Sciatica

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Definition
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The sciatic nerve begins from the lower spine on both sides of the body. It travels deep in the pelvis to the lower buttocks. From there, it passes along the back of each upper leg and divides at the knee into branches that go to the feet. Sciatica is an irritation of the sciatic nerve.

Sciatica is caused by irritation or pressure on the sciatic nerve. This can be the result of:

Herniated disk—the cushions between the bones of your spine bulge and press on the nerve as it exits the spinal column
Arthritis in the lower back
Spinal stenosis—narrowing of the spinal canal in the lumbar area
Spondylolisthesis—slippage of a bone in the lower back
Cauda equina syndrome—nerve roots at the base of the spinal cord are compressed
Piriformis syndrome— spasm of piriformis muscle

Sciatica is more common in men. Other factors that may increase your risk of sciatica include: Lifestyle and personal health factors, such as:

Obesity
Smoking
History of low back problems
Anxiety and depression

Occupational factors, such as:

Heavy manual labor
Heavy lifting
Exposure to vibrations
A job that requires standing for long periods of time and forward bending

Health conditions, such as:

Fractures in the back
Tumors
Infections
Metabolic problems, such as diabetes

Sciatica causes symptoms that can range from mild to severe. In general, sciatica may cause:

Burning, tingling, or shooting pain down the back of one leg
Pain in one leg or buttock that may get worse with:
- Sitting
- Standing up
- Coughing
- Sneezing
- Straining
Weakness or numbness in a leg or foot

More serious symptoms associated with sciatica that may require immediate medical attention include:

Continuing weakness in a leg or foot
Numbness in groin or the buttocks
Difficulty walking, standing, or moving
Loss of bowel or bladder control
Fever, unexplained weight loss, or other signs of illness

The doctor will ask about your symptoms and medical history and a physical exam will be done. Your doctor will pay particular attention to your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes. Imaging tests take pictures of internal structures. These may include:

X-ray
MRI
CT scan

Your doctor may also need to test your nerves. This can be done with a nerve conduction study or electromyography (EMG).

The goal of treatment is to reduce sciatic nerve irritation. Treatment options include:

Activity

Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising. Physical therapy may include:

Cold packs or heat therapy
Stretching and strengthening exercises
Massage
Ultrasound treatments or electrical stimulation
Posture education and appropriate lifting instructions

Your therapist will educate you on pain-relieving techniques (such as ice) and decreasing or modifying painful activities. This diagnosis often occurs from muscular tightness or weakness which causes pressure on the sciatic nerve which leads to pain and other symptoms. Your therapist will educate you on proper stretching and strengthening exercises for the back and hip. They may perform hands on, manual therapy techniques to further increase your joint flexibility. The final phase of rehab will involve strengthening during functional activities and education to prevent the injury from recurring.

Sciatica tends to be a recurrent condition. To help reduce your chances of sciatica, take these steps:

Use proper body movement when playing sports, exercising, or lifting heavy objects.
Practice good posture to reduce pressure on your spine.
Begin a safe exercise program with the advice of your doctor.
If possible, avoid sitting or standing in one position for long periods of time.
Consider job retraining if your work requires a lot of heavy lifting or sitting.

This content was created using EBSCO's Health Library

RESOURCES:

American Academy of Orthopaedic Surgeons

http://www.orthoinfo.org

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov

CANADIAN RESOURCES:

Canadian Association of General Surgeons

http://www.cags-accg.ca

Health Canada

http://www.hc-sc.gc.ca

REFERENCES:

Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999; 354:1229-1233.
Sciatica. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351 Updated October 2007. Accessed November 26, 2013.
Sciatica. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated November 22, 2013. Accessed November 26, 2013.
Sciatica. Postgrad Med. 1997;102.
Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract. 1997;47:647-652.
6/7/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.

This content was created using EBSCO’s Health Library

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This content was created using EBSCO's Health Library

RESOURCES:

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A Look at Treatment