Sciatica
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Sciatica
Definition
The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. The term "sciatica" refers to pain that radiates along the path of this nerve — from your back down your buttock and leg
Sciatica isn't a disorder in and of itself. Instead, sciatica is a symptom of another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica — which you may find considerably uncomfortable — usually goes away on its own in four to eight weeks or so
In the meantime, self-care measures may help you ease sciatica. Some times, your doctor will suggest other treatment
Symptoms
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting also can aggravate symptoms. Usually only one lower extremity is affected
Sciatica symptoms include
Pain. It's especially likely to occur along a path from your low back to your buttock and the back of your thigh and calf
Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another
Tingling or a pins-and-needles feeling, often in your toes or part of your foot
A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care. If you experience either of these symptoms, seek medical help immediately
Causes
Your sciatic nerve runs from your spinal cord to your buttock and hip area and down the back of each leg. This nerve controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet
Sciatica frequently occurs when a nerve root is compressed in your lower (lumbar) spine — often as a result of a herniated disk in your lower back. Disks are pads of cartilage that separate the bones (vertebrae) in your spine. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move
But as you grow older, the disks may start to deteriorate, becoming drier, flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk may then press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the middle or lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot
Although a herniated disk is a common cause of sciatic nerve pain, other conditions also can put pressure on your sciatic nerve, including
Lumbar spinal stenosis
Spondylolisthesis
Piriformis syndrome
Spinal tumors
Trauma
Sciatic nerve tumor or injury
Risk factors
Risk factors are health problems, lifestyle choices and inherent qualities, such as age or race, that make it more likely you'll develop a particular condition. Major risk factors for sciatica include
Age. Age-related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 30, and most people who develop herniated disks are in their 30s and 40s
Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica
Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are
Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage
Tests and diagnosis
Spinal X-ray
Magnetic resonance imaging MRI
Computerized tomography (CT) scan
Complications
Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including
Loss of feeling in the affected leg
Loss of movement in the affected leg
Loss of bowel or bladder function
Treatments and drugs
For most people, sciatica responds well to self-care measures. These may include use of hot packs or cold packs, stretching, exercise and use of over-the-counter (OTC) medications. Beyond the self-care measures you may have taken, your doctor may recommend the following
Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries
Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home
Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers
More aggressive treatments
When conservative measures don't alleviate your pain within a few months, one of the following may be an option for sciatica treatment
Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation around the irritated nerve, thereby helping to relieve pain
Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited — usually no more than three in one year
Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or you have pain that gets progressively worse or doesn't improve with other therapies
Surgical options include lumbar laminectomy and microdiskectomy. In lumbar laminectomy with diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope microdiskectomy
Success rates of standard diskectomy and microdiskectomy are about equal, but you may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks
Prevention
It's not always possible to prevent sciatica, and the condition may recur. The following suggestions can play a key role in protecting your back
.Exercise regularly
.Maintain proper posture when you sit
.Use good body mechanics
________________________________________
Sciatica
Definition
The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. The term "sciatica" refers to pain that radiates along the path of this nerve — from your back down your buttock and leg
Sciatica isn't a disorder in and of itself. Instead, sciatica is a symptom of another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica — which you may find considerably uncomfortable — usually goes away on its own in four to eight weeks or so
In the meantime, self-care measures may help you ease sciatica. Some times, your doctor will suggest other treatment
Symptoms
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting also can aggravate symptoms. Usually only one lower extremity is affected
Sciatica symptoms include
Pain. It's especially likely to occur along a path from your low back to your buttock and the back of your thigh and calf
Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another
Tingling or a pins-and-needles feeling, often in your toes or part of your foot
A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care. If you experience either of these symptoms, seek medical help immediately
Causes
Your sciatic nerve runs from your spinal cord to your buttock and hip area and down the back of each leg. This nerve controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet
Sciatica frequently occurs when a nerve root is compressed in your lower (lumbar) spine — often as a result of a herniated disk in your lower back. Disks are pads of cartilage that separate the bones (vertebrae) in your spine. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move
But as you grow older, the disks may start to deteriorate, becoming drier, flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk may then press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the middle or lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot
Although a herniated disk is a common cause of sciatic nerve pain, other conditions also can put pressure on your sciatic nerve, including
Lumbar spinal stenosis
Spondylolisthesis
Piriformis syndrome
Spinal tumors
Trauma
Sciatic nerve tumor or injury
Risk factors
Risk factors are health problems, lifestyle choices and inherent qualities, such as age or race, that make it more likely you'll develop a particular condition. Major risk factors for sciatica include
Age. Age-related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 30, and most people who develop herniated disks are in their 30s and 40s
Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica
Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are
Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage
Tests and diagnosis
Spinal X-ray
Magnetic resonance imaging MRI
Computerized tomography (CT) scan
Complications
Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including
Loss of feeling in the affected leg
Loss of movement in the affected leg
Loss of bowel or bladder function
Treatments and drugs
For most people, sciatica responds well to self-care measures. These may include use of hot packs or cold packs, stretching, exercise and use of over-the-counter (OTC) medications. Beyond the self-care measures you may have taken, your doctor may recommend the following
Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries
Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home
Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers
More aggressive treatments
When conservative measures don't alleviate your pain within a few months, one of the following may be an option for sciatica treatment
Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation around the irritated nerve, thereby helping to relieve pain
Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited — usually no more than three in one year
Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or you have pain that gets progressively worse or doesn't improve with other therapies
Surgical options include lumbar laminectomy and microdiskectomy. In lumbar laminectomy with diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope microdiskectomy
Success rates of standard diskectomy and microdiskectomy are about equal, but you may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks
Prevention
It's not always possible to prevent sciatica, and the condition may recur. The following suggestions can play a key role in protecting your back
.Exercise regularly
.Maintain proper posture when you sit
.Use good body mechanics