DefinitionThe sciatic nerve begins from the lower spine on either side. It travels deep in the pelvis to the lower buttocks. From there, it passes along the back of each upper leg and divides at the knee into branches that go to the feet. Sciatica is an irritation of the sciatic nerve.
|Sciatic Nerve Pain|
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CausesSciatica is caused by irritation or pressure on the sciatic nerve. This can be the result of:
- Herniated disk —the cushions between the bones of your spine bulge and press on the nerve as it exits the spinal column
- Arthritis in the lower back
- Spinal stenosis —narrowing of the spinal canal in the lumbar area
- Spondylolisthesis —slippage of a bone in the lower back
- Cauda equina syndrome —nerve roots at the base of the spinal cord are compressed
- Piriformis syndrome— spasm of piriformis muscle
Risk FactorsSciatica is more common in men. Other factors that may increase your chance of sciatica include:Lifestyle and personal health factors, such as:
- Heavy manual labor
- Heavy lifting
- Exposure to vibrations
- A job that requires standing for long periods of time and forward bending
- Fractures in the back
- Metabolic problems, such as diabetes
SymptomsSciatica causes symptoms that can range from mild to severe. In general, sciatica may cause:
- Burning, tingling, or a shooting pain down the back of one leg
- Pain in one leg or buttock may get worse with:
- Standing up
- Weakness or numbness in a leg or foot
- Continuing weakness in a leg or foot
- Numbness in groin or the buttocks
- Difficulty walking, standing, or moving
- Loss of bowel or bladder control
- Fever, unexplained weight loss, or other signs of illness
DiagnosisThe doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will pay particular attention to your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes.Imaging tests are used to evaluate the affected area:nerve conduction study .
TreatmentThe goal of treatment is to reduce sciatic nerve irritation.Treatment options include:
ActivityBed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising.
MedicationMedications used to treat sciatica include:
- Over-the-counter or prescription pain relievers
- Muscle relaxers for muscle spasms
- Corticosteroid injections in the back
- Antidepressants or antiseizure medications for chronic pain
Physical TherapyPhysical therapy may include:
- Cold packs or heat therapy
- Stretching and strengthening exercises
- Ultrasound treatments or electrical stimulation
- Posture education and appropriate lifting instructions
Alternative TherapiesThese therapies have not been proven by scientific studies to have an effect on sciatica. However, some people may find some pain relief from:
SurgerySurgery may be done to relieve pressure on the sciatic nerve. This is performed in emergency situations or if other treatments fail. Common surgical procedures are microdiscectomy and lumbar laminectomy .
PreventionSciatica tends to happen more than one time. To help reduce your chance of sciatica:
- Use proper body movement when playing sports, exercising, or lifting heavy objects.
- Practice good posture to reduce pressure on your spine.
- Begin a safe exercise program with the advice of your doctor.
- If possible, avoid sitting or standing in one position for long periods.
- Consider job retraining if your work requires a lot of heavy lifting or sitting.
North American Spine Society
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Allen C, Glasziou P, et al. Bed rest: A potentially harmful treatmentneeding more careful evaluation. Lancet. 1999; 354:1229-1233.
Sciatica. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351. Updated October 2007. Accessed November 26, 2013.
Sciatica. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed November 26, 2013.
Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice tostay active for acute low back pain. Br J Gen Pract. 1997;47:647-652.
6/7/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Peul WC, van Houwelingen HC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.
- Reviewer: Teresa Briedwell, PT, DPT, OCS, CSCS
- Review Date: 12/2014
- Update Date: 12/20/2014