The sciatic nerve starts at the back of the pelvis and extends down to the feet, running through the buttocks and the back of the leg on its way down. It is the longest nerve in the body and is a major source of pain for some individuals.
When the sciatic nerve gets compressed, irritated or pinched, and results in pain and other symptoms, this is referred to as sciatica.
Sciatica typically only affects one side of the body, but in rare cases it can affect both sides. This is called bilateral sciatica.
Sciatica may be caused by things such as a bone spur, bulging disc, or herniated disc. Other causes may include:
- Degenerative disc disease
- Lumbar spinal stenosis
- Injury (e.g. muscle strain)
Sciatic pain usually starts in the lower back and can radiate from the lumbar region to the buttocks, through the hips, down the back of each leg, and all the way down to the toes. Standing or sitting for too long may make symptoms worse. Lying down or changing positions may provide temporary relief. Symptoms can be mild or severe, depending on what is causing the pain, and the pain can be non-stop or intermittent.
Symptoms associated with sciatica include:
- Pain (it can range from a mild ache to a burning sensation)
DIAGNOSIS OF SCIATICA
To diagnose sciatica the physician will review the patient’s medical history and perform a physical examination. During the exam, the doctor may apply pressure to specific areas of the lower back and/or spine to pinpoint the source of the pain.
The most typical exam is the straight leg raise test. The patient will need to lie flat on the back. Then the doctor will raise one leg at a time, making sure the knee does not bend, in order to stretch the sciatic nerve. If there is a pain in the back of the leg when it is raised above a 30% angle, it is likely that the person has sciatica.
Diagnostic tests, such as an MRI scan or X-ray, may be used to determine the exact cause of your sciatica before a treatment is decided upon. If your doctor suspects an infection, blood tests may also be ordered.
For some patients, sciatica symptoms may go away on their own. If the pain does not improve with time and symptoms worsen, a spine specialist can help.
Initial treatment may include taking acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil). The doctor may also recommend using a heating pad or ice pack for 10-15 minutes every few hours, in addition to certain exercises to help relieve pain.
Depending on what is causing irritation of the sciatic nerve, some patients may require stronger medication, physical therapy, a minimally invasive procedure, or even surgery. Epidural injections, for example, are used to treat sciatica-related pain in cases where a herniated disc is the problem.