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Sciatica

Sciatica is not a spinal disease or disorder but a term used to describe a group of symptoms caused by compression of the sciatic nerve.  The sciatic nerve originates in the lower back, travels downward, and branches off behind the hip joint, through the buttocks, thighs, past the knees, and into each foot. 

Symptoms
Classic sciatica may involve these symptoms:

  • Pain involves the left or right leg
  • Pain travels below the knee
  • Pain: varying between mild ache to sharp
  • Electric shock-like pains, sudden and unexpected
  • Pain can be made worse during a cough or sneeze
  • Sitting or standing provokes pain
  • Odd sensations include numbness, tingling, burning
  • Muscle weakness
  • Bladder or bowel dysfunction (rare, but requires urgent medical care)

Risks you control

  • Do not smoke
  • Maintain a healthy weight
  • Eat well; a balanced and healthy diet
  • Exercise
  • Practice good posture and body mechanics

Risks beyond your control

  • Nerve damage (eg, diabetes can cause nerve damage)
  • Growing older
  • Degenerative spinal disorders (eg, degenerative disc disease)
  • Spinal trauma (eg, falling)

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed your sciatica symptoms as caused by wear and tear or a degenerative disorder.  If that is the case, he will want to know about any new symptoms, especially weakness, balance or walking difficulties, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment
Sciatica seldom requires surgical intervention.  Usually, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

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