Dr. Nocerini offers tips and advice on treating Sciatica pain
By Dr. Robert Nocerini
Sciatica is a broad term used to describe pain that is felt through the sciatic nerve. The sciatic nerve is a large nerve that runs through the buttock and leg and is made up of individual nerve roots that originate in the lower lumbar and upper sacral spine. The sciatic nerve is necessary to power muscles in the legs, but it also transmits sensory information, including pain.
Sciatica pain is typically experienced in the buttock with radiation down the back of the leg, sometimes all the way to the toes. The pain can be sharp, shooting, burning, shock-like, or tingling. Sometimes weakness or numbness may be present.
It may be caused by compression or irritation of the sciatic nerve at its origins in the spine, or along its course in the buttock or hip area.
Symptoms may be experienced in different parts of the leg or foot, depending on which nerve root or roots are affected.
What causes Sciatica?
Sciatica has several causes, all of which may cause pain by irritating the sciatic nerve or its nerve roots. The main causes are herniated discs, spinal stenosis, degenerated discs, facet arthritis, spondylolisthesis, and piriformis syndrome. More than one of these conditions may be present simultaneously.
- Herniated Discs are discs that have developed a bulge on the back of the disc that may compress the sciatic nerve roots. This compression causes pain, but not all herniated discs will affect nerve roots. Many people have herniated discs and do not experience pain.
- Spinal Stenosis similarly compresses nerve roots, but may also cause compression of the spinal cord or the sac that contains it. The pain of spinal stenosis typically is felt in both legs and in the back.
- Degenerated Discs have slowly become damaged over time and leak inflammatory proteins which are irritating to the nerve roots.
- Facet Joints are small joints in the back of the spine. These joints link the bones of the spine together and assist in allowing rotation and bending of the spine. With time, these joints can develop arthritis like other joints in the body, such as a hip or knee. These joints then become enlarged and may press on the nerve roots causing pain.
- Spondylolisthesis is a condition in which one vertebral body may “slip” forward over the vertebral body beneath it. This is due to a disruption in part of the vertebral bone compromising its stability. This disruption may have been present since birth, or it may have developed over time due to a stress fracture. The slipping of the vertebral body can cause pain by compressing the spinal nerve root as it travels through the now narrowed hole in the side of the spine called the neural foramen.
- Piriformis Syndrome is caused by irritation of the sciatic nerve as it travels through the piriformis muscle in the posterior hip.
How is Sciatica treated?
In many cases, sciatica will resolve within a few weeks with the use of ice or heat and a short course of over the counter anti-inflammatory medications. In cases where these measures are ineffective, physical therapy may be started along with prescription medications.
Physical therapy is often used, and it is effective at reducing pain in many instances. In some more severe cases, opioids may be prescribed. Epidural steroid injections may give relief in both acute and chronic cases of sciatica due to a herniated disc, and they may reduce pain due to other causes of sciatica as well.
In some cases, surgery may be recommended if the symptoms are severe. In some chronic cases, where the pain has been resistant to these measures, spinal cord stimulation has been effective.
What’s the difference between a slipped, bulging and herniated disc?
These terms all pretty much mean the same thing, although the term “slipped” disc is not used in medical terminology. The common terms “bulge,” “herniation,” “protrusion,” or “extrusion” each describe a different shape or degree of movement of a disk outside of its normal location.
Back pain with concerning signs
In some cases, pain may have a dangerous cause, such as infection, bleeding, trauma, malignancy, or if a part of the spinal cord called the cauda equina is compressed.
Back pain that is accompanied by fever, chills, sweats, weight loss, abdominal or chest pain, vomiting, trouble breathing, severe weakness or inability to control the bladder or bowels may be a medical emergency, and these symptoms should be evaluated as soon as possible in an Emergency Department.