Sciatica: What Patients Need to Know
Sciatica refers to pain that radiates along the path of the sciatic nerve. There are two sciatic nerves, one on the right side and one on the left. These large nerves originate in the lower back and course through the hips, buttocks, and posterior thighs as far as the knees.
The right and left sciatic nerves are the longest and thickest nerves in the body and are comprised of five nerve roots each: two (L4 and L5) from the lower back region called the lumbar spine and three (S1, S2, and S3) from the final section of the spine called the sacrum.
At the knee, the sciatic nerves divide into other nerves, which travel through the lower legs and terminate in the feet. Usually, patients experience sciatica only on one side of the body, and the pain radiates from the lower back, through the buttocks, and the posterior thigh to the knee. The pain can radiate further into the lower leg as far as the ankle and at times into the foot and can be associated with numbness, tingling, and weakness as well.
What Triggers Sciatica?
Sciatica most commonly occurs when a herniated disk or bone spur in the spine compresses part of one or more lumbar or sacral nerves that make up the sciatic in the lumbar spine or sacrum. The direct compression of these nerves can cause inflammation and pain, which can then that radiates through the sciatic nerve into the lower extremity. Additionally, this can also cause numbness, tingling, and weakness in the leg and foot.
Sciatica can also be caused by lumbar spinal stenosis, which is the narrowing of the spinal canal, and by spinal instability, which is seen in patients with spondylolisthesis. Spondylolisthesis is a spinal condition where one vertebra slips out of position (usually forward) in relation to the vertebra directly below it. Spondylolisthesis can be due to arthritis and disc degeneration and could also be due to small stress fractures in a vertebra that lead to instability. That can lead to compression and irritation of a nerve root that can lead to sciatica.
While spine surgeons know the direct causes for sciatica, other behaviors can trigger a wave of painful symptoms through the sciatic nerve. For example, certain postures may aggravate sciatic pain. Sciatic nerve pain may feel worse when sitting, standing, or when bending the forward at the waist. The type of shoes that patients wear may also trigger varying degrees of sciatic pain. Certain shoe styles can place the lumbar spine in a position that can aggravate sciatica. Other shoes may serve to transfer the impact of your steps through your legs, thighs, and hips and into your back and can also aggravate sciatic pain. While other shoes may wind up stretching and irritating the hamstring muscles in your back, which can also irritate the sciatic nerve.
What Does Sciatica Pain Feel Like?
Sciatic nerve pain radiates from your lower spine through your buttock down the back of your leg and at times into your foot. Patients may experience symptoms such as:
- Pain ranging from a mild dull ache to a sharp burning sensation
- Pain that exacerbates when coughing, bending forward, twisting the spine, or sitting for prolonged periods
- Numbness, tingling, or muscle weakness in the affected leg or foot
- Difficulty walking
If you begin experiencing symptoms such as these, you may wish to schedule an appointment with a board-certified spine specialist, who can diagnose you accurately. A trained orthopedic spine surgeon can identify and recommend a treatment plan that can help to reduce your symptoms and help you return to a normal lifestyle.
How Do I Relieve Sciatic Nerve Pain?
Fortunately, patients have several options to soothe painful symptoms from sciatica. It’s advisable to identify and treat sciatica as early as possible to avoid the progression of symptoms, which could lead to invasive treatment measures including spinal surgery.
Treatment measures for sciatica include medications, physical therapy, activity modification, structured home exercises, lumbar epidural steroid injections, and surgical intervention. Medications that can help to alleviate sciatic pain include Tylenol, over-the-counter non-steroidal anti-inflammatory pain medication (NSAIDs), skeletal muscle relaxants for spasms, nerve pain medications, tapered steroid dose packs, and rarely, opioids.
Physical therapy is one of the best methods to help reduce sciatic pain, incorporating stretching and aerobic conditioning to strengthen the spine, the lower back muscles, the core musculature, the buttocks, and the hips. Pain modalities can be added to this regimen as well and can include warm compresses, ice packs, TENS (transcutaneous electrical nerve stimulation), soft tissue mobilization, and ultrasound.
Other forms of non-surgical therapies include chiropractic therapy and massage therapy. Chiropractors aim at improving the alignment of the spine, which can provide relief of sciatic pain and may help to alleviate the underlying conditions causing the pain. Massage therapy can improve blood circulation, relax tight muscles, and release endorphins, which are hormones in the body that function as natural pain relievers.
Surgery for sciatica is reserved as a last resort and only if the pain remains at a high level, is disabling, and has failed to respond to non-operative treatment measures. Surgery would also be appropriate and recommended for patients experiencing neurological deterioration, such as leg weakness. Fortunately, most patients with sciatica respond favorably to nonoperative care, and they avoid surgery.
Sciatica Treatment at NJSS
The board-certified doctors at New Jersey Spine Specialists are here for you and will diagnose the root cause of your sciatica, which will allow them to prescribe the most appropriate treatment plan to alleviate your pain. With offices in Summit and Montclair, our dedicated spine specialists will provide a unique treatment plan that is best suited for you. Whether you experience a mild ache or severe pain, New Jersey Spine Specialists can help you to return to an active lifestyle. Dial (908) 608-9619 to learn more about our treatment options for sciatica and to schedule an appointment with us.