on many different factors. Seeking advice from a physician, physical therapist or chiropractor who has expertise in this area can help to ensure a quick recovery.

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.

Also, there may be indications for surgery in patients who have not responded to non-surgical care nor have neurological deficits. Sciatica can affect almost all ages 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.

Dr. Joseph Feinberg, HSS physiatrist

Dr. Joseph Feinberg, Physiatrist-in-Chief, specializes in brachial plexus and peripheral nerve injuries and disorders as well as in the non-surgical management of musculoskeletal disorders. Dr. Feinberg treats injuries sustained in athletes of all ages from the professional level to amateur. These can be the result of acute trauma or overuse and include Burner/Stinger Syndrome and Thoracic Outlet syndrome.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.