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Welcome to my compendium website on Sciatica Nerve Treatment.

 

The sciatic nerve is a large nerve that runs down the lower limb. It is the longest single nerve in the body.

The Sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot.


Important words found on this site in articles related to Sciatica.  Sciatica,  Nerve Treatment, Shooting Pain, Back, Buttocks, Anatomical, Pathology, Articular, muscular,  Physiology, Leg,  Foot, Rear, Inflammation, Patients, Drugs, Steroid Medication,  Lumbar Spinal Stenosis, Degenerative Disc, Medical Advice,  Cold,  Heat, Massage, Prescription, Exercise, Relief, Stretching, Physical Therapy, Causes, Cure, Symptoms, Prognosis, Health Care, Surgery,  Alternative, Chiropractic, Trigger Points, XRay, Complications, Rehabilitation, Prevention,
 

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Sciatic Nerve

Nerve: Sciatic nerve
Left gluteal region, showing surface markings for arteries and sciatic nerve.
Latin nervus ischiadicus
Gray's subject #213 960
Innervates Quadratus femoris
Obturator internus
Gemelli
Quadratus femoris
Glutæus maximus
Adductor magnus
Biceps femoris
Semitendinosus
Semimembranosus
Adductor magnus
From lumbar plexus and sacral plexus: L4-S3
Dorlands/Elsevier n_05/12566006

The sciatic nerve is a large nerve that runs down the lower limb. It is the longest single nerve in the body.

The Sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot.

Contents

[hide]

[edit] Anatomical Course

The nerve enters the lower limb by exiting the pelvis through the greater sciatic foramen, below the Piriformis muscle.

It descends between the greater trochanter of the femur and the tuberosity of the ischium, and along the back of the thigh to about its lower third, where it divides into two large branches, the tibial and common peroneal nerves.

This division may take place at any point between the sacral plexus and the lower third of the thigh.

When it occurs at the plexus, the common peroneal nerve usually pierces the Piriformis muscles.

In the upper part of its course, the nerve rests upon the posterior surface of the ischium, the nerve to the Quadratus femoris, the Obturator internus and Gemelli; it is accompanied by the posterior femoral cutaneous nerve and the inferior gluteal artery, and is covered by the Gluteus maximus.

Lower down, it lies upon the Adductor magnus, and is crossed obliquely by the long head of the Biceps femoris.

[edit] Branches

The nerve gives off articular and muscular branches.

  • The articular branches (rami articulares) arise from the upper part of the nerve and supply the hip-joint, perforating the posterior part of its capsule; they are sometimes derived from the sacral plexus.
  • The muscular branches (rami musculares) are distributed to the following muscles of the lower limb: Biceps femoris, Semitendinosus, Semimembranosus, and Adductor magnus. The nerve to the short head of the Biceps femoris comes from the common peroneal part of the sciatic, while the other muscular branches arise from the tibial portion, as may be seen in those cases where there is a high division of the sciatic nerve.

The muscular branch eventually gives off the tibial nerve and common peroneal nerve, which innervates the muscles of the (lower) leg. The tibial nerve goes on to innervate muscles of the foot.

[edit] Trivia

  • Sciatic nerves from frogs and rats are often used in physiology experiments on nerve conduction because this nerve is large, and easily dissected and manipulated.
  • In the Jewish dietary laws (Kashrut), the hindquarters of a mammal are not kosher unless the sciatic nerve and the fat surrounding it are removed (Genesis 32).

[edit] Pathology

Pain caused by a compressed or damaged sciatic nerve is called sciatica

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What you need to know about sciatica

Understanding sciatica
Low back pain and/or leg pain that usually travels down the large sciatic nerve, from the lower back down the back of each leg, is generally referred to as sciatica and is fairly common. This pain can be caused when a nerve root in the lower spine that helps form the sciatic nerve is pinched or irritated.

Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also referred to as a ruptured disc, pinched nerve, slipped disk, etc.) in the lumbar spine. The problem is often diagnosed as a "radiculopathy", meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve.

Sciatica occurs most frequently in people between 30 and 50 years of age. Often a particular event or injury does not cause sciatica, but rather it may develop as a result of general wear and tear on the structures of the lower spine. The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical treatments.

Practical point:
Symptoms of sciatica pain can vary greatly but usually decreases after a few weeks or months with non-surgical treatment.

Understanding sciatica pain
For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also radiate to the foot or toes.

One or more of the following sensations may occur as a result of sciatica:

  • Pain in the rear or leg that is worse when sitting

  • Burning or tingling down the leg

  • Weakness, numbness or difficulty moving the leg or foot

  • A constant pain on one side of the rear

  • A shooting pain that makes it difficult to stand up

  • Low back pain may be present along with the leg pain, but usually the low back pain is less severe than the leg pain

While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most sciatica pain syndromes result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.

Symptoms that may constitute a medical emergency include progressive weakness in the leg or bladder/bowel incontinence. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention. In general, patients with complicating factors should contact their doctor if sciatica occurs, including people who: have been diagnosed with cancer; take steroid medication; abuse drugs; have unexplained, significant weight low; or have HIV.

Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is a lumbar herniated disc. Other common causes of sciatica include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis.

Sciatica medical definition
To clarify medical terminology, the term sciatica (often misspelled as ciatica or siatica) is often used very broadly to describe any form of pain that radiates into the leg. However, this is not technically correct. True sciatica occurs when the sciatic nerve is pinched or irritated and the pain along the sciatic nerve is caused by this nerve (radicular pain). When the pain is referred to the leg from a joint problem (called referred pain), using the term sciatica is not technically correct. This type of referred pain (e.g. from arthritis or other joint problems) is quite common.

Sciatica treatments
Sciatica nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these factors. Typical sciatica treatments include:

  • Non-surgical sciatica treatments, which may include one or a combination of medical treatments and alternative (non-medical) treatments, and almost always includes some form of exercise and stretching. The goals of non-surgical treatments should include both relief of sciatica pain and prevention of future sciatica problems.

  • Sciatica surgery, such as microdiscectomy or lumbar laminectomy and discectomy, to remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved

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Sciatica first aid

The term sciatica (sometimes misspelled "ciatica" or "siatica") is used to describe pain that radiates down the course of the sciatic nerve, which starts from each side of the lower back, extends down the back of the thigh, and into the foot.

This type of pain is caused by compression of nerve roots in the lower part of the spine, which merge together to form the sciatic nerve in the pelvis. Pain may result from a variety of conditions, including disc problems. The good news, however, is that most cases of sciatica are not serious and will get better within a few days or weeks.

When the sciatica pain flares up, it is helpful to know several options that can be used to help alleviate the pain and discomfort and help you to quickly return to your normal activity.

Cold and heat treatment for sciatica
Ice and heat sources are easily available, inexpensive, and usually quite effective in treating sciatica.

