What is Sciatica?

by on Mar.26, 2012, under Conditions and Diseases

Q.What is sciatica? What causes it, and how is it generally treated? Are there precautions you can take to keep it from occurring?


A.Sciatica is a condition in which pain radiates from the back down the legs. It is caused by irritation of the sciatic nerve. The sciatic nerve is formed by nerve roots that exit from the lower part of the spine, then come together to form the sciatic nerve. It travels from the buttock into the back of the leg. Sciatica is most typically caused by a disc in the spine pressing on a nerve root. It can also be caused by local irritation of the sciatic nerve in the buttock or leg.

A. Treatment for sciatica is aimed at reducing the irritation of the sciatic nerve. This often initially involves a period of rest and common nonsteroidal anti-inflammatory prescription drugs (NSAIDs) such as aspirin, naproxen and ibuprofen. If these measures fail to alleviate the symptoms, then I often recommend physical therapy to my patients. I have found that chiropractic treatment can at times be effective for treatment of acute sciatica.

If a patient has persistent pain despite conservative measures, then I recommend a workup with a magnetic resonance imaging (MRI) scan, to see if there is a herniated (“slipped” or bulging) disc pressing on a nerve root or another problem that could account for the pain. Although rare, a tumor in the spine can compress a nerve root and cause pain similar to that of sciatica. If the MRI detects nerve root irritation in the spine, then we often give a lumbar epidural injection, which is a cortisone injection to the spine around the nerve roots. These injections often give relief, but it is difficult to predict which patients will get relief and for how long.

In a patient with disabling pain that has not responded to conservative measures and who has a correctable problem, such as a herniated disc, surgery becomes an option. In general, I recommend that surgery be considered as an absolute last resort.

After a patient’s symptoms have subsided, I recommend a general fitness program, including a stretching program for the spine. Some of my patients benefit from a short physical therapy program, specifically aimed at instructing the patient in a home exercise program. In patients with a herniated disc whose symptoms have subsided, it is not unusual to see occasional flare-ups. Typically, after the first episode, these are shorter and less severe.

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