Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the lower back through the hips and buttocks and down each leg. This condition most often occurs when a herniated disc or bone overgrowth puts pressure on part of the nerve. This causes inflammation, pain, and often numbness in the affected leg.
Sciatica: it is important to treat it properly
While the pain associated with sciatica can be severe, most cases resolve with treatment within a few weeks. People who have severe sciatica and severe leg weakness or bowel or bladder changes may need surgery.
The pain caused by sciatica can be almost anywhere along the nerve’s path. It is especially likely to follow a path from the lower back to the buttock and back of the thigh and calf.
The pain can range from a mild ache to a sharp, burning pain. Sometimes it can feel like an electric shock. It can get worse when you cough or sneeze or sit for a long time. Usually, sciatica affects only one side of the body. Some people also have numbness, tingling, or muscle weakness in the affected leg or foot. One part of the leg may be sore, while another part may be numb.
Mild sciatica usually goes away over time. Call your primary care physician if self-care measures don’t relieve your symptoms. Also call if the pain lasts more than a week, is severe, or gets worse. Get immediate medical help for:
Sudden, severe pain in the lower back or leg and numbness or muscle weakness in one leg
Pain after a violent injury, such as a car accident
Difficulty controlling bowels or bladder
Sciatica occurs when the sciatic nerve is pinched. The cause is usually a herniated disc in the spine or an overgrowth of bone, sometimes called bone spurs, that forms on spinal bones. More rarely, a tumor can put pressure on the nerve. Or a disease like diabetes can damage the nerve.
Risk factors for sciatica include:
Age. Age-related changes in the spine, such as herniated discs and bone spurs, are the most common causes of sciatica.
Obesity. Being overweight increases the stress on the spine.
Occupation. A job that requires you to twist your back, carry heavy loads, or drive a motor vehicle for long periods could play a role in your sciatica.
Prolonged sitting. People who sit a lot or don’t move much are more likely to develop sciatica than active people.
Diabetes. This condition, which affects how the body uses blood sugar, increases the risk of nerve damage.
Most people recover completely from sciatica, often without treatment. But sciatica can damage nerves. Seek immediate medical attention for:
Loss of feeling in the affected leg
Weakness in the affected leg
Loss of bowel or bladder control
It is not always possible to prevent sciatica, and the condition can recur. To protect your back:
Exercise regularly. To keep your back strong, work your core muscles, abdominal and lower back muscles necessary for good posture and alignment. A healthcare professional can recommend activities.
Maintain good posture when sitting. Choose a seat with good lumbar support, armrests, and a swivel base. For better lumbar support, place a pillow or rolled towel in your lower back to maintain its normal curve. Keep your knees and hips level.
Use your body correctly. When standing for long periods, occasionally put one foot on a stool or small box. When you lift something heavy, let your legs do the work. Keep the load close to your body. Don’t lift and twist at the same time. Find someone to help you lift heavy or awkward objects.
It is always best to treat sciatica as soon as possible to avoid progression of symptoms. Treatment of sciatica can include both nonsurgical and surgical methods. Typically, nonsurgical methods are tried first. Surgery may be indicated when the underlying cause is severe and/or progressive neurological deficits such as leg weakness occur.
First-line treatments of sciatica typically include a combination of physical therapy, medications, therapeutic injections, and alternative therapies. Acute sciatica usually improves with 4 to 6 weeks of nonsurgical treatment. For chronic sciatica with pain lasting over 8 weeks, treatment time may take longer and may depend on the underlying cause.
Physical therapy incorporates a combination of strengthening, stretching, and aerobic conditioning and is a central component of nearly every sciatica treatment plan. Therapeutic exercises can also be added to a physical therapy program. The goals of physical therapy and exercises for sciatica include:
Strengthens the spine and muscles of the lower back, abdomen, buttocks and hips.
Increase core strength
Stretch tight and inflexible muscles, such as the hamstrings
Encourage the exchange of fluids and nutrients in the body with light aerobic exercise such as walking, swimming or pool therapy
While some rest or modification of activity may be necessary, it is important to maintain as much activity as possible and to avoid prolonged periods of physical inactivity or bed rest.
Some exercises to treat sciatica may be specific to the underlying cause. Trained healthcare professionals, such as a qualified physiatrists, physical therapists, chiropractors, or certified athletic trainers can help formulate an effective treatment plan to relieve sciatica pain through exercise and physical therapy.
Both prescription and over-the-counter (OTC) medications can be used to relieve sciatica pain. Some examples of medications used to treat sciatic pain include:
Oral steroids, such as prednisone
Anticonvulsant drugs, such as gabapentin
Tricyclic antidepressants , such as amitriptyline
These medications are usually taken to get pain relief and enable the patient to participate in physical therapy. Drugs such as opioid pain relievers are usually prescribed for short periods to avoid addiction.
Manual manipulation, typically performed by a chiropractor, aims to improve spinal alignment. This technique can help address underlying conditions that may be causing sciatic nerve pain, such as herniated discs or spinal stenosis. Manual manipulation can also create a better healing environment and shouldn’t be painful.
Some forms of massage therapy, such as deep tissue massage, may have pain-relieving benefits. The benefits of massage therapy include:
Improving blood circulation, which in turn creates a better healing response in the body
Relax tight muscles, which can contribute to the pain
By releasing endorphins, which are hormones in the body that work as natural pain relievers
Lumbar therapeutic injections can help treat pain resulting from conditions affecting the sciatic nerve. The injections are used with the goal of providing sufficient pain relief for the patient to fully participate in and benefit from a physical therapy program. Injections also perform a function in diagnosing the source of pain and can be used to identify target nerves.
The most common types of injections for sciatic pain relief include:
Epidural steroid injections. Epidural steroid injections can help relieve sciatic pain resulting from conditions such as spinal stenosis, a herniated disc, or degenerative disc disease. The primary goals of this treatment include:
Control the inflammatory response around the sciatic nerve from chemical and mechanical sources of pain, such as a herniated disc or degenerated disc.
Reduce the activity of the immune system to decrease the production of inflammatory cells in the body.
Steroids injected into the epidural space are dispersed into nerve endings and other tissues, dissipating the anti-inflammatory effect in all pain-transmitting structures.
Selective blocks of nerve roots. This type of injection is given near the spinal nerve as it exits the intervertebral foramen (a bony opening between adjacent vertebrae). The drug reduces inflammation and numbs the pain transmitted by the nerve. Selective nerve root blocks can be administered to one or more nerve roots from L4 to S3 to control sciatic pain.
For most therapeutic injections, results vary widely. Some people may experience immediate and sustained pain relief, some may only have pain relief for a few weeks or months, and some may experience no pain relief at all.
The above list of potential treatments is by no means exhaustive. For anyone suffering from sciatica pain, it is advisable to see a qualified physician for treatment. As a general rule, if nonsurgical methods fail to provide relief after 6 to 8 weeks of treatment or if neurological deficits (such as leg weakness) increase, surgery may be considered.
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