  • A cold pack or ice application can reduce inflammation and numb sore tissue, alleviating some of the pain in the sciatic nerve. This should be used initially when pain is sharp and intense, usually for 2 to 7 days, depending on the severity of the pain.
  • Heat dilates blood vessels, increasing the flow of oxygen and nutrients to the area, which assists in healing. Applying heat also stimulates sensory receptors in the skin, so the brain focuses less on the pain of sciatica. This is best used after the acute, sharp pain has subsided, typically 3 to 7 days after the start of the condition.

For some people, alternating between ice and heat is the most effective sciatica treatment.

One option for applying cold is to utilize an ice massage. This is most easily accomplished by freezing water in a paper cup and after its frozen, cut the top half of the cup away exposing the ice (like a Popsicle). The ice cup is then applied directly to the skin, usually in a circular motion over the course of the painful area. There are 4 stages of cooling, of which the second to last is a burning sensation, similar to eating ice cream too quickly. The last stage is numbness after which time frostbite can occur so stop when the burning turns into numbness. This process usually takes between 3 to 6 minutes, depending on the thickness of the area being treated. 

The ice massage can be given by someone else with the patient lying on his or her stomach or side. The ice should be gently applied to the six-inch area where the pain is felt, and massaged using a circular motion, using care to avoid the bony portion of the spine. The goal is to numb the area of discomfort, at which time gentle, minimal movements can be made to stretch out the sciatic nerve and relieve the compression that is causing the pain. When the numbness wears off, the ice can be re-applied and the procedure repeated. This treatment can be done two or three times a day.

An ice pack is another approach where the ice is wrapped it in a towel or, a commercial ice pack can be used. This is usually kept in one spot, such as the low back, for 15 to 20 minutes per application, and repeated for three times (15 minutes on-off-on-off-on, which takes 1 hour, 15 minutes = 1 session). For sciatica, the pack is placed over the lower back as that is where the sciatic nerve is usually pinched. Several sessions can be performed throughout the day.

Heat should also be applied carefully to avoid burning. The temperature of the heating pad, hot water bottle, (or water for a bath), should be warm, not hot, and is frequently buffered with a towel so the skin does not get too moist. In addition to the benefits stated above, heat relaxes the muscles, which again, allows for some pain relief, allowing the patient to stretch out the sciatic nerve and diminish the compression that is causing the sciatica.

Medications to treat sciatic pain
The pain associated with sciatica may also be reduced and sometimes relieved with the use of over-the-counter or prescription medications. Because some of the pain is coming from inflammation of the sciatic nerve, treatment using non-steroidal anti-inflammatory drugs (NSAID's) can be very effective. Aspirin can also help reduce the inflammation, but NSAID's have fewer gastrointestinal side effects (such as gastritis or ulcers).

There are many options to consider when choosing NSAID's. Each is somewhat different and it is always advisable to discuss the benefits and drawbacks of each with a physician or pharmacist. NSAID options include:

  • Ibuprofen—such as Advil, Nuprin, Motrin
  • Naproxen—such as Naprosyn, Aleve
  • COX-2 inhibitors—such as Celebrex or Bextra (which require a prescription)

Acetaminophen (such as Tylenol) can also be used for relief of sciatic pain. Because NSAID's and acetaminophen work differently, the two medications may be taken at the same time or staggered (i.e., NSAID's followed by acetaminophen, etc.).

Other, stronger pain medications are also available through a prescription from a physician and may be necessary to help alleviate the pain from irritation to the sciatic nerve.

Exercise for long-term pain relief
Once pain control has been achieved, gentle stretching of the affected area, and low-impact exercise, (such as walking two to three miles) will help bring healing nutrients to the affected area and help to restore function. As with any back treatment, care should be taken to not further aggravate the situation. It is always advisable to consult with a doctor with any questions or concerns that may arise during the course of care.

For long-term relief of sciatica pain, most experts agree that a regular routine of stretching and exercise is crucial.

  • Stretching. Patients may find it takes several weeks or months to develop flexibility in the spine and soft tissues, but may also find that the stretching helps bring sustained pain relief. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and limitations in this motion can accentuate pain and make one more susceptible to re-injury.

    Stretching exercise should focus on increasing flexibility in the disc, muscles, ligaments, and tendons. Additionally, it is important to stretch muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a major role in lower back pain, as it is clear that hamstring tightness limits motion in the hip, which increases stress across the low back, especially during forward bending.
  • Strengthening. Building strength is also important to help prevent and/or lessen future recurrences of sciatic pain. Specific exercises designed to strengthen the “core” or trunk muscles are most important in the management of low back pain.

    Depending on the underlying cause of sciatica (such as a herniated disc vs. a degenerated disc), different exercises may be prescribed. Two common forms of strengthening exercises to treat sciatica are McKenzie exercises and Dynamic Lumbar Stabilization exercises. Learning which exercises to do, as well as how to do them correctly, is typically best learned with the help of a qualified spine specialist.

Manipulation and physical therapy
Another treatment option that can be helpful for many causes of for sciatica is manipulation by a qualified health care provider (most commonly a chiropractor or an osteopath). The type of manipulation, amount of force, the direction of the manipulation and the frequency of application are taken into consideration when managing patients complaining of sciatica. Combining this with various forms of physical therapy such as exercise therapies can be very effective.

Other considerations with sciatic pain
Though uncommon, when the sciatic condition worsens, it is most important to obtain a prompt evaluation. This is especially true if progressive muscle weakness, foot drop, or loss of bowel or bladder control occur, as these symptoms require immediate emergency attention and permanent problems can result if not managed promptly. In general, whenever questions arise about the course of care and associated signs and symptoms, health care provision should be obtained and the questions answered.

The good news is that most cases of sciatica will resolve naturally within a few weeks. The treatments described here can help alleviate pain until things return to normal, and help speed recovery, as well as avoid recurrence. Every patient is different of course, and not all sciatica treatments will work for all cases of sciatica.

Sciatic pain can be mild and intermittent, but this type of pain along the large sciatic nerve can also be searing and unbearable. For severe cases of sciatic pain, it makes sense to get a firm or definitive diagnosis regarding the underlying cause of the sciatica (e.g. a herniated disc, degenerative disc disease, spondylolisthesis) and discuss additional treatment options with a spine specialist. In addition to the remedies discussed above, there are a wide variety of additional treatment options, including injections, surgery, and more.
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 Sciatica

Alternative names   

Neuropathy - sciatic nerve; Sciatic nerve dysfunction

Definition  

Sciatica is a condition involving pain, weakness, numbness, or tingling in the leg. It is caused by injury to or compression of the sciatic nerve.

Causes, incidence, and risk factors   

Sciatica is a form of peripheral neuropathy. It occurs when there is damage to the sciatic nerve, located in the back of the leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Incomplete damage to the sciatic nerve may appear identical to damage to one of the branches of the sciatic nerve (tibial nerve dysfunction or common peroneal nerve dysfunction).

A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy. The usual causes are direct trauma (often due to an injection into the buttocks), prolonged external pressure on the nerve, and pressure on the nerve from nearby body structures. It can also be caused by entrapment -- pressure on the nerve where it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve.

