The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg. Sciatica is not a medical diagnosis in and of itself – it is a symptom of an underlying medical condition.
What causes Sciatica?
Sciatica has a high sensitivity (95%) for disk herniation, and, without sciatica, the diagnosis of a significant herniation is less likely. Magnetic resonance imaging (MRI) is generally accepted as the most sensitive test to detect herniations.
Sciatica is often characterized by one or more of the following symptoms:
• Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
• Pain that is worse when sitting
• Burning or tingling down the leg (vs. a dull ache)
• Weakness, numbness or difficulty moving the leg or foot
• A sharp pain that may make it difficult to stand up or to walk
How long will it last?
Fifty percent of episodes nearly completely resolve within two weeks, and 80% by six weeks. Unfortunately, the duration and severity of a single episode cannot be predicted based on the onset, location of pain, or even the initial severity. Excruciating initial pain may resolve within several days, while moderate or mild symptoms may persist for weeks. However, up to 30% of individuals will experience recurrent pain or develop persistent pain in the future.
What treatments should I have?
This pain often settles after the first few weeks with simple over the counter medications. Specific anti-nerve pain medications such as amitriptylline, gabapentin, pregablin can be useful in resistant cases.
Injection therapy is usually only required if the problem is not settling satisfactorily after an appropriate period of time. The two injection techniques most often employed are :
1. Epidural injections into the space around the nerves in the spine and within the spinal canal.
2. Nerve root canal injections which are more specific to the affected nerve.
Both injection techniques have the same aim, which is to relieve the pain and inflammation in the nerve while natural healing continues. They can be repeated if required. Both methods seem equally safe. Complications are uncommon, but can include infection or damage to nerves or blood vessels.
As pain subsides, more intensive therapy is aimed at improving strength and function.
Spine stabilization exercises are directed at improving function by conditioning the muscles around the lumbar spine. A key component to spine stabilization is establishing a neutral spine position (the midpoint between available anterior and posterior pelvic tilt) that provides the greatest comfort and functional stability. Correction of predisposing factors such as poor posture when sitting or standing, faulty lifting techniques, abnormal biomechanics, muscle inflexibilities, and poor conditioning is essential to treatment, especially for athletes. Education and individualized coaching on proper technique may help prevent recurrence.
Other manual therapy techniques such as joint mobilization, myofascial release, and muscle energy techniques may be used to improve soft-tissue flexibility and segmental joint function.
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