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Sciatica

Topic Overview

What is sciatica?

Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve . The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. It goes down through the buttock, then its branches extend down the back of the leg to the ankle and foot.

What causes sciatica?

The most common cause of sciatica is a bulging or ruptured disc ( herniated disc ) in the spine pressing against the nerve roots that lead to the sciatic nerve. But sciatica also can be a symptom of other conditions that affect the spine, such as narrowing of the spinal canal ( spinal stenosis ), bone spurs (small, bony growths that form along joints) caused by arthritis , or nerve root compression ( pinched nerve ) caused by injury. In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy.

What are the symptoms?

Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot. Weakness, tingling, or numbness in the leg may also occur.

  • Sitting, standing for a long time, and movements that cause the spine to flex (such as knee-to-chest exercises) may make symptoms worse.
  • Walking, lying down, and movements that extend the spine (such as press-ups ) may relieve symptoms.

How is sciatica diagnosed?

Sciatica is diagnosed with a medical history and physical exam. Sometimes X-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.

How is it treated?

In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by:

  • Avoiding sitting (unless it is more comfortable than standing).
  • Alternating lying down with short walks . Increase your walking distance as you are able to without pain.
  • Taking acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).
  • Using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you.

Additional treatment for sciatica depends on what is causing the nerve irritation. If your symptoms do not improve, your doctor may suggest physical therapy , injections of medicines such as steroids, stronger medicines such as muscles relaxants or opiates, or even surgery for severe cases.

References

Other Works Consulted

  • American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Lumbar herniated disc. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 952–956. Rosemont, IL: American Academy of Orthopaedic Surgeons.
  • Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
  • Ellenberg M, Honet JC (2008). Lumbar radiculopathy. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 241–246. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
Last Revised March 12, 2012

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