Sciatica Causes and Treatment

Leg Pain, Tingling, and Numbness from Nerve Irritation

A diagnosis of sciatica means that there is irritation of the sciatic nerve. The sciatic nerve transfers information to and from your spinal cord. The brain sends messages to the muscles through the spinal cord and nerves, and the nerve transmits signals back about pain and sensations. The sciatic nerve is quite large—in fact, it is the largest peripheral nerve in the body.

Man sitting on bed with his hand on the small of his back
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The sciatic nerve is formed from the lower segments of the spinal cord; it is made up of the lumbar and sacral nerve roots of the spine. The sciatic nerve exits the lower part of the spinal cord, passes behind the hip joint, and runs down the back of the thigh.

The sciatic nerve, like most other nerves, performs two basic functions: first, it sends signals to your muscles from the brain; and second, it collects sensory information from the legs and passes this back to your brain. Conditions such as sciatica that affect the nerve will alter these normal functions. Common symptoms of sciatica include:

In addition, patients with sciatica may notice a worsening of their symptoms with maneuvers such as squatting or coughing. These maneuvers can increase pressure around the nerve and increase the symptoms of sciatica.

Causes of Sciatica

The most common cause of sciatica is a herniated spinal disc. When this happens, the normal cushion between the vertebrae of your spine protrudes, causing the disc to push out into areas normally occupied by these nerves. As a result, the nerves are compressed, and people then experience the symptoms of pain, weakness, and numbness. Other conditions, such as spinal stenosis, spondylolisthesis, or piriformis syndrome, can also cause sciatica symptoms by irritating the sciatic nerve.

Sciatica can affect just about anyone, but it is extremely uncommon in children and adolescent patients. Sciatica typically affects 30 to 50-year-old patients. Often there is a sudden onset that may be attributed to over-exertion or a back injury.

Treatment of Sciatica

It is important to determine the correct cause of your symptoms prior to beginning treatment for sciatica. Your doctor will take a thorough history, perform a physical exam, and test several specific functions of the sciatic nerve. Several other conditions may cause hip and thigh pain and also need to be considered. Other tests, including x-rays or possibly an MRI, may be helpful, but they may not be needed.

Treatment is initially aimed at addressing the inflammation associated with sciatica. Rest, anti-inflammatory medications (such as Motrin or Celebrex), and muscle relaxers are often good places to start. Some patients require a more powerful anti-inflammatory treatment and may be given steroid medication orally or by injection. Steroids do have potential side effects, and there is conflicting data about how much relief they actually provide in the treatment of sciatic pain. Be sure to discuss the pros and cons of each treatment option with your physician.

Once the pain subsides, exercises and physical therapy are helpful. Many people find that heat packs and ice packs soothe the muscles that are painful in sciatica. Some doctors may prescribe an epidural steroid injection that can deliver anti-inflammatory medication directly to the inflamed area around the nerves.

Surgical treatment of sciatica is not usually needed, but in individuals who undergo the above treatments and continue to have persistent symptoms, surgery may be considered. The surgical procedure allows more room for the nerve in the area being compressed. This may mean removing the herniated disc, opening up the bone around the nerve, or a combination of both.

Most people (80-90%) fully recover from sciatica without surgery. In most cases, the nerve is not permanently damaged, and individuals recover in a three-week to three-month time frame.

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