Sciatica Treatment, Sciatica Symptoms, & Leg Nerve Pain Relief

Definition

Sciatica is not actually a disease, but a symptom that something abnormal is occurring. It is used by different people to describe different conditions. Some individuals use the term to describe any kind of pain that starts in the lumbar, or lower back region and radiates down the leg. Other people use the word "sciatica" specifically to describe the condition that happens when a spinal disc herniates in the lumbar area, causing pressure on the nerve roots.  

Sciatica usually occurs in the area that is supplied by the nerve root that is injured or compressed, and runs down the leg to the foot. Other symptoms associated with dysfunction of the nerve may also occur, such as muscle weakness. The pain travels quickly along the path of the sciatic nerve, and is typically described as "shooting pain."   This shooting pain can sometimes be relieved by specific sciatica stretches and sciatica exercises.


Sciatica, back, backbone
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Prevalence

Depending on how it is defined, 1.6% to 43% of people have sciatica. 

Risk factors

Some factors that increase your risk of developing sciatica are beyond your control, but there are also some lifestyle changes you can make to decrease your chances of developing the condition. Risk factors for sciatica include the following:

  • Age: This risk factor is beyond your control. The older you are, the greater your risk of sciatica. Changes in your spine that occur as you age, like bone spurs and herniated discs, are the most frequent cause of sciatica. Sciatica exercises and sciatica stretches to increase strength and flexibility may decrease the risk of early onset degenerative changes. 

  • Obesity: People who are overweight have an increased risk for sciatica. Maintaining a healthy weight can help prevent extra body weight from increasing stress on your spine. Stress on the spine contributes to the changes that trigger sciatica. 

  • Occupation: There is no conclusive evidence to prove this, but if your job requires heavy lifting and carrying or twisting of your back you may be at increased risk for sciatica. Sciatica exercises to strengthen your muscles may be helpful.

  • Prolonged sitting: Sitting for extended periods or being sedentary most of the time increases your risk of developing sciatica. Sciatica stretches and sciatica exercises, done to break up periods of prolonged sitting may be helpful.

  • Diabetes: This disease increases your risk of nerve damage that leads to sciatica.  People with diabetes may find sciatica stretches and sciatica exercises beneficial.

Reasons

Causes of sciatica include the following:   
  • Spinal disc herniation: A herniated disc occurs when the nucleus pulposus, which is the gel-like inner substance of an intervertebral disc, breaks through the annulus fibrosus, which is the tough, outer rim of the tire-like structure. Pain is the most common symptom. However, nerve compression and inflammation can cause other symptoms including numbness, tingling and/or weakness in the extremities. When a disc ruptures in the lumbar part of the spine it can lead to sciatica. 
  • Spinal stenosis: The word "stenosis"  means narrowing. Spinal stenosis refers to a narrowing of the spine, and it occurs when the bones of your back, the vertebrae, compress the spinal cord or the nerves that branch out from it to the muscles. Spinal stenosis can affect any region of the back, but it happens most frequently in the lower (lumbar) spine. Lumbar spinal stenosis can cause sciatica to occur. Sciatica stretches may help to relieve this as well as sciatica exercises.
  • Piriformis syndrome: This is a disorder of the nerves and muscles that occurs when the piriformis muscle, which is located near the joint of the hip in the buttocks, presses on the sciatic nerve. The sciatic nerve is thick and long, running along the side of or passing through the piriformis, down the back of the thigh and calf and branching off into a network of smaller nerves, eventually ending in the feet. Spasms of the piriformis muscle can cause pressure on the sciatic nerve and sciatica stretches and sciatica exercises done gently can help to relieve this syndrome.

  • Other conditions: Sciatica can also be caused by arthritis or bone spurs. Tumors can also cause compression on the nerve roots or the spinal cord. Traumatic injuries to the spine can lead to the condition. Sometimes pregnancy causes sciatica. Specific gentle sciatica exercises and sciatica stretches are sometimes recommended during pregnancy.

Symptoms

The classic symptom of sciatica is pain that starts in the lumbar or lower spine and radiates into the buttock. From there, the pain travels down the back of the legs. The pain may be felt in many different areas where the sciatic nerve runs,  but it most commonly follows a path that leads from the low back area to the buttock and down the backs of the legs. Gentle sciatica exercises done to relieve this compression can sometimes be helpful.