The sciatic nerve is commonly injured by fractures of the pelvis, gunshot wounds, or other trauma to the buttocks or thigh. Prolonged sitting or lying with pressure on the buttocks may also injure it. Systemic diseases, such as diabetes, can typically damage many different nerves, including the sciatic nerve. The sciatic nerve may also be harmed by pressure from masses such as a tumor or abscess, or by bleeding in the pelvis.

In many cases, no cause can be identified.

Note: A ruptured lumbar disk in the spine may cause symptoms that simulate the symptoms of sciatic nerve dysfunction.

Symptoms  

Signs and tests   

Sciatica might be revealed by a neuromuscular examination of the legs by a physician. There may be weakness of knee bending or foot movement, or difficulty bending the foot inward or down. Reflexes may be abnormal, with weak or absent ankle-jerk reflex. Pain down the leg can be reproduced by lifting the leg straight up off the examining table.

Tests that reveal sciatic nerve dysfunction may include:

Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, MRIs, or other tests and procedures.

Treatment  

Treatment is aimed at maximizing mobility and independence. The cause of the nerve dysfunction should be identified and treated as appropriate. In some cases, no treatment is required and recovery is spontaneous.

Conservative treatment is usually appropriate if there was sudden onset, minimal sensation changes, no difficulty in movement, no history of trauma to the area, and no evidence of degeneration of the nerve axon.

Surgical removal of lesions that press on the nerve, such as a herniated disk, may relieve symptoms. In cases of severe injury to the nerve, such as laceration, recovery may be not possible or may be limited.

Injections can be used to reduce inflammation around the nerve. Over-the-counter or prescription analgesics may be needed to control nerve pain.

Various other medications may reduce the stabbing pains that some people experience, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline. Steroids may help with nerve inflammation related to a herniated disk. Whenever possible, their use should be avoided or minimized to reduce the risk of medication side effects.

Physical therapy exercises may be appropriate for some people to maintain muscle strength. The use of braces, splints, orthopedic shoes, or other appliances may help compensate for lost or impaired function. Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended.

Expectations (prognosis)   

If the cause of the sciatic nerve dysfunction can be identified and successfully treated, full recovery is possible. The extent of disability varies from no disability to partial or complete loss of movement or sensation. Nerve pain may be severe and persist for a prolonged period of time.

Complications 

  • Partial or complete loss of leg movement
  • Partial or complete loss of sensation in the leg
  • Recurrent or unnoticed injury to the leg
  • Side effects of medications

Calling your health care provider   

Call your health care provider if you have symptoms of this disorder. Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a pain specialist to ensure that you have access to the widest range of treatment options.

Prevention   

Prevention varies depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.
Misspelled words used to find this page 4 of 7. deegnerative, dgeenerative, edgenerative, degenerativ, egenerative, disc, disk, dysc, desc, d1sc, dics, dsic, idsc, medical, meical, medcal, medicl, mdical, medycal, medicar, medycar, metical, meticar, medial, medail, medyal, mediar, medyar, medair, metial, metiar, medear, medeal, medica, medyca, metica, ned1ca1, ned1cal, nedical, medicla, mediacl, medcial, meidcal, mdeical, emdical, edical, advice, advise, adv1ce, adviec, advcie, adivce, avdice, davice, advic, advie, advce, adice, avice, dvice, cold, coaled, cord, colde, clod, crod, co1d, codl, ocld, heat, hiat, hat, het, heet, heta, haet, ehat, massage, mssage, massge, massae, masage, massag, masag, nasag3, masag3, massaeg, massgae, masasge, msasage, amssage,prescription, prescriptiom, pescription, prescliptiom, prscription, plescriptiom, precription, plescliptiom, presription, presciption, prescrption, prescrition, prescripion, prescriptin, prescrippedion, presclippedion, plescrippedion, plesclippedion, presclipchon, plescripchon, plesclipchon, prescripchun, presclipchun, plescripchun, plesclipchun, prescripchon, prescripton, plescripshon, prescripshun, plescliption, prescripshon, plesclipton, prescliption, plesclipshun, presclipton, plesclipshon, presclipshun, prescripsion, presclipshon, presclipsion, plescription, plescripsion, plescripton, plesclipsion, plescripshun, rscription, lescriptiom, recription, lescliptiom, resription, resciption, rescrption, rescrition, rescripion, rescriptin, rescription, rescriptiom, rescliptiom, rescrippedion, resclippedion, lescrippedion, lesclippedion, lescripshon, rescripshun, lescliption, rescripshon, lesclipton, rescliption, lesclipshun, resclipton, lesclipshon, resclipshun, rescripsion, resclipshon, resclipsion, lescription, lescripsion, lescripton, lesclipsion, lescripshun, rescripton, prscriptio, prescriptio, precriptio, prescliptio, presriptio, plescriptio, presciptio, plescliptio, prescrptio, prescrippedio, prescritio, presclippedio, prescripio, plescrippedio, prescripto, plesclippedio, pescriptio, prescr1pt1on, prescriptino, exercise, exerise, exercse, exercie, exercyse, exelcyse, exersise, exelsise, eercise, exersyse, exrcise, exelsyse, execise, exersize, exelsize, exercize, exelcise, exelcize, exercice, exersice, exelcice, exelsice, execis, exersee, exercis, exeris, exelcee, exercys, exercs, exelsee, exersis, exercus, exersys, exersus, exelcis, exelcus, exelcys, exelsus, exelsis, eercis, exelsys, exrcis, exercee, exerc1se, exercies, exercsie, exericse, execrise, exrecise, eexrcise, xeercise, xercise,relief, releef, leleef, rereif, lerief, releif, lereif, rleief, rleeif, lelief, leleif, lleief, lleeif, rerief, re11ef, rel1ef, relife, reilef, erlief, relie, relif, relef, reief, rlief, elief, stretcing, stretching, stretchng, stretchig, stretchyng, stretchynt, sretching, stletchyng, stetching, stletchynt, strtching, streching, strething, stletcheigng, stletcheignt, stretchiegng, stretchiegnt, stletchiegng, stletchiegnt, stretcheigng, stretcheignt, stretchint, stletching, stletchint, stretch1ng, stretchimg, stretchign, stretchnig, stretcihng, strethcing, strecthing, strteching, stertching, srtetching, tsretching, stretchin, tretching, physical, physicl, pysical, phsical, phyical, physcal, physial, phisical, phisicar, fisical, fisicar, physicar, fysical, fysicar, physica, phisica, fysica, fisica, pysica, phsica, phyica, physca, physia, fys1ca1, phys1ca1, phys1cal, physicla, physiacl, physcial, phyiscal, phsyical, pyhsical, hpysical, hysical, therapy, thelapie, therepie, tehrepie, terapy, tehlapie, thrapy, thelepie, theapy, tehlepie, therpy, theray, therapie, tehrapie, tehlapi, thelepy,

What is the treatment of the sciatic nerve?

Article on what the sciatic nerve is and how to treat it. 

