Sciatica is a condition in which pain travels or radiates along the path of the sciatic nerve. This nerve is the longest and the largest in the body and it travels from the lower back down the back of the thigh to the leg and foot.
The causes of sciatica include compression of the sciatic nerve by herniated disks and bone spurs (overgrowths) from the spine. Other causes include compressing tumors and spinal stenosis which is a condition in which the nerve passages in the spine are narrowed. Infections, trauma to the nerve and conditions like diabetes which damage the nerves can also cause sciatica.
Risk factors for developing sciatica include advancing age since herniated discs and bone overgrowths are more common in the elderly. Obesity, by virtue of the fact that it increases stress on the spine, also contributes to the changes that can cause sciatica. Jobs that require the lifting of heavy objects or sitting for long durations can also predispose a person to developing sciatica.
Symptoms of sciatica include leg pain which can vary from a mild discomfort to an excruciating ache. This pain which usually affects just one leg, can be burning in nature or sharp like an electric shock. It can be worsened by coughing or sneezing or even sitting for long periods of time. Numbness and tingling sensations of the leg as well as muscle weakness are other symptoms of sciatica.
Diagnostic test for sciatica include x-rays of the back since these can show bone spurs. Magnetic resonance imaging (MRI) is also done to reveal the presence of herniated disks.
Medications used to treat sciatica include non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen since they reduce the pain and inflammation. Narcotics like codeine are prescribed for those with more severe pain. Heat and/or ice packs are also used to relieve the pain of sciatica. These are usually applied for 20 minute durations several times during the day.
Corticosteroids like prednisone are also prescribed to reduce inflammation that contributes to the pain. Muscle relaxants like diazepam are given for those with spasms. Tricyclic antidepressants are also prescribed for the treatment of sciatic nerve pain since they reduce the perception of pain in the brain.
Sciatic notch injections are also given to treat sciatica. These are usually mixtures of local anesthetics and corticosteroids which are injected into the areas around the affected nerve to reduce pain and inflammation of the piriformis syndrome which is another cause of sciatica.
Surgery is usually reserved for those patients who do not improve on medications after using them for more than six weeks. Operations are also done for those in whom the compressed nerve causes severe leg muscle weakness or incontinence. In these procedures the surgeons remove the disks or bone spurs that are compressing the nerve.
Supportive treatment for sciatica includes physical therapy in which a structured exercise program is designed by a physical therapist to strengthen the muscles and correct the posture in order to prevent recurrent injuries.
The treatment of sciatica is important since if not treated it can progress and cause severe weakness of the leg muscles as well as complications like incontinence of urine and stool. However, not all patients require treatment since it can resolve spontaneously.
The latest research on sciatica which was published in the Spine Journal reveals that patients who had sciatica with disc protrusion and who received active manipulation treatment by chiropractors experienced dramatic pain reduction without any adverse effects when compared to those who received simulated manipulation.