A pain that begins in the lower back, radiates out from the buttocks through the back of the thigh and calf, and sometimes down into the feet is the classic sign of sciatica. Numbness, pain or weakness in different parts of the leg and foot are also commonly reported. Sciatic pain can be as innocuous as a feeling of pins and needles, but it can also be excruciating and debilitating as well.
Fortunately, most incidences of sciatica do not require surgery and can be ameliorated by a combination physical therapy, rest and, in some cases, medication. Alternative therapies have also been known to provide relief. If you suspect you are suffering from sciatica, contact the Ainsworth Institute of Pain Management for a consultation.
Sciatica is often mistaken for a disease or condition in itself. It actually refers to symptoms created by any compression or irritation of the sciatic nerve, the longest and widest nerve in the human body, and can be caused by a wide variety of factors.
What is Sciatica?
Sciatica, also called Lumbar Radiculopathy, refers to the pain caused by the compression or irritation of one, or both of the sciatic nerves. Your sciatic nerves start in the lower back and travel downward behind the hip joint, through the buttocks, and along the back of each leg into the feet. They are important as they are the main nerves in your legs, providing your nervous system’s connection to the skin and muscles of the thighs, calves, and feet.
The sciatic nerves have five roots in the spinal cord. When compression or irritation occur at or near these roots, it is often experienced as a pain that “radiates” down the legs. This can result in pain, weakness, numbness or difficulty controlling specific muscles, particularly in a distribution specific to the affected nerves.
Along with the aforementioned lower back pain that travels down the length of the leg, other common symptoms include:
*Loss of bowel and/or bladder control may be a symptom of cauda equina syndrome, a serious medical condition. Seek medical care immediately if you experience a loss of bowel or bladder control.
Sciatica can develop as a result of back injury or various lifestyle habits. Some of these include:
In addition, a variety of conditions unrelated to overuse, injury, or lifestyle can also associated with sciatica. These include:
Any of these factors can cause compression or irritation of the lumbar or sacral nerve roots, or the sciatic nerve itself, and result in any of the above pain symptoms.
Diagnosis of sciatica should only be made by an expert physician. In most cases the doctor will be able to diagnose with nothing more than your medical history and a thorough physical examination. He/she will most likely want to know when your symptoms began, their severity, what treatments you have previously tried, and what were the results.
In the physical examination, the doctor will examine you for limitations of movement, balance problems, and pain. He/she may also test reflexes in the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
If needed, an x-ray is obtained to rule out more serious conditions, such as a herniated disc in the lower back, tumor, or other problem.
Sciatica can heal without treatment and surgery is rarely needed. If treatment is prescribed, it is usually a combination of therapy and medication.
Nonoperative Treatments can include:
Cold & Hot Therapy
Medications for sciatica can include:
Over-the-counter or prescription pain medication
Muscle relaxant medication
Interventional Pain Management Treatments
Interventional techniques can be a faster and more definitive method of pain relief for sciatica. These treatments are useful in the presence of severe pain that has failed conservative medical treatment and/or medication.
Lumbar Epidural Steroid Injection – This procedure is considered by many to be the “gold-standard” treatment for sciatica. It is basically the same treatment a woman will receive during childbirth. Under fluoroscopic guidance, your physician will place a small needle into the epidural space and inject a small amount of medication to eliminate the pain.
Transforaminal Epidural Steroid Injection – This procedure is similar to the one above, however instead the medication is focused directly onto the nerve fibers that make up the sciatic nerve – the result is more medication on the affected area.
Spinal Cord Stimulation (SCS) – When the inflammation in and around the affected nerves is too great for an epidural injection, SCS is an excellent and effective treatment option that can eliminate the pain without surgery. In SCS, an electrical pulse is delivered directly to the spine, blocking certain neuron fibers’ access to the brain and consequently the brain’s ability to sense the previously perceived pain.
Microdiscectomy – Another option in cases where the inflammation in and around the affected nerves is too great for an epidural injection. With microdiscectomy, some of the damaged material around the nerve(s) is removed.
In a minority of cases, the cause of the sciatica may be something that requires surgery to fix. The presence of neurological deficit, cauda equina syndrome (i.e. loss of bowel and/or bladder control), or other problems, may require a surgical intervention.
Part of treatment will be learning healthy spine habits and making lifestyle changes which may reduce current symptoms and prevent further attacks.
Schedule an Appointment Today
Our doctors at the Ainsworth Institute of Pain Management are experts in using the most cutting edge and advanced methods for treating sciatica. Call and schedule an appointment today with one of our board-certified pain management doctors and find out what treatment options would best suit your symptoms.
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