Sciatica is characterised by pain in the lower back and gluteal region. This pain can radiate down one or both legs into the thigh, calf, ankle and foot. Genuine
sciatica occurs when pain travels below the knee.
Sciatic pain results when the base of the spine is compressed or when injury or pressure have compressed the spinal roots of the sciatic nerve. The sciatic nerve systems are located in in the lumbar and the sacral regions of the spine. Sciatic pain or sciatica can be described as sharp, dull, burning, tingly, numb, continuous or intermittant and usually only affects one side of the body. It can radiate the entire length of the nerve, in some cases all the way down to the toes.
Sciatic pain is most often the result of a herniated disc, spinal stenosis (an overgrowth of bone in the spinal canal) or in extremely rare cases, infection or tumor.
1 Sciatic Nerve (yellow) 2 Sacrum 3 Hip Bone
Yellow = Nerve Structures
Red Structures = Arteries
Blue Structures = Veins
Herniated disc
Each vertebral disc is composed of a tough outer layer of cartilage and a more elastic central area. As we age, these discs degenerate becoming thinner and weaker. Extra pressure from a fall or from heavy lifting can cause cracks in the outer layers of the discs, allowing the central mass to squeeze out. This kind of rupture can put pressure on the spinal cord or the nerves that branch from it. Herniated discs in the lumbar or sacral regions can put pressure on the sciatic nerve causing pain and discomfort.
How is it treated?
Those with lower back pain have historically been prescribed bed rest in order to offer relief for aching bones and joints. Research in recent years has suggested that bed rest alone will not offer relief for those suffering from nerve pain such as sciatica. Staying active may be more beneficial for those who suffer from back pain. Not to say that you should be running marathons! Activity means being up and mobile for periods of time that are not enough to cause further pain and aggravation to your back. Some physicians may prescribe specific exercises, or some may simply suggest walking.
A Dutch study, published in The New England Journal of Medicine, followed 183 patients with sciatica. Half of these were counseled to follow a regimen of bed rest with breaks only for bathing and using the toilet. The other half were instructed to remain active as usual. The patients symptoms were evaluated after two weeks and again after twelve weeks. Whether they had rested or not, the patients symptoms in the two groups were consistent. Two thirds reported improvement and both groups recorded similar numbers of days off work and subsequent surgeries.
Pain relief
Pain is best treated with a non-steroidal anti-inflammatory such as ibuprofen or codeine (in acute cases).
In some cases a cortisone like drug may be injected into the epidural space surrounding the spinal column. This procedure is similar to the epidural used during childbirth. A course of this type of treatment may offer temporary relief, but does not address the root of the problem.
Surgery
Some patients with sciatica may find significant relief from surgery. In cases of herniated discs, a surgical procedure called a laminectomy may be performed. In this procedure, a portion of the posterior arch is removed to relieve pressure on affected nerve tissues.
In cases of spinal stenosis, the portion of bone that is putting pressure on the sciatic nerve system can be removed.
Surgery is not for everyone. However, for those who have shown no sign of improvement in four to six weeks and who have had CT scans (computed tomography) or MRI that show a herniated disc or spinal stenosis, surgery may offer significant relief.
Last Updated: 04/04/2008
