Sciatica is a symptom consisting of radiating leg pain, which may range from feeling like a bad leg cramp to excruciating, shooting pain that makes standing or sitting nearly impossible. Sciatica can occur suddenly or it can develop gradually. Along with leg pain, you might also feel weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes. Less common symptoms might include the inability to bend your knee or move your foot and toes.
What causes sciatica?
The symptoms of sciatica can be caused by several conditions. Each of these conditions involve irritation of the sciatic nerve, which runs from the low back down the back of the leg and divides into smaller nerves that travel down the calf to the bottom of the foot. The sciatic nerve can become irritated in several different locations.
Conditions that cause sciatica:
Herniated disc- A bulging or herniated disc puts pressure on a nerve root and is the most common cause of sciatica.
Spinal stenosis– This condition results from narrowing of the spinal canal which can put pressure on the nerves.
Spondylolisthesis– This is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits the spinal canal.
Piriformis syndrome– This develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve.
A complete medical history, including a review of your symptoms, and a detailed physical exam will allow the health care provider to diagnose sciatica and determine its cause. The exam should include orthopedic and neurologic testing to determine the location and extent of the sciatic nerve irritation.
Other diagnostic tests might be performed to look for other causes of sciatic pain. Such testing might include:
However, most patients with sciatica can be treated without the need for further diagnostic imaging.
The goal of treatment is to decrease pain and improve mobility, while restoring proper function so the condition does not reoccur. The techniques and treatments utilized will vary depending on the cause of your sciatica symptoms. A detailed evaluation will be performed to classify your condition and identify the best treatment approach to quickly relieve your pain. You will then be given specific exercises based on your exam findings to reduce pain and centralize or decrease the radiating pain into the leg. If your symptoms are resulting from a lumbar spine condition, treatment will focus on reducing irritation to the nerve root and improving joint and disc function in the low back. If your symptoms are stemming from piriformis syndrome, treatment will focus on proper hip mobility and establishing a muscle balance between the glute muscles and the deep external hip rotator muscle group (piriformis, gemelli, obturators, and quadratus femoris muscles).
Treatment may include the following techniques:
In few cases, patients do not respond well to conservative care or pain is too severe to begin manual therapy treatments. In these situations, care will be coordinated with your medical doctor to achieve a positive outcome and reduce pain. Other treatment options for sciatica include the following:
Medicine — Pain medicines and anti-inflammatory drugs may help to relieve pain and stiffness, allowing for increased mobility and exercise. Muscle relaxants might be prescribed by a medical doctor to relieve the discomfort associated with muscle spasms. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment to allow for more effective conservative care results.
Spinal injections — An injection of an anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility, if conservative care methods are not yielding the expected results.
Surgery — Surgery might be needed for people who do not respond to conservative treatment, have progressing symptoms, and are experiencing severe pain.
Surgical options include: