How to relieve sciatica

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Sciatica is one of the most common problems that may occur as a result of arthritis involvement of the lumbar spine (low back). Sciatica is a term that refers to pain that follows the course of the sciatic nerve that runs from the lower back down the back of each leg. The sciatic nerve consists of nerve root contributions from L4, L5, and S1.

Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is lumbar herniated disc ("slipped disc".) The discs (or inter-vertebral discs) are the cushions which separate the bones of the spine (vertebrae).

Other common causes of sciatica include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis.

The pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side, and the pain often radiates from the low back all the way down through the buttock, the back of the thigh, and down the leg. Depending on where the sciatic nerve is affected, the pain may also radiate to the foot or toes.

One or more of the following sensations may occur as a result of sciatica:

• Pain in the rear or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up

Most sciatica pain syndromes result from inflammation and will get better within two weeks to a few months.

Symptoms that constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. Patients with these symptoms should seek immediate medical attention.

The intervertebral disc looks like a doughnut. The ring around the outside is tough and fibrous, and the center is more like a jelly. These discs allow for flexibility between the bones of the spine, and also act as shock absorbers.

The pressures within the discs can reach high levels when patients bend or twist, and with carrying a heavy load.

The softer center (nucleus pulposus) may push its way through the outer fibrous ring. This is called a herniation.

Sciatica occurs when the herniated disc presses against the nerves which make up the sciatic nerve. This is especially true when the nerve is pinched between the disc and an adjacent bone.

When a nerve is pinched, it causes pain, numbness, pins and needles, and weakness.

An MRI scan will demonstrate the various soft tissue structures in the spine, as well as the bones, and will show whether a nerve is being squeezed by a disc, or whether something else is causing irritation of the nerve.

Bed rest for the first three days is usually recommended. Rest for longer is detrimental since the core muscles weaken.

Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. A physical therapist can develop a program. Here are some steps to take in the meantime:

•Practice good posture. Stand up straight with ears aligned with the shoulders, shoulders aligned with the hips and the buttocks tucked in. The knees should be bent slightly.
•Walk/swim. Walking and swimming can help to strengthen the lower back.
•Lift objects safely. Always lift from a squatting position, using the hips and legs to do the heavy work. Never bend over and lift with a straight back.
•Avoid sitting or standing for extended periods. Take regular breaks to stand and walk around. If on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day.
•Use proper sleeping posture. Take pressure off the back by sleeping on the side or on the back with a pillow under the knees.
•Avoid wearing high heels. Shoes with heels that are more than 1½ inches high shift weight forward, throwing the body out of alignment.

Core strengthening is key. A therapist can help develop a program for this.

Other possibly effective sciatica treatments include:

•Manual treatments for sciatica (including physical therapy and osteopathic or chiropractic treatments) to help relieve the pressure.
•Medical treatments for sciatica (such as non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, or epidural steroid injections) to help relieve the inflammation.
•Surgery for sciatica (such as microdiscectomy or lumbar laminectomy) to help relieve both the pressure and inflammation may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.

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