• Sciatica is a symptom not a disease.
• The Sciatic nerve is the largest nerve in the human body.
• Most people with sciatica can be treated without surgery.
Q. I have shooting pain down my right leg. I was told that I have the disease sciatica. What is this strange word and disease sciatica?
A. It is true there are many “strange” sounding words used in medicine. Sometimes the words sound like something else in “common language” but instead have a real medical meaning. “Artery” is not the study of paintings but rather refers to blood vessels that carry blood away from the heart. “Bacteria” does not refer to the back door to the cafeteria but rather a microscopic living organism that may cause disease. “Benign” is not what you are after the age of 8, but a term that refers to a disease that will not spread. And, “sciatica” (sai-AT-ti-ka) does not refer to your favorite uncle from Duck Dynasty, Uncle Si visiting a prison in NY, Attica.
Sciatica, instead, is pain in the lower extremity that results from irritation of the sciatic nerve. Sciatica is then not a disease, but rather a symptom.
The sciatic nerve is the longest nerve in the human body. It runs from the low back through the buttocks, down the leg, ending below the knee. This nerve controls several muscles and the sensation in much of the leg. When this nerve is irritated, pain results in the leg. The pain may vary from simple tingling to severe excruciating pain that shoots down the leg. The pain may worsen with sitting, sneezing or coughing. If the irritation to the nerve is prolonged and severe, numbness or even weakness of the leg may develop.
The most common cause of sciatic nerve irritation is a herniated or slipped disc in the lower back. When a lumbar (low back) disc is herniated it may directly press on the sciatic nerve causing irritation and inflammation, resulting in sciatica (the pain symptom). Aside from a “pinched” nerve from a disc, other causes of sciatica include irritation of the nerve from bone, possibly from narrowing of the spinal column (spinal stenosis), tight or muscle spasms that push on the nerve, or injury to the nerve from trauma, like a fall. In addition, the nerve may be irritated by infection, tumors, or internal bleeding. Pregnancy, due to the uterus putting pressure in the lower abdomen and back, may also result in sciatic nerve irritation and pain.
Sciatica may be diagnosed by a complete history and physical. There may be times when X-rays, MRI scans, or nerve conduction studies may be ordered to confirm the diagnosis. The goal of treatment of sciatica is to decrease pain and increase mobility. Most cases of sciatica respond to a treatment regimen that includes anti-inflammatory medications, stretching exercises and physical therapy. Hot or cold compression packs, as well as, chiropractic manipulation may also help relieve symptoms. Approximately half of affected individuals will recover from an episode of sciatica within six weeks. As always, check with your health care provider before starting any treatment regimen to ensure it is right for you.
Those cases that do not respond to conservative care may be referred for spinal injections. An injection of cortisone into the lower back usually helps reduce the inflammation and irritation of the sciatic nerve resulting in less pain and increased mobility. If injections fail, a final treatment option is surgery to remove the pressure or irritation from around the sciatic nerve. The vast majority of individuals, 80 percent or more, get better without surgery.
You can limit your odds of developing sciatica by: 1. Practicing proper lifting techniques. Lift with your back straight, bending at the knees, and holding the object close to your chest. 2. Avoid cigarettes, as smoking promotes disc degeneration. 3. Exercise and stretch regularly to strengthen muscles of your back to support your spine. 4. Use good posture when sitting and standing. Good posture relieves the pressure on your low back. 5. Avoid sitting for prolonged periods of time.
Your symptoms sound like those of sciatica most likely from a herniated disc. You should see your health care provider who will prescribe an appropriate treatment regimen for you. If you are prescribed physical therapy, there won’t be any “bandages” involved other than perhaps The Eagles or Rolling Stones playing on your iPod or radio.
Stay healthy and remember the quote by Aristotle, “The aim of the wise is not to secure pleasure, but to avoid pain.”
— Dr. Arun Nagpaul is a medical doctor and is board-certified in Internal Medicine. He currently is the Medical Director at Newark-Wayne Community Hospital and also serves as the Medical Director for Wayne County Public Health, Wayne County Nursing Home and Blossomview Nursing Home. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions, email Dr. Nagpaul at Arun.Nagpaul@rochestergeneral org and put “Ask a Doc” in the subject line.