Sciatica & Herniated Discs

Condition

Definition: Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.

Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

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 might 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 pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.

Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

Causes: Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.

-Mayo Clinic Staff

Treatments

Pharmacotherapy – The treatment of sciatica may include medications like NSAIDs (Ibuprofen-like drugs), acetaminophen, membrane stabilizing drugs, muscle relaxants, and other analgesics.

Epidural Steroid Injections (ESI) – These injections deliver a long-lasting steroid and a local anesthetic into the epidural space, targeting the irritated nerve root. The steroid reduces inflammation and irritation and the anesthetic works to interrupt the pain-spasm cycle and transmission of pain signals (Boswell et al, 2007). The combined medicines then spread to other levels and portions of the spine, reducing inflammation and irritation. The entire procedure usually lasts under fifteen minutes. ESIs have been shown to provide rapid relief of symptoms that allows patients to regain normal daily activity (Vad V et al, 2002). A large study in 2005 including two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica were randomized to either three lumbar ESIs of or a placebo injection at intervals of three weeks. The ESI group demonstrated a 75% pain improvement over the placebo group (Arden et al, 2005).

Physical Therapy – Physical Therapy helps improve symptoms of sciatica by increasing flexibility, range of motion, posture, and improving muscle strength. In fact, current evidence shows that an active exercise program promotes early recovery in sciatica patients (Goh L et al, 2003).

Nutrition and Exercise – Exercise improves the pain of sciatica by increasing flexibility and range of motion. Another benefit is the releases hormones called “endorphins,“ which are your body’s natural pain relievers. Nutrition and healthy eating may be powerful treatments to combat nutritional deficits.

Jonathann Kuo, MD
Pain Medicine / Executive Director
Alexander Rances, DO
Pain Medicine / Medical Director
Robert Zhang, MD
Pain Medicine / Anesthesiology

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