 
 

Sciatica is a condition caused by the sciatic nerves in the body becoming inflamed. The sciatic nerves begin from your lower spine and continue down the buttock area, back of the leg, and into the foot. Symptoms can range from a light tingling feeling, burning sensation to a full blown shooting pain radiating from your lower back, buttock area or leg. Sciatica usually affects only one side, although it is possible to also run down both legs.

There are several reasons why sciatica occurs. Sometimes the nerve in the lower spine can become pinched or a disk might be slipped. Arthritis or a sprained ligament will narrow the nerves' passageways causing the nerve endings to become tender and sore. Other possibilities could include an abscess, growth or blood clot, but this is rare.

 

Many people can be doing something relatively simple when a particular movement will cause such excruciating pain that standing up becomes extremely difficult. Sitting can make the pain worse. Sciatica can be very frightening especially if you do not realize what is wrong. You begin to feel that you may become crippled, although most of the time sciatica can be treated effectively.

For the first few days it is vitally important to stay off your feet as much as possible. The worst thing you can do is get up and down repeatedly as this causes the nerve to become more irritated. Although there does seem to be a debate on whether bed rest makes the symptoms better or not, it is generally agreed upon that bed rest is advisable for the first few days at least.

Although soaking in warm baths soothe and ease the pain, do not use heating pads at first while the nerve is inflamed. Prolonged heat draws the inflammation in, keeping the swelling high. Most doctors tell their patients to apply ice packs directly on the lower back area for about twenty minutes at a time, every couple of hours. Although this can feel like torture, the cold pack helps reduce swelling. Mineral ice is also great at soothing the pain and offering temporary relief.

Some doctors will prescribe muscle relaxers but it is best to avoid them if at all possible because of the side effects associated with these types of prescription drugs. Many medications can be highly addictive, or they can also give you a sense of feeling better that you wind up straining your back worse by overdoing it. Over the counter drugs such as aspirin or ibuprofen will effectively relieve mild to moderate pain.

Chiropractors will give you massage therapy and back adjustments which is a highly effective treatment. You should be able to go home and rest after your appointment so that your spine will have a better opportunity to stay in alignment for longer periods of time. When your back begins to heal there are stretching and/or low impact exercises your doctor will give you so that the muscle won’t stiffen too much. But you should only exercise after your doctor approves it.

Surgery is not considered a good alternative as it only helps about one in one hundred people. Surgery has also been known to cause even more damage in many cases. In extreme, chronic cases your doctor may suggest an MRI to rule out certain things such as nerve or tissue damage.

There are some alternative treatments available that you might find helpful. Accupressure and acupuncture, herbal therapies, homeopathy and biofeedback and guided imagery are just a few.

Be sure to improve your posture and use safe lifting techniques. Placing a pillow between your legs while you sleep can also help if you experience back pain while sleeping. If you travel a lot, be sure to place a pillow behind your lower back and pull over every two hours or so and walk around. The same applies if you must work at a desk for long periods of time or study and read a lot.

These are just a few ideas to help you begin your recovery from sciatic. Be patient, treat the pain by using these techniques and you should be as good as new in no time at all.

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Sciatica    What is sciatica?

The diagnosis of 'sciatica' means that there is inflammation of the sciatic nerve. The sciatic nerve supplies information about movements to the leg, and sends information about sensations back to the brain. The sciatic nerve is quitelarge, in fact, it is the largest peripheral nerve in the body.

The sciatic nerve is formed from the lower segments of the spinal cord; it is made up from the lumbar and sacral nerve roots from the spine. The sciatic nerve exits the lower part of the spinal cord (lumbosacral region), passes behind the hip joint, and runs down the back of the thigh.

How does this nerve normally function?
The sciatic nerve, like most other nerves, performs two basic functions: first, it sends signals to your muscles from the brain; and second, it collects sensory information from the legs and passes this back to your brain.

Conditions such as sciatica that affect the nerve will alter these normal functions. This usually manifests as either weakness of these leg muscles, pain in the legs and thighs, or both.

What happens to cause sciatica?
The most common cause of sciatica is a herniated spinal disc. When this happens, the normal cushion between the vertebra of your spine ruptures. This causes the disc to push out into areas normally occupied by these nerves. The nerves are compressed and people then experience the symptoms of pain, weakness, and numbness. Other conditions, such as spinal stenosis, spondylolisthesis, or piriformis syndrome can also cause cause sciatica symptoms by irritating the nerve.

What are the signs and symptoms of sciatica?
As stated above, sciatica can cause both sensory and muscular abnormalities in the legs and thighs. Common symptoms of sciatica include:

    • A cramping sensation of the thigh
    • Shooting pains from the buttock, down the leg
    • Tingling, or pins-and-needles sensations in the legs and thighs
    • A burning sensation in the thigh

In addition, patients with sciatica may notice a worsening of their symptoms with maneuvers such as squatting or coughing. These maneuvers can increase pressure around the nerve and magnify the symptoms of sciatica.

Who is prone to developing symptoms of sciatica?
Sciatica can affect just about anyone, but it is extremely uncommon in young patients. Sciatica typically affects 30 to 50 year old patients. Often there is a sudden onset that may be attributed to over-exertion or a back injury.

What do I need to do for sciatica?
Most importantly, you need to find out if sciatica is the cause of your symptoms. Your doctor will take a thorough history, perform a physical exam, and test several specific functions of the nerve. Several other conditions may cause hip and thigh pain, and need to be considered. It is important to determine the correct cause of your symptoms prior to beginning treatment of sciatica. Other tests, including X-Rays or possibly an MRI may be helpful, but they may not needed.

What treatments are available for sciatica?
Treatment is initially aimed at addressing the inflammation associated with sciatica. Rest, anti-inflammatory medications (such as Motrin or Celebrex), and muscle relaxers are often good places to start. Some patients require a more powerful anti-inflammatory treatment and are given oral steroids (often called a Medrol Dose-Pak). These steroids do have potential side-effects, but the powerful anti-inflammatory effect can be helpful in the treatment of sciatica.

Once the pain subsides, exercises and physical therapy are helpful. Many people find that heat packs and ice packs soothe the muscles that are painful in sciatica. Some doctors may prescribe an epidural steroid injection that can deliver anti-inflammatory medication directly to the inflamed area around the nerves.

Surgical treatment of sciatica is not usually needed, but in individuals who undergo the above treatments for a minimum of three months, and still have symptoms, surgery may be considered. The surgical procedure is one that allows more room for the nerve in the area being compressed. This may mean removing the ruptured disc, opening up the bone around the nerve, or a combination of both.

Will I get better from sciatica?
This is the good news. Most people (80-90%) fully recover from sciatica without surgery. In most cases the nerve is not permanently damaged, and individuals recover in the 3-week to 3-month time frame.

Sciatica is not a medical emergency. However, if you experience difficulty with bowel or bladder function, decreased sensation around the genitals, or progressive leg weakness, this may be the sign of cauda equina syndrome, a medical emergency. If you have these symptoms, contact your doctor or go to the emergency room immediately.

Sciatica & Leg Pain

Sciatica can be a distracting pain that starts in the lower back and extends down into one or both legs. Chiropractic care has proven to be quite helpful.

