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Many of the small nerve roots that emerge from the spine in the low back area
converge to become the sciatic nerve, which extends down the leg to supply the
muscles and skin of the leg. Compression of the nerve roots can cause sciatica;
pain that usually begins in the buttock area and extends down the back of the
thigh and into the lower leg and foot. Most people who have suffered sciatica
(many of whom have tolerated low back pain for many years) claim that there
is no pain as excruciating as sciatic nerve pain down the leg, and dread suffering
a recurrence of these symptoms.
Sciatica is not a disease or a condition, but a symptom of a disorder in the
low back causing spinal nerve compression. The most common disorder that can
cause sciatica is a lumbar herniated disc or a bulging disc. Other spinal disorders
can cause sciatica and include spondylolisthesis, lumbar spinal stenosis, spinal
tumor, and trauma. Spine specialists are doctors who can determine what is causing
sciatica. Once a diagnosis is made, a treatment plan is formulated and put into
action to relieve sciatic nerve pain and related symptoms (numbness, tingling
sensations).
Self-Care Under a Doctor's Care
Doctors recognize that some patients with sciatica can be helped by self-care
efforts. Some of these self-help measures include:
1. Being aware of and avoiding activities or bodily movements that trigger
or aggravate sciatica.
2. Avoiding prolonged bed rest. Although sciatica is painful, some activity
is better than none. Inactivity can make symptoms worse. A day or two of rest
may be helpful, but avoid the temptation to lay in bed doing nothing else for
a week.
3. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are helpful
to reduce inflammation and sciatic nerve pain. NSAIDs include aspirin and ibuprofen.
Acute or chronic sciatic nerve pain may require more aggressive types of non-surgical
treatment. The doctor may combine therapies for maximum back and leg pain relief.
Chiropractic
Doctors of Chiropractic medicine provide many conservative, non-invasive and
drug-free therapies to reduce sciatic nerve symptoms. Chiropractic care of sciatica
is covered separately in the article Chiropractic
Treatment of Sciatica.
Stronger Medication
If pain is severe, the doctor may prescribe a more potent NSAID. Chronic sciatica
may require a muscle relaxant and/or anti-depressant medication. Certain anti-seizure
and anti-depressant medications are effective in blocking pain messages sent
to the brain. Some of these drugs may enhance the body's production of natural
pain killers - endorphins.
Epidural Steroid Injection
This type of spinal injection places a steroid (corticosteroid) medication near
spinal nerve roots. Steroids reduce inflammation and can help to ease back and
leg pain. An epidural steroid injection may provide pain relief for several
months or longer.
Structured Physical Therapy Program
Physical therapy and rehabilitation include passive treatments and therapeutic
exercises customized to meet the patient's individual needs. Physical therapists
work one-on-one with the patient to reduce pain, increase flexibility, and build
strength.
Passive treatments include ultrasound, transcutaneous electrical stimulation
(TENs), myofascial release (deep tissue massage), and cold/heat therapies.
Such therapies usually are administered to the patient before exercise to
warm and ready the body for movement.
Therapeutic exercise helps the patient to increase flexibility, spinal
range of motion, and build a stronger body. Patients are urged to continue
a regular flexibility and strengthening program at-home. The patient's physical
therapist provides an easy-to-follow plan to enable continued progress outside
of the rehab facility. In addition, exercise enhances the production of endorphins.
Endorphins help to reduce pain and improve mood.
A structured physical therapy program educates the patient about proper posture
and body mechanics, which help to prevent spinal disorders and sciatica.
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