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. It is the longest nerve in the body and for some individuals is a major source of pain. Sciatica is a condition when the sciatic nerve gets compressed, irritated or pinched manifesting with pain and other symptoms. It may be caused by things such as a bone spur, bulging disc, or herniated disc.
Sciatica is characterized by pain along the path of the sciatic nerve, usually affecting only one side of the body, with the pain localized in any part of the nerve. In very rare cases the condition may affect both sides of the body which is called bilateral sciatica.
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 all the way to the toes.
Symptoms associated with sciatica include:
- pain (it can range from a mild ache to a burning sensation)
- tingling and numbness
The symptoms can be mild or severe, depending on what is causing the pain. The pain can be non-stop or intermittent. Standing or sitting for too long may make the symptoms worse. Lying down or changing positions usually provides temporary relief.
A person should see a doctor if the symptoms are severe or last for more than six weeks.To diagnose sciatica, a physician will review the 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.
Often the physician may do a straight leg raise test. To do this, the patient will need to lie flat on the back. The doctor will raise one leg at a time, making sure the knee does not bend, in order to stretch the sciatic nerve. If the person feels pain in the back of the leg when it is raised above a 30% angle, it is likely to have sciatica. Diagnostic tests, such as an MRI scan or X-ray, may be used to determine the exact cause of sciatica before a treatment is decided. If the 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) accompanied with heat/ice applications and certain pain relief exercise.
If the pain persists other treatments such as physical therapy, epidural injections, minimally invasive procedure or surgery will be recommended.