What Is Sciatica?

Sciatica is a severe pain in the leg caused by compression, irritation, or inflammation of the sciatic nerve. The sciatic nerves are the largest and longest nerves in the body, reaching about the size of your thumb in diameter, and running down the back of each leg. Each sciatic nerve is composed of five smaller nerves that leave the spinal cord from the lower spinal column, join together and then travel down each leg It then divides into ninny smaller nerves that travel to the thigh, knee, calf, ankle, foot and toes When these nerves are irritated or affected by the inflammation of nearby soft tissues, doctors refer to this as sciatica.

Symptoms Of Sciatica

People with "sciatica" can suffer from a wide range of symptoms. Often the pain will come and go at times, it may be constant, but then it may subside for hours or days. Some people may feel only a dull ache or numbness, which travels down the back into the upper leg. For others, it may be intense "shooting pains" down the leg into the foot and toes.

Many factors affect the pain of sciatica. Sitting in one position for long periods of time as when driving or working at a computer can increase the pain. Working out or running, or even simple things like walking, bending, turning or standing up may be difficult and painful. Tennis or golf and other twisting activities can cause sciatica pain to flare up. For some, the pain may be in both legs or change from side to side. For a number of others, back pain may occur before the sciatica itself. In the most severe cases, sciatica can damage reflexes, or even cause a wasting of the calf muscles.

Causes Of Sciatica

Because the sciatic nerve is so long, irritation can occur at many points. The first place is the lower back. Commonly, a misalignment of one or more of the lumbar vertebra causing pressure on the nerve is responsible. This condition is known as a subluxation, one underlying cause of sciatica as well as many other health problems.

Another source of sciatica can be disc involvement. Discs are the cartilage-like cushions occupying the spaces between vertebrae. Serving as spinal shock absorbers, they allow the back to turn and bend normally. Trauma or injury from car accidents or falls can cause a disc to bulge to one side resulting in what many people call a "slipped disc." The proper term is disc herniation.

Sciatica has also been linked to various non-spinal conditions. Arthritis, advanced diabetes, tumors, constipation, and even vitamin deficiencies have been reported as causes.

Finally, degeneration of the spine resulting from long-standing or neglected back problems can also irritate the sciatic nerve. Cases of sciatica have even been reported following childbirth, usually due to pressure on the spine.

Those suffering from sciatica are often in their 40s and 50s. It usually begins as an acute pain in the lower back and then extends down the back of either leg. The pain usually worsens with long periods of sitting or standing.

Like a large river created by smaller streams, five pairs of nerves exit the spine in the lower back to form tile two sciatic nerves. The soft, pulpy disc between each spinal bone is often involved. While a disc can’t “slip’ it can bulge, herniate or rupture. This can put direct pressure on the nearby nerves. The result? Swelling. Inflammation. Pain when coughing, sneezing or with other kinds of movement.

It’s easy to trace some spinal problems to an event, such as a car accident. Yet, sciatica is often the result of cumulative damage. Years of bad posture, poor muscle tone, excess weight or countless other causes set the stage. Then, something simple like bending over to tie your shoes can trigger an episode.

Spinal decay can be another culprit. Instead of disc thinning that puts pressure on the sciatic nerve roots, arthritic bone spurs can intrude into the space normally reserved for the nerve.

Treatment For Sciatica

The medical approach managing sciatica is to treat the symptoms. This may include using painkillers, muscle relaxers or anti-inflammatory drugs. Traction, physical therapy or injections directly into the nerve roots may also be used. In severe cases, even surgery may be tried.

The chiropractic approach to treating sciatica is to find the source of nerve irritation and relieve the pressure causing the pain. By correcting the source of the problem, the body can heal naturally without nerve interference. Sciatica, like other health conditions that can be traced to the spine, often responds dramatically to the restoration of normal spinal function through chiropractic care.

Your chiropractor's methods will vary according to the specific source of sciatica in each case. First, a complete history is taken to determine when the problem first appeared and possible sources. Next, a complete physical and chiropractic exam is performed, and x-rays may be taken. These tests are reviewed and discussed with you along with recommendations for treatment.

Treatment will vary according to the severity of the condition. With most patients, a series of adjustments to move the related vertebra back to a more normal position is helpful to reduce the pressure on the nerve. In some cases, the use of ultrasound and ice is needed. Massage therapy to reduce the pain related to muscle spasms is frequently helpful. Combining adjustments with physical therapy has proven very successful in treating most sciatica. 

Can chiropractic cure sciatica?

Actually, chiropractic doesn’t cure anything! Only your body can do that. The chiropractic approach to sciatica (and other health problems) is to help restore the way your spine works, reducing nerve irritation and revitalizing your own healing ability.

Sciatica often worsens with extended bed rest. Pain pills or muscle relaxers are unable to correct the nerve compression caused by a bulging disc. Physical therapy merely exercises the unstable joints. Surgery often involves cutting away disc tissue or removing bone to make room for the nerve. Fortunately, sciatica often responds to safe, natural chiropractic care.

Improving joint motion with a series of chiropractic adjustments has produced results for millions. “Before” and “after” images of the lower back often show improved disc height and spacing. Many patients report that they can resume their lives and that their symptoms disappear without drugs or surgery.

Your chiropractic doctor is uniquely skilled to evaluate and reduce the most common cause of sciatica nerve pain. It’s the natural approach to relief and better health.

Most sciatica patients are delighted with the results they get after weeks or months of care. Naturally, this varies from patient to patient. Many discover that years of neglect have produced spinal instabilities that never fully heal. These patients elect to continue with periodic chiropractic checkups. It’s up to you. There is hope!

Don't Wait !

Whatever the cause of sciatica, it is important to seek treatment promptly. Too many people wait, hoping the pain will go away or get better by itself. However, it is usually easier to treat a problem when it is first noticed. Too many people wait until the pain becomes unbearable, suffering needlessly. Long-term nerve damage may result from this delay in seeking treatment.

Long-Term Results

A 1990 British study compared patients who received traditional medical treatment for a variety of back related problems with others who received chiropractic care. Of 741 patients followed over three years, researchers found that those seen by chiropractic doctors experienced better results and missed less time from work.

SCIATICA CLINIC

Sciatica is the term given to pain down the leg, which is caused by irritation of the main nerve into the leg, the sciatic nerve.

Looking at this website probably means that you think you may have sciatica but are not sure. What you DO know is that you literally HAVE (not are) a pain in the bum! What you want to know is what is it, what caused it but most of all how do you get rid of it!

What is Sciatica? Route of the sciatic nerve down the thigh

Technically speaking, sciatica is a symptom not a diagnosis It is a non-specific term commonly used to describe symptoms of pain radiating downward from the buttock over the posterior or lateral side of the lower limb. It is usually assumed to be caused by compression of a nerve but this is not necessarily so.

A common neurolgical cause of this pain is entrapment of the sciatic and/or posterior femoral cutaneous nerves. But the pain may be caused by trigger points in the soft tissue. This latter case is easily overlooked and requires manual palpation of the musculature associated with the hip if the pain is not to be misdiagnosed.

