Sciatica, or lumbar radiculopathy, is pain that is created when the sciatic nerve becomes compressed or otherwise irritated. Sciatic nerves run from each side of the lower back through the buttock and back of the thigh all the way to each foot. The sciatic nerve is the largest nerve in the body. It serves a major role in the connection of the spinal cord to the leg and foot muscles.
Sciatic pain may be felt in the lower back, hips, legs, and feet. It usually only affects one side of the body. The pain can feel like sharp stabbing, a dull ache, or numbness and tingling. Severity has a wide range. Some patients experience mild to moderate pain that comes and goes. Others have severe pain and weakness that interferes with daily activities. All types of sciatica are treatable.
Sciatica is not a diagnosis. It is usually a symptom of another condition or injury. Understanding the underlying cause can be useful in finding the right treatment. There are many possible causes of sciatica. Emergent cases that occur suddenly are usually related to a fall or a car accident. Gradual onset of sciatica may occur due to a bone spur, bulging or herniated disc, or inflammation caused by a medical condition. Common conditions that cause sciatic pain include:
- Herniated disc – This condition occurs when the outer shell of the cushion between vertebrae breaks allowing the soft center to ooze onto surrounding tissue and nerves including sciatic nerves.
- Bone spur – When a knobby outgrowth of extra bone forms on a vertebra, the sciatic nerve may become compressed.
- Isthmic spondylolisthesis – When a small stress fracture occurs in the spine, one disc can slip forward on another. The result can pinch the sciatic nerve.
- Spinal stenosis – Narrowing of the spine is common with age. This condition is seen most often in patients over 60.
- Piriformis Syndrome – When the piriformis muscle in the buttock spasms and affects the sciatic nerve, hip and leg pain may be similar to sciatica. However, piriformis pain is not clinically diagnosed as sciatica.
- Pregnancy – Weight gain and a shift of the center of gravity during pregnancy may cause temporary sciatica.
- Muscle strain – Strained muscles in the lower back can cause inflammation which compresses the sciatic nerve.
Most people who experience sciatica do not require surgery. Although pain may be severe and debilitating, the condition can usually be resolved over time. When the nerve is no longer compressed, the pain is relieved. There are many conservative treatments for sciatica.
- Bed rest – A few days off your feet can relieve inflammation and pressure from the sciatic nerve. Bed rest should be limited to a few days and a firm mattress is necessary.
- Ice and heat – Alternate ice and heat can improve sciatic symptoms. Begin with ice then switch to heat.
- Physical therapy – After determining the cause of your sciatica, your doctor may prescribe physical therapy. Targeted exercise can improve most back conditions.
- Stretching – Lower back stretches can relieve pressure.
- Light exercise – Exercise can reduce inflammation, so short walks are advised.
- Medication – Over-the-counter pain relievers or anti-inflammatories are usually effective in reducing sciatic back pain. If pain persists or is particularly severe, your doctor may prescribe muscle relaxers or stronger anti-inflammatories.
- Spinal injections – If other conservative measures are not effective, your doctor may recommend steroid injections that bring relief directly to the affected nerve. The treatment is temporary but may relieve pain to allow you to participate in physical therapy for recovery.
Sometimes, surgery is necessary to relieve the pain of sciatica. If conservative treatment has been ineffective, your condition is too advanced to allow you to participate in physical therapy, or you are suffering vital nerve damage, your doctor might recommend surgery. If your bowels or bladder are affected or you suffer extreme leg weakness, surgery is often required to prevent permanent damage.
There are two types of surgery usually recommended for sciatica pain. The best option may depend on the cause of your sciatica.
- Discectomy – During this surgery, the surgeon removes whatever is pressing on the sciatic nerve. The goal is to only remove the portion of disc or bone spur causing pain. You may be able to return home a few hours after surgery.
- Laminectomy – This surgery requires a surgeon to remove part of the lamina (a portion of a ring of bone that surrounds the spinal cord). The lamina and any tissue pressing the nerve is removed. You may return home the same day or the day after surgery.
If you are suffering from ongoing sciatic pain, it is important to understand the cause. A Miami spine doctor can help you understand your condition. Finding the right treatment can finally provide you the relief you have been hoping for.