What is Sciatica?
Sciatica is pain somewhere in the leg that originates in the back. Many people never even have any back pain, and that is why it is sometimes hard to understand the diagnosis. The sciatic nerve emerges from the lower spine, goes down the leg, and stimulates the muscles and skin of the thigh, leg and foot.
What Causes Sciatica?
Injury or inflammation of the sciatic nerve can cause pain to travel down the leg from the thigh and into the foot and toes. Sciatica may be caused by a back injury, or from pressure on the nerve at various points along the nerve pathway. Sciatica pain may also be caused by an abnormal bulging or protrusion of a disc in the lower back. The discs are jelly-like pads that act as elastic cushions to separate the vertebrae (spinal bones). The affected disc(s) may press on the spinal nerve root of the sciatic nerve. This condition is known as a herniated or "slipped" disc, and the pain may be felt all along the lower back. Sciatica may arise when a muscle goes into a spasm, contracts abnormally and puts pressure on the nerve. Injury occurs as a result of weak back muscles, by prolonged or improper use of the back, or as a result of being overweight.
How is Sciatica Diagnosed?
Sciatica is diagnosed with a medical history and physical exam. Your health professional will ask you questions about your symptoms.
Your doctor may be able to tell that you have sciatica just by asking you these questions. However, X-rays and tests such as magnetic resonance imaging (MRI) are necessary to confirm a diagnosis.
How Can I Ease My Pain?
If you have low back pain or have reason to believe you have sciatica, apply a heating pad to the lower back to help reduce inflammation and swelling and to decrease the pain. Use the heat for periods of 20-30 minutes, with at least a 30-minute interval between each application. Avoid sitting for any length of time. Sitting puts the weight of the body on the lower discs of the spine, which may aggravate disc problems related to sciatica.
You may be most comfortable when lying on your back or walking. A word of caution: these are temporary remedies and not a substitute for seeking immediate professional care. If you have sciatica, consult your doctor as soon as possible.
What Can My Back Specialist Do?
Back specialists are educated and trained in the detection and treatment of problems affecting the spine. Many cases of sciatica lend themselves to correction through epidural steroid injection (ESI). Physical therapy can also be helpful.
What is Epidural Steroid Injection?
ESI is a procedure in which a cortisone-like drug is injected into the spinal canal. Though the anti-inflammatory properties of the medication tend to be temporary (one week to one year), an ESI can be beneficial in providing relief for patients during an episode of severe back pain and allows patients to progress in their rehabilitation. The procedure causes very little discomfort, and the risk of complication is very low.
How is an ESI Done?
ESI is an outpatient procedure, really no more than an office visit. A small area in the lower back is numbed with a local anesthetic. A very small needle is then placed through the skin into the epidural space - an area adjacent to the affected nerves. The medications are painlessly injected through the needle and spread to the nerves.
Physical Therapy After ESI
Physical therapy after an ESI injection is designed to strengthen the muscles of the lower back, abdomen, buttocks and legs in order to promote good posture and enhance your treatment. The therapy may include ultrasound, moist heat and massage. In addition, the education portion of the program should teach you how to minimize the recurrence of sciatica. Topics include which exercises to do, which exercises to avoid, as well as medications and proper body mechanics.
Your physical therapist can recommend helpful exercises that you can do at home to ease pain or to prevent future problems.