Background

It is often assumed that there is sciatic nerve root entrapment, resulting in the compression of the nerve. Pain and symptoms being transmitted or referred from the low back to one of the buttocks and down the back of the leg along the pathway of the sciatic nerve. Hence the term sciatica.

The exact cause of sciatica is not fully understood but is commonly thought to involve a slipped or herniated disk. This means one of the disks, which lie between each of the vertebra in the lower back (lumbar area), has cracked and allowed some of the inner disk material to protrude out, putting pressure on the adjacent nerve root, which in this case is the sciatic nerve. The term 'lumbago' is often banded about as well which is a general term for low back pain. However, some people have been found to have a slipped disk but have no pain.

Sciatica Symptoms

Symptoms can vary from extreme pain in the low back radiating into one buttock and down the leg. Pain often increases on exertion or bending forward. Alternatively, there may only be a mild sensation in the leg or buttock. There may be numbness in the area, weakness in the leg and diminution of the reflexes. Pain may be triggered by coughing or straining and can be so severe that the lower back becomes locked in sideways bending position (scoliosis) caused by a strong contraction.

Alternatively, it may only come on when sitting or standing in a certain position. Clinical experience indicates that these certain positions are usually associated with continually holding a poor posture either at home or at work. For example, protruding the head forward peering at a computer all day or regularly lifting a baby out of the back of the car. But some or all of these symptoms are also associated with other conditions which is probably why the name is often misused as a catchall word for any pain affecting the buttocks or other parts of the leg. In this case the pain is triggered by a local trapping (trigger point) or straining of the nerve along its pathway. All of which can lead to sciatic-like symptoms, giving rise to conditions such as Piraformis, Psoas, Hamstring Syndromes, Back Pocket Sciatica and Pseudo-Sciatica.

Trigger Points

An area of extreme irritability that when compressed is very tender and can give rise to referred pain and tenderness.
Sciatica
 Causes  Symptoms Treatment                                                                
 

What is Sciatica?
Sciatica is a name describing any form of nerve pain that occurs when the sciatic nerve is compressed or damaged.  There are two branches of the sciatic nerve in the hip area, each about as wide as a thumb.  They originate at the base of the spine, thread through the pelvis and buttocks, and down the hip.  At a point above the knee, the sciatic nerve divides into branches that make the muscles move (motor) and supply sensation to the calves, soles, and outer edges of feet.  These are the largest nerves in the body.

Sciatica most commonly occurs when a branch of the sciatic nerve is compressed at the base of the spine, where the nerve leaves the spinal canal. When a sciatic nerve is stretched or pinched, usually by a herniated disk, sciatica is the result.

Causes of Sciatica?
Most people have at least one experience of sciatica in their lives, usually affecting only one leg.  The most common cause, especially in those between the ages of 20 and 40, is a herniated or prolapsed disk in the spinal column that presses on a nerve root.  Very often this disk injury is the result of strain caused by lifting a heavy object.

In older people, sciatica may be the result of changes in the bone of the spine caused by conditions such as osteoarthritis.  Rarely, sciatica may also be caused by congenital anomalies of the spine, such as spondylolisthesis, spinal stenosis, or tumors of the spinal canal.  In all people, ageing causes the normal disc to shrink and because of that we become shorter in height as we age.

In a pregnant woman it sometimes happens that the position of the fetus puts pressure on the sciatic nerve, especially during the last few months of pregnancy.

In all age groups, sciatica may occur as the result of muscle spasm or of sitting for long periods in a cramped or awkward position, such as during a long airplane flight.

Symptoms of Sciatica?
The effects of sciatica vary widely, from a mild tingling sensation to pain severe enough to cause immobility. Some people experience sharp pain in one part of the leg or hip and numbness elsewhere. The pain may increase after prolonged standing or sitting, or be aggravated by sneezing, coughing, or laughing.  When spinal stenosis is the cause of sciatica, patients may also experience pain after physical exercise such as bending backwards or walking more than 50 to 100 yards. Some people, especially the elderly, may have difficulty walking.  It may be hard to lift the foot on the affected side due to muscle weakness.

Symptoms of sciatica may develop either gradually or suddenly.  They include:

  • spasmodic or persistent pain in the affected leg.
  • a sharp, needlelike sensation running from the buttocks down the side of the leg.
  • pain that extends down back of the leg to the knee or even the foot.
  • pain may be made worse by movement or by coughing.
  • sensations of tingling or numbness.
  • muscle weakness.
  • tenderness to palpation over the sciatic nerve.

Treatment of Sciatica?

While the pain of sciatica often subsides gradually over about the course of 1-2 weeks, especially with proper treatment, it is not unusual for it to recur.

Anyone experiencing the symptoms of sciatica should consult a doctor, who after getting your complete history, then tests muscle strength, reflexes, and sensation. The patient may be asked to sit, stand, and walk in a variety of ways -- flat-footed, on the toes, and on the heels. They will be asked to bend forward, backward, and sideways, to twist, and to lift the leg straight up while lying down. These tests indicate the strain on the sciatic nerve.

The doctor will also move the patient's legs in different positions, bending and straightening the knees. To test nerve function and reflexes, the physician will tap the knees and ankles with a rubber hammer. Muscle deterioration can often be detected by measuring the circumference of the calves and thighs. The doctor may test for numbness and nerve sensitivity by touching parts of the body lightly with a pin, cotton swab, or feather.

Blood and urine samples are sometimes used, particularly if it appears the sciatica is related to an infection, arthritis, or other conditions. Sometimes the doctor locates the level in the spine where problem occurs by injecting a drug that blocks pain into the nerves in the back. A procedure called a facet block may also be also used to locate areas of specific damage.

When a herniated disk appears to be the cause of sciatica, imaging tests such as MRI (magnetic resonance imaging) scans are sometimes used. Provocative discometry is a test in which saline solution is injected into the suspected disc to reproduce the pain, followed by injection of an anesthetic.

Treatment options include:

  • bed rest for one or two days, using a firm mattress
  • the use of non-steriodal anti-inflammatory medication
  • physical therapy, including exercises designed to treat and prevent back pain
  • on rare occasions, surgery is used to relieve pressure on the nerve

Temporary relief from the symptoms of sciatica include:

  • change of position
  • application of heat, using a compress or whirlpool treatment
  • bending into a knee-to-chest position

Sciatica caused by pregnancy usually disappears after childbirth.

Surgery is generally recommended only in severe cases of sciatica, when the condition appears unresponsive to other forms of treatment.  Patients should discuss the possibility of surgery with an experienced orthopedic surgeon, weighing the likelihood of success in their particular case. 

The surgical procedure for a herniated disk, called a microdiskectomy, helps relieve pressure on the sciatic nerve. In this operation, which requires a brief hospital stay, the protruding edge of the damaged disk is removed.  Once the disk is repaired, it no longer exerts pressure on the spinal cord.

