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Sciatica

What is Sciatica?

The term sciatica refers to pain, numbness or tingling along the sciatic nerve, which runs from your lower back, down the back or side of your thigh and leg, to your foot. Your symptoms may be constant or happen with certain activities such as sitting too long or driving.

Your symptoms may be described as severe, sharp pain, dull and aching pain, a tightness sensation, numbness, tingling or burning.  

Common Causes

There are multiple causes of sciatica. 

  • The nerves in your lower back that are part of the large sciatic nerve can become irritated, inflamed or swollen for various reasons.
  • Wear and tear of the spinal joints that happens during the the natural aging process, referred to as degeneration or spondylosis, can cause or contribute to sciatica.
  • Excessive wear and tear can cause the openings in the spinal joints to narrow. This narrowing is referred to as stenosis which can also cause or contribute to sciatica.
  • Disk herniations as well as tight muscles in the buttock region can also cause or contribute to sciatica.   

Diagnosis

History and physical exam by a qualified musculoskeletal expert is the first step to diagnosing sciatica. X-ray or MRI scanning may be required.

Treatment Options

Most patients with sciatica will get better over time and not need surgery. Some patients will have pain go away quickly while for others it could take longer. There are both non-surgical and surgical treatments available.

  • Nonsurgical Treatment
    Non-surgical treatment could include physical therapy to improve the flexibility and strength of the back. Treatment may also include non-steroidal anti-inflammatory drugs such as ibuprofen. If over the counter anti-inflammatories are not adequate, oral corticosteroids could be taken to reduce swelling and pain. Corticosteroids can also be injected into the lower back to further reduce swelling and pain enough for recovery.
  • Surgical Treatment
    In some cases, the non-surgical treatments are not enough and surgery may be an option. The goal of surgery is to create more space in the low back joints to reduce the compression that may be irritating the nerves.  The type of surgery chosen typically depends on the structures that are causing the compression. Compression may be caused by a disc that has herniated, a bone spur, a narrow hole, or a collapsed joint. Common surgeries include: decompression, discectomy (removal of the disc), laminectomy (removal of a part of the bone), foraminotomy, and fusion. Surgical options will be discussed during a consultation with a physician.

    Rehabilitation Following Surgery
    Recovery time following surgery depends on the individual patient as well as several other factors, including the type of procedure performed. The prognosis for surgery is good and the majority of people will return to normal activity after surgery. Healing may take longer for some patients. Range of motion exercises can be recommended depending on healing time. Physical therapy may also be prescribed to help restore flexibility, strength and function after surgery.