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Nebraska City News-Press - Nebraska City, NE
  • Dr. Jeff Hersh: Sciatica: one big pain in the back

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  • Q: I developed back pain that radiated down my leg. My doctor said it was sciatica and prescribed ibuprofen. How common is this?
    A: The left and right sciatic nerves, the largest nerves in the body, emerge from the spine in the lower back and then travel to the left and right leg. They carry the signals that control some of the muscles of the calf, foot and the back of the knee. They also carry the sensation signals for the back of the thigh and calf as well as the sole of the foot.
    Sciatica is actually a description of symptoms and not a disease. Sciatica symptoms include pain (or sometimes a tingling or numb sensation) and/or muscle weakness (of the muscles innervated by the sciatic nerve). Sciatica is due to pressure, injury and/or inflammation of the sciatic nerve, usually on one side of the body, although occasionally the causative condition can affect both sciatic nerves as they emerge from the spine.
    There are disks (soft, cushioning tissue that act as a kind of shock absorber) between the spinal vertebrae that enable the spine to be able to bend and twist. The most common cause of sciatica is pressure on the sciatic nerve from a herniated, slipped or bulging disk. Degenerative disease of the lower spine, spinal stenosis (a narrowing of the space between the vertebrae), misalignment of the vertebrae (for any reason) or spasm of the piriformis muscle (a muscle deep in the buttocks) may also cause sciatica. Other less common causes include bone tumors or fractures (for example a pelvic fracture).
    Although sciatica is uncommon before age 20, it becomes pretty common by age 40 to 50; 10 to 40 percent of people will have an episode of sciatica in their lifetime. Risk factors for developing sciatica include obesity, smoking (possibly by increasing degenerative bone disease and possibly for other reasons), prolonged sitting and frequent lifting/twisting (these last two may be related to the type of work the patient does).
    The severity of sciatica varies from one person to another and over time in a given patient, and may range from an annoying ache/burning to severe disabling pain. Similarly, the weakness can be subtle or overt. Sciatica is often exacerbated by certain positions (such as sitting) and/or certain movements.
    The diagnosis of sciatica is made based on the history and physical exam; laboratory or imaging tests are not usually needed. In fact serial MRI’s show that most people with disk herniation actually have the herniation improve over time, and about a third of people without back pain or sciatica have some disk herniation; so disk herniation clearly comes and goes in many people.
    In someone who develops concerning symptoms such as fever and/or low back skin redness (these may suggest an infection), severe weakness, bowel or urinary symptoms or unexpected worsening/persistence of symptoms, or has trauma as the initiating event (maybe suggesting a fracture), testing may be indicated. If infection is suspected, blood tests may be ordered. X-rays, CT or MRI may be utilized to image the lower spine to help identify possible causative pathology.
    Page 2 of 2 - Over three quarters of people with sciatica get better over the course of days to weeks, so the initial treatments are aimed at alleviating symptoms (usually with over-the-counter or prescription pain medications), avoiding things that make it worse (such as lifting, prolonged sitting or other activities), and allowing time for improvement. Bed rest can actually be counter-productive; slowly increasing activity as tolerating typically leads to the best results.
    Since spasm of the muscles in the lower back may exacerbate symptoms, muscle relaxants and/or application of heat/cold may be useful. For patients with persistent symptoms where inflammation may be part of the problem, steroid injections may be considered. In selected patients, for example those with persistent symptoms or other complications, surgery to decompress the sciatic nerve root (for example removal of parts of a herniated disk or bone that is pressing on the nerve) may be considered.
    Staying active and fit can minimize the risk of developing sciatica. Physical therapy and/or exercises to strengthen the abdomen and lower back may be useful to help minimize recurrences once the patient is better.
    Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
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