The sciatic nerve is the longest nerve in your body. It runs from your pelvis, through the buttocks, and down each leg to the foot. Its role is a vital one in that it connects the spinal cord with the leg and foot muscles. Any pain that radiates along the path of this nerve is known as sciatica. Sciatica is a common type of radiculopathy: a disease of the root of a nerve, such as from a pinched nerve or tumor. Learn more about radiculopathy here.
Sciatica is not a medical diagnosis but rather a symptom of an underlying medical condition (i.e. something is putting pressure on the nerve in your lower back). The most common causes of this nerve compression include a lumbar herniated disc, spondylolisthesis, degenerative disc disease, or spinal stenosis. Pregnancy and muscle spasms in the back or buttocks can also cause sciatica nerve pain.
Common symptoms of sciatica include:
Symptoms will be different based on which spinal nerve is affected and how much it is compressed. While symptoms can cause excessive pain, permanent tissue damage or spinal cord involvement is rare.
In most cases, nonsurgical remedies are enough for people to find pain relief. For others, however, a more structured treatment approach, or surgery, may be the best option for alleviating severe pain.
There is a broad range of nonsurgical treatments available for sciatica treatment. Combining one or more of these treatments with exercise will increase the success rate of pain relief.
Alternative care is another approach used for the care of sciatic pain. Some of these treatments include:
While these treatments are common, they may not work for everyone. Patients will find what works best for them through a process of trial and error.
Exercise, not bed rest, is usually better for relieving sciatic pain. Inactivity exceeding more than a day or two after sciatic pain flares up can actually make the pain worse.
Without exercise or movement, the back muscles and spinal structures aren’t able to provide as much support to the back. This deconditioning and weakening can lead to injury and strain, which can then create more pain. Exercise and movement also aid in improved spinal disc health. The movement helps exchange nutrients and fluids throughout the disc area, resulting in healthy discs and less pressure on the sciatic nerve.
Core muscle strength is beneficial in providing adequate back support. Gentle strengthening and stretching exercises can help people recover quickly from sciatica flare up and reduce future episodes of pain. Doing the wrong type of exercise can worsen the pain, so it is important to get an accurate diagnosis before starting an exercise program.
If nonsurgical treatments have failed and the pain has lasted longer than six weeks, or, if you are unable to participate in everyday activities, then it is reasonable to consider surgery for sciatica. One of two general surgeries will typically be considered: a microdiscectomy or a lumbar laminectomy.
For sciatica pain caused by a lumbar disc hemiation, a microdiscectomy–a small open surgery using magnification–is the most common surgical approach. Only the portion of the herniated disc that is pinching the nerve is removed–the rest of the disc is left intact.
In cases where sciatica pain is due to lumbar spinal stenosis, a lumbar laminectomy is typically recommended. In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed.
In most cases, surgery is the patient’s decision. Decisions are often based primarily on the amount of pain and dysfunction, as well as the duration of the pain. The patient’s overall health is also taken into consideration when surgery becomes an option.