Sciatica also known as lumbar radiculopathy is a pain that originates along the sciatic nerve, which extends from the back of the pelvis down the back of the thigh. The sciatic nerve is the primary nerve of the leg. It is also the largest nerve in the entire body. Typically, sciatica affects only one side of your body. Sciatica most commonly occurs when a herniated disk or a bone spur on the spine compresses a part of the nerve. This causes inflammation, pain and often some numbness in the affected leg. Although the pain associated with sciatica can be severe, most cases resolve with just conservative treatments in a few weeks. People who continue to have severe sciatica after six weeks of treatment might be helped by surgery to relieve the pressure on the nerve. It may also be caused by the following reasons: Obesity, poor posture, tumor, abscess, blood clot, awkward sitting position, nerve disorders, piriformis syndrome or entrapment of the nerve by muscle and connective tissue.
During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during these activities.
If your pain doesn’t improve with self-care measures, your doctor may suggest some of the following treatments.
Medications: The types of drugs that might be prescribed for sciatica pain include:
- Muscle relaxants
- Anti-seizure medications
Physical therapy: Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent recurrent injuries. This typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility.
Steroid injections: In some extreme cases, your doctor may recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections are administered too frequently.
Surgery: This option is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.
In addition to a complete medical history and physical examination, diagnostic procedures for sciatica may include the following:
X-ray: A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Electromyography and nerve conduction study (EMG and NCS). A diagnostic procedure conducted together that records and analyzes electrical impulses in the muscles. During the EMG, thin needles are placed in the muscle to record electrical activity. The NCS is often done along with the EMG to determine if a nerve is functioning normally. Electrodes are then placed in various locations on the skin along the nerve pathway. When stimulating the nerve at various places, the doctor can then determine the specific site of the injury.