SCIATICA
Sciatica is a term used to describe symptoms such as pain that radiates from
the back down the leg. It is also a term used to describe irritation and/or compression of one of five nerves that make up the sciatic nerve. The sciatic
nerve is the longest nerve in your body; it runs from the spinal cord to your
buttock, down the hips, and down the backs of both legs. Sciatica is a term
that is often misunderstood. Sciatica is not a diagnosis but instead a set of symptoms. Treatment is geared towards treating the symptoms, depending upon the underlying cause.
There are several causes of sciatica, the most common of which is compression of a nerve root from a herniated disc in the lower back. Lumbar discs are pads of cartilage that separate the bones in your spine. The middle of the disc is a soft material which is surrounded by a more fibrous covering. Occasionally, the soft material from the middle of the disc can leak out causing a herniation. The herniation can then be in a position to press on a nerve causing symptoms such as: pain in the back, numbness, weakness, burning, tingling, and/or pain going down the leg. Other causes of sciatic nerve pain may be lumbar spinal stenosis, spondylolisthesis, trauma, piriformis syndrome, sacroiliac joint
dysfunction, or spinal tumors. Diagnosing the underlying cause of sciatica is
key to proper treatment.
There are a number of steps to help diagnose sciatica. The first step we would
have you do is to provide us with a complete medical history including onset of
symptoms and factors that aggravate and relief your pain. We will then perform
a physical examination. The physical exam will include checking your muscle
strength, testing your reflexes, lifting your legs up in the air one at a time,
waling on your heels and toes, and other tests that will help us diagnose the
source of your pain. Along with a physical exam we may order specific tests.
A spinal x-ray may be ordered but because they can not detect herniated discs
they are not as helpful for diagnosing sciatica. An MRI (Magnetic Resonance
Imaging) is the most sensitive test for assessing nerve pain. This test can
detect damage to discs as well as damage to ligaments and tumors. A CT scan
(Computerized Tomography) is used to look at your spine by using a beam of
radiation to produce detailed images of your body. A dye may be used during a
CT to help visualize the spinal cord and nerves.
Treatment of sciatica can begin after a correct diagnosis has been made. Most
cases of sciatica will respond well to conservative treatments. The use of heat
and/or cold packs, over-the-counter medications, and exercise/yoga may be all
you need to relieve your pain. If your pain continues we may consider other
treatment options such as:
PHYSICAL THERAPY: Physical therapy may help prevent future injuries by
teaching proper stretching and strengthening exercises.
MEDICATIONS: Some medications such as anti-inflammatories, muscle
relaxors, anticonvulsants, and/or narcotics may be prescribed to help manage
your symptoms.
EPIDURAL STEROID INJECTION: The epidural steroid injection is a
procedure in which a local anesthetic and a steroid are administered into the
epidural space, or near the nerve root, in the area of the spinal cord. This is
usually done under fluoroscopy (watching under live x-ray) to deliver the drug
to the precise location. The steroid acts as an anti-inflammatory to help the
nerve and surrounding area “calm down”.
SURGERY: Surgery is usually the last resort when all other treatment options
have failed. The exact type of surgery should be determined by a neurosurgeon
or spine surgeon. Surgical options may include a lumbar laminectomy or
microdiskectomy.
In conclusion, SCIATICA is a very general term which is often used to describe
pain caused by compression or irritation of a nerve originating in the low back.
Treatment depends on a correct diagnosis. If you or someone you know are
suffering from sciatica please contact our office to see how we can help! Our
office phone number is
219-838-1100.
Megan Colburn, RN, NP-C
Last update October 2008
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