Sciatica and Radicular (Nerve Related) Back and Leg Pain

Written by Donald S. Corenman, MD, DC

Do you have lower back or buttocks pain that runs down into your thigh or beyond the knee into one leg? Your doctor may diagnose your symptoms as “sciatica”. Sciatica is a term doctors use to describe pain and sensations caused by compression of the sciatica nerve. This compression is normally caused by a disc herniation or a bone spur pressing on one of the nerves in the lower back.
Sensations, or unusual feelings may include numbness, tingling, pins and needles, and sometimes pain described as electric-shock-like. Depending upon the individual nerve that is affected, pain can radiate only into the buttocks or all the way down to the foot.

Sciatica pain radiates along the sciatic nerve, usually from the low back, down the buttocks, into the thigh and leg. One hallmark of classic sciatica is the pain and symptoms are felt below the knee and sometimes into the foot and great toe. Usually, sciatica only affects one side of the lower body.

Radicular Pain, Radiculopathy
Radicular pain or radiculopathy are other terms your doctor may use when discussing sciatica. A radiculopathy is pain and/or adverse sensation that travel along a nerve. When a spinal nerve root is compressed, pinched or injured, it may become inflamed. Lumbar (low back) conditions that may cause this type of problem are spinal stenosis, foraminal stenosis or herniated disc.

Proper Diagnosis Essential to Treatment
The doctor will ask you about your symptoms, such as:

The doctor may perform a straight-leg test to see if you have an inflamed nerve. You lie on your back while the doctor lifts each leg. If lifting a leg causes, or produces sciatic-like pain and sensations, you may have a bulging or ruptured disc.

The doctor may ask you to walk as you normally do, then on your heels and next, your toes. This helps the doctor to check your balance and aspects of lower-body strength. Compression of the nerve can cause muscle weakness in the foot which will be revealed by these tests.

During your exam, your doctor will:

Your doctor may order a plain x-ray, CT scan or MRI. The CT scan or MRI provides the doctor with many snapshots of your spine, and can help confirm a suspected diagnosis. The findings of an imaging test are compared to the information the doctor gathers during the taking of your medical history, and physical and neurological examination results. An accurate diagnosis is one of the first steps in determining the best treatment options.

What Else Could it Be?
Only your doctor can tell for sure if your symptoms are sciatica. There are many other structures in the spine that can cause similar types of pain. For instance, the joint between the pelvic and sacrum (sacroiliac joint, or SI joint), the lowest part of the spine can cause pain in the buttock. You may also feel sciatica-like pain if you sprain a low back facet joint, which are the connecting joints in the back part of the spine. A tear in a disc can cause pain down into the leg. The hip joint can occasionally cause pain in the thigh.

Sciatica Treatment
Sciatica usually can be treated nonsurgically with brief (24 to 48 hours) bed rest and pain relievers such as ibuprofen or acetaminophen. In some cases, the doctor may prescribe medication that relieves nerve pain, such as gabapentin. Oral steroids are a good medication to calm down nerve pain. In most cases, patients with sciatica feel better over time, usually within a few weeks. If pain persists, injections might be discussed.

Muscle spasms, which may accompany sciatic symptoms, may be treated with heat or cold. Your doctor may tell you to take short walks, and may prescribe physical therapy. Once you recover, your doctor may give you exercises to strengthen your back.

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