Sciatica

Sciatica, or pain that runs down the sciatic nerve from the lower back and along the back of each leg - is one of the most common causes of pain in adults.

For some people, the pain can be chronic, severe and incapacitating. For others, the pain may not be severe and comes and goes, but has the potential to get significantly worse over time.

• Disc herniation - the soft inner core of the disc presses through the fibrous outer core of the disc and the bulge places pressure on the nerve root.
  
  
• Spinal stenosis - the facet joints become enlarged and place pressure on the nerve roots as they exit the spine.
  
  
• Degenerative disc disease - as discs degenerate, the inflammatory proteins from inside the disc can become exposed and irritate the nerve root.
  
  
• Isthmic spondylolisthesis - the nerve root can get pinched through a combination of the disc space collapse, fracture, and the vertebral body slippage associated with this condition.
  
  
• Piriformis syndrome -The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttocks
  
  
• Sacroiliac joint dysfunction - the sacroiliac joint can also irritate the L5 nerve, which lies on top of it, and cause sciatica.

• Heat/ice: For moderate pain along the sciatic nerve, heat and/or ice packs may be helpful. It is usually recommended to use ice in the acute phase of pain, and later heat and ice may be alternated as symptoms begin to subside.
  
  
• Back Braces, Seat Wedges or Lumbar Supports for Seating: Proper support of the lumbar spine helps take pressure off the lumbar disks and can be a valuable adjunct in an overall treatment program for sciatica. Seat wedges can often better disburse pressure equally across the thighs rather than having a seat that applies localized pressure to the sensitive sciatic nerves.
  
  
• Chiropractic or osteopathic manipulation: A chiropractor or osteopathic physician can develop a treatment program to relieve the pain and provide rehabilitation.
  
  
• Physical therapy: An experienced physical therapist can develop an exercise program to help rehabilitate your back and prevent future recurrences.
  
  
• Medications: There are a number of medications that can help alleviate pain and discomfort, such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen or COX-2 inhibitors), acetaminophen, or oral steroids.
  
  
• Epidural steroid injections: If the pain is severe, an epidural and/or intradiscal injections can reduce the inflammation or swelling that may be putting pressure on nerve roots.
  
  
• Surgical treatments: If the pain is severe and has not gotten better within six to twelve weeks, it may be reasonable to consider surgery. Depending on the cause and the duration of the pain, your surgeon may recommend either a microdiscectomy or a lumbar laminectomy.
  
  
• Danger signs that may expedite the need for surgery: loss of bowel or bladder function, unbearable pain not relieved by medication or therapy, foot drop(inability to raise foot or use muscles of lower leg)