Treatment for sciatica should be individually designed once an accurate diagnosis has been obtained.  Back injuries of any kind are extremely serious, and it is important to seek professional treatment for them.

As in the case of any surgical procedure, outcomes of microdiskectomy are dependent on the state of one’s general health, including mental and emotional health. Surgical outcomes are also more complicated when there are multiple levels of degeneration, involving more disks, nerves, and vertebrae. The same disc may produce more disc material and cause a recurrence of symptoms so that surgery may again be needed.

When required, excellent or good results of surgery are more possible now than in the past, due mainly to advances in diagnostic imaging and surgical procedure. Before surgery, any other conditions should be under effective management.  Follow your surgeon’s directions carefully before and after any surgical procedure.

  

 


 

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.
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Sciatica

   

Introduction

The longest nerve in your body, the sciatic nerve runs from your pelvis through your buttock and hip area and down the back of each leg. It controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet. The term "sciatica" refers to pain that radiates along the path of this nerve — from your back into your buttock and leg.

Sciatica isn't a disorder in and of itself. Instead, it's a symptom of another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica usually goes away on its own in six weeks or so.

In the meantime, heat and cold applications, over-the-counter pain relievers, and exercise or physical therapy can help ease the discomfort of sciatica and speed recovery. Surgery to relieve pressure on the nerve may be an option when symptoms of sciatica don't respond to conservative treatment and pain is chronic or disabling.

Signs and symptoms

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It may be worse when you cough or sneeze, and prolonged sitting or walking can also aggravate symptoms. Usually only one lower extremity is affected.

In addition to pain, you may also experience:

  • Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another.
  • Tingling or a pins-and-needles feeling, most commonly in your toes or part of your foot.
  • A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care. If you experience either of these symptoms, seek medical help immediately.

Sciatica frequently occurs when a nerve root is compressed in your lower (lumbar) spine — most often as a result of a herniated disk in the low back. Disks are pads of cartilage that separate the bones (vertebrae) in your spine. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move.

But as you grow older, the disks may start to deteriorate, becoming drier, flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk may then press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the middle or lower part of your back, you also may experience numbness, tingling or weakness in your buttock, leg or foot.

Although a herniated disk is by far the most common cause of sciatic nerve pain, other conditions can also put pressure on the sciatic nerve, including:

  • Lumbar spinal stenosis. Your spinal cord is a bundle of nerves that extends the length of your spine. It's housed inside a channel (spinal canal) within the vertebrae. Thirty-one pairs of nerves branch off from the spinal cord, providing communication between your brain and the rest of your body. In spinal stenosis, one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of the branching nerves. When the narrowing occurs in the lower spine, the lumbar and sacral nerve roots may be affected.
  • Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves the spine.
  • Piriformis syndrome. Running directly above the sciatic nerve, the piriformis muscle starts at your lower spine and connects to each thighbone (femur). Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the sciatic nerve. The pain may radiate down the back of your thigh but doesn't extend below the knee. Active women — runners and serious walkers, for example — are especially likely to develop the condition. Prolonged sitting, car accidents and falls also can contribute to piriformis syndrome.
  • Spinal tumors. In the spine, tumors can occur inside the spinal cord, within the membranes (meninges) that cover the spinal cord, or in the space between the spinal cord and the vertebrae — the most common site. As it grows, a tumor compresses the cord itself or the nerve roots. This can cause severe back pain that may extend to your hips, legs or feet; muscle weakness and a loss of sensation, especially in your legs; difficulty walking; and sometimes loss of bladder or bowel function.
  • Trauma. A car accident, fall or blow to the spine can injure the lumbar or sacral nerve roots.
  • Sciatic nerve tumor or injury. Although this doesn't occur often, the sciatic nerve itself may be affected by a tumor or injury.
  • Other causes. In some cases, your doctor may not be able to find a cause for your sciatica. A number of problems can affect the bones, joints and muscles, all of which could potentially result in sciatic pain.

Risk factors

Risk factors are health problems, lifestyle choices and inherent qualities, such as age or race, that make it more likely you'll develop a particular condition. Major risk factors for sciatica include:

  • Age. Age-related changes in the spine are the most common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 30, and most people who develop herniated disks are in their 30s and 40s. Spinal stenosis, another leading cause of sciatica, primarily strikes people in their 50s and beyond.
  • Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica.
  • Physical activity. Although walking and jogging have been associated with an increased risk of sciatica, exercise in general has not. In fact, people who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
  • Genetic factors. Researchers have identified two genes that may predispose some people to disk problems.
  • Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

When to seek medical advice

Mild sciatica usually goes away given a little time and patience. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than six weeks, is severe or becomes progressively worse. Get immediate medical care if:

  • You experience sudden, severe pain, numbness or muscle weakness in your back or leg
  • The pain follows a violent injury, such as a traffic accident
  • You have trouble controlling your bowels or bladder

  • Screening and diagnosis

    To help diagnose sciatica and pinpoint which nerves, if any, are affected, your doctor will ask about your medical history and perform a thorough physical exam, paying special attention to your spine and legs.

    You're also likely to have some basic tests that check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during these activities.

    If your pain lasts longer than six weeks or is very severe, or you have another serious condition such as cancer, you may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes for your symptoms.

    These tests include:

    • Spinal X-ray. Because ordinary X-rays can't detect herniated disk problems or nerve damage, they're not usually helpful for pinpointing the cause of sciatica. A spinal X-ray can show most cancers affecting the bony structures of the spine, narrowed disks and spondylolisthesis, however, and can help rule out other causes of nerve root impingement.
    • Magnetic resonance imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments as well as the presence of tumors. MRI is noninvasive and has no harmful side effects.

      During the test, you lie on a movable table inside the MRI machine, which is essentially a large magnet. If you have a hard time lying still for the required period of time — usually 30 to 90 minutes — or you're anxious about the enclosed space, you may be given a sedative. Some MRI units may be wider, shorter or open on all sides, which may be more comfortable for you, although the quality of images taken with these systems may vary.

    • Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body. When CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.

      The test can show herniated disks and tumors, but it poses some risks, including infection and damage to the spinal cord. In addition, CT exposes you to more ionizing radiation than do regular X-rays.

      Complications

      In some cases, sciatica can result in permanent nerve damage, although this is uncommon. Depending on what's causing the nerve to be compressed, other complications may occur, including loss of feeling or movement in the affected leg and loss of bowel or bladder function

       

    Treatment

    For most people, sciatica responds well to self-care measures. You'll heal more quickly if you continue with your usual activities but avoid what may have triggered the pain in the first place. Although resting for a day or so may provide some relief, prolonged bed rest isn't a good idea. In the long run, inactivity will make your symptoms worse.

    In addition, try the following measures:

    • Cold packs. Initially, your doctor may suggest using cold packs to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least four times a day.
    • Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
    • Stretching. Initially, passive stretching exercises for your low back can help you feel better and may help relieve nerve root compression, but avoid jerking, bouncing or twisting.
    • Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, and acetaminophen products such as Tylenol can both be helpful for sciatica.

