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Sciatica

by Robert S. Dinsmoor

Pain radiating along the path of the sciatic nerve. The sciatic nerve is the longest nerve in the body. Roughly the diameter of a finger, it starts in the lower spine and travels down the buttocks and through the back of each leg to the feet. It controls many of the muscles of the lower legs and gives sensation to the thighs, legs, and feet.

Sciatica may take the form of pain along all or part of the sciatic nerve pathway. The pain can vary from a mild ache to a burning sensation to excruciating pain. It may be accompanied by numbness or muscle weakness along the nerve pathway, tingling or a “pins and needles” sensation in the toes or foot, or a loss of bladder or bowel control.

Sciatica can have many causes, though it is most commonly the result of compression of the sciatic nerve or its root in the lower (lumbar) spine. This compression may occur when the cushioning disk between the two vertebrae becomes ruptured or herniated and presses into the nerve. Other causes of sciatica include lumbar spinal stenosis (in which areas of the spinal canal, the channel through which the spinal cord passes, become narrower), spondylolisthesis (in which the sciatic nerve gets pinched between two vertebrae), and piriformis syndrome (in which the piriformis muscle of the lower spine and thighbone becomes tight or spasms, pressing on the sciatic nerve).

Mild cases of sciatica typically go away over time. However, people should call their doctor if the pain lasts more than six weeks, is severe, or continues to worsen. People should get medical help immediately if they notice sudden, severe pain, numbness, or weakness in the back or leg, if the pain follows a violent injury, or if they have trouble controlling either bowels or bladder.

Doctors usually diagnose sciatica based on a medical history and physical examination. In severe cases, imaging tests such as spinal x-rays, magnetic resonance imaging (MRI), and computerized tomography (CT) may be used to find out what is pressing on the sciatic nerve.

There are a number of measures people can take to treat sciatica themselves. Staying active is the most important step. Though it is tempting to rest in bed, prolonged inactivity can make the symptoms of sciatica worse. Other self-care measures include applying cold packs to painful areas immediately after the onset of symptoms, applying hot packs to these areas after 48 hours, performing stretching exercises, and taking over-the-counter painkillers such as acetaminophen (brand name Tylenol) or ibuprofen (Advil, Motrin).

In more severe cases, muscle relaxants, prescription anti-inflammatory drugs, tricyclic antidepressants, or anticonvulsant drugs may be required. Physical therapy is another option. If these measures don’t successfully manage pain, a doctor may inject corticosteroid drugs into the affected area. In dire cases, especially when a compressed nerve causes severe weakness or incontinence, a surgeon may remove part of the herniated disk that is putting pressure on the nerve.

Prevention is key. Though not all cases of sciatica can be prevented, a person can lower the risk of developing it by exercising regularly, strengthening the back and abdominal muscles, and avoiding sitting for long periods of time.

Last Reviewed on May 30, 2013

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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