Sciatica

What is sciatica?
Sciatica is generally referred to as the pain shooting down the leg along the sciatic nerve. The sciatic nerve begins in the lower back, extends through the buttocks and goes down the length of the leg to the foot. It is the longest nerve in the body.

What are the symptoms of sciatica?
Sciatica can be felt at any part of the sciatic nerve or along its entire length. Sciatica may take several forms, including: numbness, dull or sharp pain, burning sensation, tingling sensation, and/or weakness in the affected area. Activity, such as walking, may make the pain more intense.

What causes sciatica?
Disc herniations account for the large majority of sciatica cases. Discs have a thick tough exterior called the annulus, with softer material inside the annulus. They are located between the bones of the spine, called the vertebrae, and act as shock absorbers. Discs can become weak because of pressure from repetitive twisting and bending movements, heavy lifting, bad posture, pregnancy, obesity or other conditions that place strain on the disc. A weakened disc can herniate (buldge) and come in contact with the sciatic nerve which may then cause sciatica. Other problems that may result in sciatica include spodylolisthesis, spinal stenosis, piriformis syndrome, or evan a cyst or tumor causing compression of the nerve.

How is sciatica diagnosed?
Sciatica is typically diagnosed by physical examination, and the history of the symptoms. Imaging tests such as MRI or CT scan can help with the diagnosis of lumbar disc herniation and evaluating the specific cause of sciatica.

What are the treatments for sciatica?
Many cases resolve spontaneously over the first weeks to months. Ice and/or heat applied to the the low back can also be effective following the initial injury as well as during the course of treatment. Anti-inflammatory medications can be beneficial in decreasing both the pain as well as the inflammation, which may be contributing to the pain. There are several treatment options as listed below:

Epidural steroid injections (ESI): Epidurals involve injecting a medication into the epidural space where the actual irritated nerve root is located. This injection includes both a long-lasting steroid and a local anesthetic. The steroid reduces the inflammation and irritation and the anesthetic works to interrupt the pain-spasm cycle and pain transmission. The most important and greatest success achieved with the use of epidural steroid injections (ESI) is the rapid relief of symptoms that allows patients to experience enough relief to become active again and regain the ability to resume their normal daily activities. A study performed comparing epidural steroid injections to placebo showed the ESI group demonstrated a 75% pain improvement over the placebo group (Arden 2005).

Physical therapy: Physical therapy improves symptoms of sciatica by increasing flexibility, range of motion, posture, and improving muscle strength.
Nutrition and exercise: Exercise improves the symptoms of sciatica by increasing flexibility and range of motion. Another benefit is the release of hormones called endorphins, which are your body’s natural pain relievers. Nutrition and healthy eating may be powerful treatments to combat nutritional deficits.

Spinal Cord Stimulation (SCS): An implanted electrical device can decrease the perception of pain by targeting the spinal cord and brain pain processing centers. Before the surgical implantation, a one week minimally invasive trial is performed to see if this device will help you long-term. If there is significant pain decrease and an increase in functional ability during the trial, you would be a candidate to have a permanent SCS device implanted.
Intrathecal pump implantation: Implanted pain pumps are also available that can be extremely helpful at providing long-term pain control.

Trigger point injections (TPIs): These injections can be an effective treatment for muscle spasms. The procedure involves injecting a local anesthetic and steroid into a trigger Point. Performing a piriformis injection can be considered a type of TPI.

Biofeedback: This is a treatment that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature, and heart rate control). This method enables you to gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness of one’s body teaches one to effectively relax, and this can help to relieve chronic pain.

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