Sciatica - All you need to know

By Mayo Clinic staff
1.Definition
Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg.

Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica — which may be quite uncomfortable — usually goes away on its own within a couple of months.

In the meantime, self-care measures may help you ease sciatica. Sometimes, your doctor will suggest other treatment.

2.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. It may be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one lower extremity is affected.

Sciatica symptoms include:

Pain. It's especially likely to occur along a path from your low back to your buttock and the back of your thigh and calf.
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, often 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.

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

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

4.Causes
Your sciatic nerve branches from your spinal cord through your hips and buttocks and down the back of each leg. This nerve controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet. Sciatica may develop when a nerve root is compressed in your lower (lumbar) spine — often as a result of a herniated disk in your lower back.

Disks are pads of cartilage that separate the bones (vertebrae) in your spine. Filled with a gel-like substance, they keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move.

If the outer covering of a disk tears (herniates), gel may seep out and press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot.

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

Lumbar spinal stenosis. Spinal stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. 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 your spine.
Piriformis syndrome. 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. Prolonged sitting, car accidents and falls 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. As it grows, a tumor compresses the cord itself or the nerve roots.
Trauma. A car accident, fall or blow to your spine can injure the lumbar or sacral nerve roots.
Sciatic nerve tumor or injury. Sometimes, 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 your bones, joints and muscles, all of which could potentially result in sciatic pain.

5.Risk factors
Risk factors for sciatica include 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 a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 40.
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.
Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

6.Complications
Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including:

Loss of feeling in the affected leg
Loss of movement in the affected leg
Loss of bowel or bladder function

7.Preparing for your appointment
Make an appointment with your primary care provider if you have symptoms common to sciatica that are severe or that don't improve within a month of self-care measures.

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

Write down any symptoms you've been having, and for how long.
Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
Note any recent accidents or injuries that may have damaged your back.
Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
For radiating low back pain, some basic questions to ask your doctor include:

What is the most likely cause of my back pain?
Are there any other possible causes?
Do I need any diagnostic tests?
What treatment approach do you recommend?
If you're recommending medications, what are the possible side effects?
For how long will I need to take medication?
Am I a candidate for surgery? Why or why not?
Are there any restrictions that I need to follow?
What self-care measures should I be taking?
Is there anything else I can do to help prevent a recurrence of these symptoms?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that arise during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

What are your symptoms?
When did you first notice these symptoms?
How often do your symptoms occur?
Have you had any unexplained fevers or weight loss?
Have you had any new problems with bowel or bladder control?
Do your symptoms include any numbness or weakness in your legs?
Does anything make your pain better or worse?
How much is your pain limiting your ability to function?
Does your work or recreational activities involve any heavy physical work?
Do you exercise regularly? If yes, with what types of activities?
Do you smoke?
What treatments or self-care measures have you tried so far? Has anything helped?
Are you currently being treated or have you recently been treated for any other medical conditions?
What medications are you currently taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
What you can do in the meantime
While you're waiting for your appointment, you may find some relief by using over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others). You may also benefit from applying alternating cold and heat to the area that's causing you pain.

8.Tests and diagnosis
To help diagnose sciatica and pinpoint which nerves, if any, are affected, your doctor will use these approaches:

Medical history. Your doctor will ask about your medical history.
Physical exam. Your doctor will perform a thorough physical exam, paying special attention to your spine and legs.
Basic muscle tests. Likely, your doctor will have you undergo 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.
Imaging tests
If your pain lasts longer than four 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. Ordinary X-rays can't detect herniated disk problems or nerve damage. A spinal X-ray can help pinpoint the cause of sciatica.
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. Most MRI machines are large, tube-shaped magnets. During the test, you lie on a movable table inside the MRI machine.
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.
Treatments and drugs
By Mayo Clinic staff
For most people, sciatica responds well to self-care measures. These may include use of alternating cold packs and hot packs, stretching, exercise, and use of over-the-counter (OTC) medications. Beyond the self-care measures you may have taken, your doctor may recommend the following:

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.

Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers.
More aggressive treatments
When conservative measures don't alleviate your pain within a few months, one of the following may be an option for sciatica treatment:

Epidural steroid injections. In some cases, your doctor may recommend injection of a corticosteroid medication into the affected area. Corticosteroids suppress inflammation around the irritated nerve, thereby helping to relieve pain.

Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited. If your doctor recommends corticosteroids, he or she will determine a safe course of injections for you.

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

Surgical options include diskectomy and microdiskectomy. In diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. 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 may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks.

9.Lifestyle and home remedies
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 signs and symptoms worse.

In addition to resuming usual activities, try the following measures:

Cold packs. Initially, using cold packs may be able 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 up to 20 minutes at least several times a day.
Hot packs. After two to three days, apply heat to the areas that hurt. Use hot 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. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.
Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that treat only pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and acetaminophen (Tylenol, others) can both be helpful for sciatica.

Although they can provide real relief, there's a limit to how much pain they can control. 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 and periodically re-evaluate whether you still need them. Exercise, stretching, massage and other nondrug treatments can often provide the same benefits without side effects.

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. Sustained, regular exercise prompts your body to release endorphins — the body's natural painkillers.

Early in the course of sciatica, water exercise or other low-impact exercise, such as stationary bicycling, will help you stay active without worsening your symptoms. As you improve and the pain lessens, a combined program of aerobic activity, strength training and core stability exercises can help limit the effects of age-related back problems.

Ask your doctor to help you design a safe step-up program for exercise. You may benefit from working with a certified personal trainer, fitness specialists or physio therapist

10.Alternative medicine
Many alternative therapies are being studied intensely, and some have proved to help alleviate back pain.

Acupuncture. In acupuncture, the practitioner inserts sterilized stainless steel needles into your skin at specific points associated with the flow of a vital energy called qi (chee). It's believed that these fine needles can loosen blocked qi and restore balance. In most cases, you won't feel the needles — in fact, many people find the treatments extremely relaxing.

Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide you'd like to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.

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.

Some studies done on spinal manipulation have found it to be as effective and safe as standard treatments, especially for initial pain relief, though the optimal number of treatments is unknown.

Massage. It's difficult to conduct objective clinical trials in massage due to variances in practitioners and in massage types. However, studies that have been conducted suggest that massage may ease low back pain symptoms.
Hypnosis. 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. No one knows exactly how hypnosis works, but it may alter your brain wave patterns in much the same way as other relaxation techniques.

11.Prevention
It's not always possible to prevent sciatica, and the condition may recur. 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. Ask your doctor to recommend specific activities.
Maintain proper posture when you sit. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.

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.

Use good body mechanics. Being conscious of how you stand, how you 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.

When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward or if you're fatigued.