Sciatica

Definition

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.

Alternative Names

Neuropathy - sciatic nerve; Sciatic nerve dysfunction

Causes, incidence, and risk factors

Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower spine and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot.

Common causes of sciatica include:

• Slipped disk
• Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
• Pelvic injury or fracture
• Tumors

Symptoms

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.

The pain often starts slowly. Sciatica pain may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if caused by spinal stenosis

Signs and tests

The health care provider will perform a physical exam. This may show:

• Weakness of knee bending or foot movement
• Difficulty bending the foot inward or down
• Abnormal or weak reflexes
• Pain when lifting the leg straight up off the examining table

Tests determine on the suspected causes. They are often not needed unless pain is severe or long lasting. They may include:

• Blood tests
• X-rays
• MRIs or other imaging tests

Treatment

Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated.

In some cases, no treatment is required and recovery occurs on its own.

Conservative treatment is best in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation.

• Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use heat after that.
• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first 6 weeks after the pain begins. You should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine.

See: Taking care of your back pain at home

If at-home measures do not help, your doctor may recommend injections to reduce inflammation around the nerve. Other medicines may be prescribed to help reduce the stabbing pains associated with sciatica.

Physical therapy exercises may also be recommended. Additional treatments depend on the condition that is causing the sciatica.

Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options.

Support Groups

Expectations (prognosis)

Often, sciatica will get better on its own. However, it is common for it to return.

Complications

More serious complications depend on the cause of sciatica. See:

• Slipped disc
• Spinal stenosis

Calling your health care provider

Call your doctor right away if you have:

• Unexplained fever with back pain
• Back pain after a severe blow or fall
• Redness or swelling on the back or spine
• Pain traveling down your legs below the knee
• Weakness or numbness in your buttocks, thigh, leg, or pelvis
• Burning with urination or blood in your urine
• Pain that is worse when you lie down, or awakens you at night
• Severe pain and you cannot get comfortable
• Loss of control of urine or stool (incontinence)

Also call if:

• You have been losing weight unintentionally
• You use steroids or intravenous drugs
• You have had back pain before but this episode is different and feels worse
• This episode of back pain has lasted longer than 4 weeks

Prevention

Prevention varies depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.

visHeader

References

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93.

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010 Apr;41(2):217-24.