      Although they can provide real relief, both types of medication have a "ceiling effect" — that is, there's a limit to how much pain they can control. If you have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDS can cause side effects such as nausea, stomach bleeding or ulcers, and acetaminophen can cause liver problems if taken in excess.

      If you use these medications, talk to your doctor so that you can be monitored for problems. In addition, periodically re-evaluate whether you still need them. Exercise, stretching, massage and other nondrug treatments can often provide the same benefits without side effects.

    • Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Tricyclic antidepressants and anticonvulsant drugs also may be prescribed for chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers.
    • Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries.

      Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home.

    • Regular exercise. It may seem counterintuitive to exercise when you're in pain, but regular exercise is one of the best ways to combat chronic discomfort.

      Exercise prompts your body to release endorphins — chemicals that prevent pain signals from reaching your brain. Endorphins also help alleviate anxiety and depression, conditions that can make your pain more difficult to control. What's more, combining aerobics with strength training and exercises that maintain or improve flexibility can help prevent age-related degenerative changes in your back.

      If you're new to exercise, start out slowly and progress to at least 30 minutes most days. To prevent injury, consider learning proper weightlifting techniques from a certified personal trainer, fitness specialist or physical therapist.

    More aggressive treatments
    When conservative measures don't alleviate your pain within a few months, one of the following may be an option:

    • Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation, thereby relieving pressure and pain.

      Their usefulness in treating sciatica is a matter of debate, however, and they seem most effective when used in conjunction with a rehabilitation program. In addition, corticosteroids can cause serious side effects, so the number of injections you can receive is limited — usually no more than three in one year.

    • Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or you have pain that gets progressively worse or doesn't improve with other therapies.

      Surgery is most often performed to remove a portion of a herniated disk that's pressing on a nerve, a procedure called diskectomy. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy).

      Success rates of standard diskectomy and microdiskectomy are about equal, but you're likely to have less pain and to recover more quickly with microdiskectomy. Possible complications for either type of disk surgery include bleeding, infection, injury to the nerves or spinal cord, scarring, and the risks of anesthesia. What's more, although you may experience immediate results from disk surgery, it doesn't stop degenerative changes and your pain may recur in time.

       

    Prevention

    It's not always possible to prevent sciatica, but the following suggestions can play a key role in protecting your back:

    • Exercise regularly. This is the most important thing you can do for your overall health as well as for your back.

      Pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Pilates — an exercise technique for total body conditioning and rehabilitation — may be particularly helpful in keeping these muscles strong.

      For cardiovascular benefits, try using a stationary bike, treadmill, elliptical trainer or cross-country ski machine. Cycling outdoors is also recommended, but be sure your seat and handlebars are adjusted properly.

    • Maintain proper posture when you sit. A good chair should comfortably support your hips and the seat shouldn't press on the back of your thighs or knees. If the chair doesn't support the natural curve in your lower spine, place a rolled towel or pillow behind your back.

      When working at a computer, adjust your chair so that your feet are flat on the floor and your arms rest on your desk or the chair's arms, with your elbows bent at a right angle. Take frequent breaks, even if it's just to walk around your office.

      When you drive, adjust your seat to keep your knees and hips level, and move the seat forward to avoid overreaching for the pedals.

    • Use good body mechanics. Being conscious of how you stand, lift heavy objects and even how you sleep can go a long way toward keeping your back healthy. That's because poor posture stresses your back, leading to fatigue and stress on joints and nerves. If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level instead of bending forward.

      Before you lift something heavy, decide where you'll place it and how you'll get there. Bend at your knees, not your back, so that your legs do the lifting. Carry objects close to your body at about waist level. If possible, set the object down on a surface between shoulder and knee height to avoid lifting objects over your head or bending over too far. Don't twist at your waist. Instead, turn by pivoting your feet.

      Be careful moving heavy things when you're tired — fatigue can cause you to move more awkwardly. Heavy loads pose the greatest risk, so know your limitations. Don't attempt to lift something you feel is beyond your ability.

      For the best sleep posture, choose a firm mattress. Use pillows for support, but don't use one that forces your neck up at a severe angle.

      Complementary and alternative medicine

      Complementary and alternative medicine (CAM) refers to medical and health care systems, practices, and products that aren't currently part of conventional medicine — the care you receive in your primary care doctor's office. Many of these therapies are being studied intensely and some have proven to help alleviate back pain.

      • Acupuncture. Originating in China more than 2,500 years ago, this medical system is based on the idea that that health and life depend on a vital energy called qi — pronounced "chee" and sometimes written chi — that flows along 14 pathways in your body. When qi is blocked, disease and pain result. Inserting very fine needles into specific points along the meridians unblocks energy flow and restores your body's healthy balance.

        During an acupuncture treatment, you're likely to have from one to 20 or more hair-thin needles inserted into your skin. Most needles are inserted superficially, although some may go deeper, depending on where they're placed and the problem being treated. In most cases, you won't feel the needles — in fact, many people find the treatments extremely relaxing. The needles may remain in place from a few minutes to half an hour or longer.

        Acupuncture has received a great deal of attention from western scientists in the past decade, and studies of this complex medical system are ongoing. In 1998, the National Institutes of Health acknowledged that acupuncture appears to be effective at relieving a number of kinds of pain, including low back pain from sciatica.

        Most important to the success of an acupuncture treatment is a skilled practitioner. Licensed acupuncturists usually have extensive training — up to four years of specialized schooling after college — and have passed a stringent state or national exam.

      • Acupressure. This therapy is based on the same principles as acupuncture, but rather than using needles, the practitioner massages or presses specific points along the meridians to effect healing. Although the results may be more subtle than with acupuncture, acupressure may be a good choice if you'd rather avoid needles.
      • Chiropractic. Chiropractic treatment is based on the philosophy that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain.

        Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm.

        In 1994, the Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research, rated spinal manipulation as an effective treatment for acute back pain.

      • Hypnosis. People have been using hypnosis to promote healing since ancient times. In the past 50 years, however, it has experienced a resurgence among physicians, psychologists and mental health professionals. Hypnosis produces an induced state of deep relaxation in which your mind stays narrowly focused and open to suggestion.

        During hypnosis, you can receive suggestions designed to decrease your perception of pain and increase your ability to cope with it. It also can help you stop habits such as smoking. No one knows exactly how hypnosis works, but experts believe it alters your brain wave patterns in much the same way as other relaxation techniques.
 

Sciatica
*If you are experiencing back pain, see a doctor who can determine the cause. If the pain spreads down your leg or is accompanied by tingling, numbness or weakness, see a doctor immediately. Occasionally, sciatica may be caused by a serious condition that requires immediate surgery.

Sciatica refers to pain along the path of the sciatica nerve. It is usually caused by pressure on the sciatic nerve. Fortunately, most cases of sciatica are not serious and usually resolve within six weeks.

The sciatic nerve branches off nerve roots at the lower end of the spinal cord – it’s two branches run from the lower back through the each side of the pelvis, buttocks, back of leg to the foot. The sciatic nerve is the longes