Sciatica Symptoms

Usually sciatica affects one side of the body. The pain may be dull, sharp, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain.

The Cause: Nerve Compression
Compression of the sciatic nerve can cause any of the above-cited symptoms. Rarely is nerve damage permanent and paralysis is seldom a danger as the spinal cord ends before the first lumbar vertebra. However, increasing trunk or leg weakness, or bladder and/or bowel incontinence is an indication of Cauda Equina Syndrome, a serious disorder requiring emergency treatment.

Lumbar spine disorders known to cause sciatic nerve compression include the following:

• Herniated discs are the most common cause of sciatica in the lumbar spine.
• Degenerative Disc Disease, a natural biological process associated with aging, is known to cause disc weakness that can be a precursor to a disc herniation.
• Lumbar Spinal Stenosis is a narrowing of one or more neural passageways due to disc degeneration and/or facet arthritis. The sciatic nerve may become impinged as a result of these changes.
• Isthmic Spondylolisthesis results from a stress fracture often at the 5th lumbar vertebra (L5). The fracture combined with disc space collapse may allow the vertebra to slip forward on the first sacral segment (S1). The slippage may cause the L5 nerve root to become pinched as it leaves the spine.

Spinal Tumors and Infections are other disorders that may compress the sciatic nerve, but this is rare.

There are other conditions, which may occur, and may mimic true sciatica but these are difficult to diagnose.

Diagnosis of Sciatica

The physician's examination includes the patient's medical history, a review of current medications, a physical and neurologic examination and, if warranted, x-rays, CT scan and/or MRI. A proper diagnosis requires an analysis of the patient's pain. The patient is often provided a Pain Diagram to illustrate pain distribution and sensation (eg, tingling and burning).

The physician's questions may include:

• "How did the pain develop?"
• "On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain."
• "Is the pain worsened by walking uphill or downhill?"
• "How does the pain affect activities of daily living?"
• "What type of treatment has been tried and what was effective?"

The patient's range of motion is observed. Reflexes and muscle strength are tested. The physician may use one or more movement tests to determine the source or cause of the pain.

Treatment
Non-Surgical Treatment
Sciatica often responds well to non-operative forms of treatment and rarely requires surgical intervention. Time, non-steroidal anti-inflammatory (NSAIDs) medication, short-term use of a narcotic for acute pain, lumbar injections, and physical therapy are beneficial.

Although short-term bed rest is recommended during the acute phase, some activity is good. In this scenario "activity" is defined as being up for periods of time that will not cause severe pain. Prescribed exercise may include light stretching, walking, and aerobic type exercise.

Surgery
Surgery is not for all patients. However, in some situations, surgery may be indicated. Patients who have followed a non-surgical course of treatment for four to six weeks without relief certainly require a re-evaluation by their physician. If a MRI scan reveals a herniated disc or spinal stenosis, surgery may provide relief of the leg pain. The type of surgical procedure is dependent in part on the patient's condition and diagnosis

Recovery
Whether treatment for sciatica is non-operative or surgical, it is always wise to follow the instructions provided by the doctor and/or physical therapist.

Work toward relieving unnecessary mechanical stress to the spine. For example, when standing, alternate resting one foot on a stool. When driving, place a small pillow or rolled towel behind the back to maintain natural spinal curvature. At bedtime, sleep on the back with a pillow under the knees or between the knees if sleeping on the side.