That Pain in the Rear……….Sciatica

Are you experiencing pain that begins in your back and travels down through your buttock muscles, thigh, leg, and into your foot? Is the pain only on one side of your body? Is this pain a sharp needle or a burning sensation? Do you have numbness or weakness? Are you having difficulty with walking? Is there tingling in your foot? If so, these are the common signs and symptoms of Sciatica. These symptoms are produced when the Sciatic Nerve gets pinched or irritated.
The Sciatic Nerve begins in the back and travels down through the thigh and then divides into two nerves in the leg. The Sciatic Nerve is one of the largest nerves in the body and provides sensation to the skin and motor innervation to move many muscles in the lower limb. The Sciatic Nerve is usually well protected by the body since it is surrounded by the muscles and travels close to the bone; however, despite this protection the nerve can be damaged or irritated by the following causes:
• Herniated disc-1 in 50 people will herniate at least one disc during their life and 10-25% will have symptoms of Sciatica that last longer that 6 weeks.
• Vertebral (spine) bone spur
• Tumors growing that may press on the nerve
• Trauma
• Degenerative disc disease
• Narrowing of the spinal canal, which is called lumbar stenosis
• Piriformis Syndrome-15% of patient’s Sciatic Nerve courses through the Piriformis Muscle fibers. With Piriformis Syndrome, the Piriformis Muscle shortens and will entrap the Sciatic Nerve, which will cause irritation to the Sciatic Nerve.
Sciatica is usually diagnosed based off of the symptoms. However, usually the cause of the Sciatica will need to be diagnosed using various types of advanced imaging. For example, a vertebral bone spur that is compressing the Sciatic Nerve will be able to be viewed on a plain film x-ray. Whereas a MRI may be needed to view a tumor that is compressing the nerve; MRI allows for visualization of soft tissue structures, such as muscles. CT scans may also help to aid in the diagnosis of what may be leading to Sciatica.
Fortunately, Sciatica is usually not a permanent condition and can be treated non-surgically. In fact, 80-90% of Sciatica cases will heal with ample rest. Many patients will also take anti-inflammatory medications, such as Ibuprofen to decrease the inflammation in an attempt to decrease the pain. Other non-surgical treatment options are physical therapy exercises and/or cortisone injections. It is also very important to treat the underlying cause of Sciatica to prevent recurrent episodes.
Unfortunately, 100% of Sciatica cases cannot be treated with the above conservative treatments and surgery will be needed. Patients who have pain in their leg for 3 months and have failed to get relief from the conservative treatment methods are usually considered a possible surgical candidate. Patients who have symptoms of Sciatica that are localized to the leg have a 90% chance getting relief from surgery. After surgery, rehabilitation and physical therapy will be needed to get the body’s strength back and prevent further episodes. If you are having any of the symptoms of Sciatica, consult your doctor immediately, so conservative treatments will be more effective.

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