The amount of pain sciatica causes varies from mild to excruciating. It can feel like an ache, a sharp burning pain or an electric shock. Sometimes it is worse with coughing or sneezing. Prolonged periods of sitting can cause an increase in symptoms. Sciatica stretches to relieve this compression can sometimes be beneficial. In most cases, only one side of the body is involved.  

Some people with sciatica also have muscle weakness, tingling or numbness in the lower extremity on the affected side. It's also possible to have numbness and tingling in one part of your leg, and pain in another. Sciatica exercises and stretches can sometimes help to relieve the numbness and tingling. 

Diagnostic procedures

Doctors typically diagnose sciatica through a thorough physical examination and by taking a history of the patient's symptoms. Usually, if the patient is experiencing radiating pain in one leg, which is typical of sciatica, and at least one sign of nerve involvement, the diagnosis of sciatica can be made. 

The diagnostic test most often used is a straight leg lift to assess for Lasègue's sign. The sign is positive if pain in the sciatic nerve is produced when the straight leg is lifted 30 to 70 degrees. Lasègue's test is positive in approximately 90% of sciatica patients, however, about 3/4 of the patient's who test positive, do not have the condition. 

While imaging testing is not typically used to diagnose sciatica, sometimes tests like magnetic resonance imaging (MRI) or computerized tomography (CT) scans can help find what is causing the condition, such as a herniation of a lumbar disc.  

Pathological changes

Sciatica is most often caused by compression of the last three lumbar nerves, the first three sacral nerves or of the sciatic nerve. Gentle sciatica exercises done to relieve this compression can sometimes be beneficial. When radiating pain is due to pressure on a dorsal nerve root, rather than on a nerve,  the condition that results is considered to be a lumbar radiculopathy. If inflammation also occurs, the condition is radiculitis.   

If swelling occurs in the spinal canal, it can spread to the joints of the spine, causing pain in the lower back and radiating or referred pain into the backs of the thighs. Radiating pain in a lower extremity, with numbness and tingling, can also result due to nerve compression related to muscle spasms or tension in the muscles surrounding the sciatic nerve, usually the piriformis muscle in the buttocks. Gentle sciatic stretches can sometimes help relieve this piriformis muscle pain.

Treatment

Most cases of sciatica resolve spontaneously over a course of a few weeks to months if the cause is lumbar disc herniation. Conservative treatment is usually recommended for the first six to eight weeks. Some of the typical conservative measures for treating sciatica include:

Medications

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These medications are available over-the-counter and will help control the pain of sciatica as well as help reduce the inflammation. Some common NSAIDs are ibuprofen, aspirin and naproxen. 
  • Muscle relaxants: These medications are available only with a prescription and your doctor may suggest them to help relieve muscle spasms. Examples of muscle relaxants for sciatica include cylobenzaprine (Flexeril) and methocarbamol (Robaxin).
  • Narcotics: These medications also require a prescription from your doctor and are generally only used for extreme sciatica pain due to their potential for addiction. Examples are hydrocodone (Vicodin) and oxycodone (Percocet).
  • Antidepressants: Some types of pain are relieved by medication that is also used to treat depression. A doctor's prescription is required for these medications. Examples are venlafaxine (Effexor) and duloxetine (Cymbalta).
  • Anti-seizure medications: Your doctor may prescribe medications used for epilepsy to help control your sciatica pain. An example is gabapentin (Neurontin).

Physical therapy

After the most severe sciatica pain starts to improve, your doctor may recommend physical therapy or another form of rehabilitation to help prevent further injuries. Rehab typically includes:  

  • Exercises to strengthen your back and abdominal muscles that help support your back. Sciatica exercises are critical to your recovery. 
  • Exercises to improve or maintain your flexibility. Sciatica stretches can help improve or your flexibility. 
  • Learning ways to correct your posture

Steroid injections

In some cases of sciatica, physicians recommend injections of a corticosteroid into the area directly surrounding the affected nerve root. Steroid medications help to relieve pain by reducing inflammation in the area. The benefits typically last only a few months. You can only receive a limited number of these injections because of the risk of serious side effects is greater if they are given too frequently for sciatica.   

Surgery

Surgery is usually only used if nerve compression is causing extreme weakness, loss of bowel or bladder control or pain that is increasing and not improving despite other treatments. Surgical procedures can be used to remove the part of the disc that has herniated and is compressing the nerve or the bone spur that is causing compression.