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Sciatica: What You Need To Know

 

Sciatica Definition:

Sciatica describes pain in the low back, hips, buttocks and down one or both legs. This pain sometimes extends all the way to the foot. Usually, however sciatica only affects one side of the body.

Sciatica Causes:

There are several potential causes of sciatica. The most common cause is irritation of the nerve roots in the lumbar spine. This can be caused by several problems including a herniated disc, spinal stenosis, degeneration of the lumbar discs.

Sciatica Diagnosis:

Your physician or healthcare provider may use a number of methods to accurately diagnose the cause of sciatica symptoms. Since the term "sciatica" is not technically a diagnosis but a description, it is important to find the underlying cause of the symptoms. The first step in accurate diagnosis is a proper history and physical examination by a healthcare provider experience in treating such problems. Other diagnostic tools such as x-rays, MRI, CT, ultrasound, or injections may be necessary for an accurate diagnosis.

Sciatica Exercises:

There are several effective stretches that are used to conservatively treat sciatica symptoms. Many of these are based on principles and practice of yoga. Here is a list of several of the various stretches and a link to an article illustrating the correct performance of each of the stresses. As with any new exercise program, before you start, ask your doctor if it is okay for you to safely perform these exercises.

Sciatica Exercises: Stretches for Pain Relief 

  • Pigeon pose
  • Reclining pose
  • Sitting pose
  • Forward pose
  • Knee to opposite shoulder
  • Sitting Spinal Stretch
  • Standing Hamstring Stretch

Sciatic nerve pain symptoms lasting more than a month should be evaluated by a doctor experienced in treating conditions such as this. Also, evaluation and treatment by an experienced physical therapist may be necessary to design an therapy program and an in-home exercise program specifically tailored to their condition.

The first line of intervention for sciatica should definitely be physical therapy because it is active, it is educational, and the primary goal is to restore function and make each patient independent.

The clue is to find experienced, manual trained physical therapists who combine an understanding of alignment, movement, and therapeutic exercise, and who set up a clear plan of care to reach measurable goals. After that, what's left is to actively participate in the program!

– Mindy Marantz, PT, MS, GCFP

Sciatica Treatment:

Nonsurgical Treatment for Sciatica

Heat/ice

For an acute injury resulting in pain along the distribution of the sciatic nerve, ice packs can be helpful, particularly in the first 48 hours after symptoms begin. After that time, heating pads or ice packs can be used depending on which is more effective. Usually, either one of these treatments is applied for only 20 minutes at a time. They can usually be repeated about every two hours as necessary. It is very important, if using a heating pad, to use one that has a timer device to avoid potentially severe burns to the skin. Likewise, it is important to limit the application time of ice packs in order to avoid the potential of frostbite to the skin.

Pain medications

Over-the-counter or prescription medications for pain are often useful in relieving or at least reducing the pain from sciatica. Nonsteroidal anti-inflammatory drugs “NSAID’s) or acetaminophen (Tylenol) are the most common over-the-counter medications you use. People with a history of liver disease should ask your physician before taking products containing acetaminophen. People with history of stomach ulcers, kidney disease, or who are at risk for cardiovascular problems such as heart attack and stroke should ask their position whether it is safe to take the nonsteroidal anti-inflammatory drugs since several studies have shown that these can increase risk of problems such as heart attack and stroke.

Prescription medications such as muscle relaxants and opiate pain medications may be useful for more severe cases. As a rule, these should be used only on a short-term basis since there is little long-term evidence in the medical literature that these give lasting benefit beyond a few weeks. These medications, particularly the opiate medications, do have significant risk of developing problems such as addiction/dependence as well as a multitude of other risks and side effects that can result in prolonged pain, worsening of function, and even accidental overdose or death.

Physical Therapy:

Physical therapy is a cornerstone of effectively treating sciatica. For cases that do not resolve on their own in a timely fashion, evaluation and treatment by an experienced physical therapist can be very useful. Depending on the cause of the symptoms, the physical therapist can design a program tailor-made for the individual. Some of the various protocols used include myofascial release, core strengthening, and the Mackenzie Extension Protocol.

Alternative Care Treatments for Sciatica

Aside from standard conservative care, physical therapy, medical care, interventional pain management, and surgery; there are also several alternative care options to treat sciatica symptoms.

These options include chiropractic, acupuncture, and massage therapy.

Behavioral medicine approaches use psychology-based treatments such as cognitive behavioral therapy to treat the pain from sciatica as well as many other chronic pain conditions.

Chiropractic/manual manipulation
Chiropractic physicians use manual manipulation in an effort to restore proper spinal alignment.

Acupuncture

  • This alternative treatment is based on ancient Chinese medicine. The acupuncturist goal is to open and balance the flow of energy through the body with the use of hair thin needles. Although the exact mechanisms are not completely understood, this form of treatment is recognized by the US FDA. The National Institutes of Health has also recognized acupuncture as an effective option for treating low back pain, including the pain from sciatica.

 

Massage Therapy

Massage therapy can be helpful in both acute and chronic low back pain. The goal of massage is to relax tense muscles, improve blood circulation through the tissue, as well as to release the body's natural pain relievers known as endorphins. An experienced massage therapist can choose the best form of massage to meet a patient's goals and needs.

While this is not an exhaustive list of all alternative treatments for sciatic pain, these are some of the most common. It is important to understand that many alternative treatments that are offered may or may not have significant research supporting their efficacy and safety. Additionally, the requirements for a practitioner of alternative treatments can vary greatly depending on the particular treatment. It is generally a good idea for a person considering using an alternative treatment to discuss this with their physician to ensure that important diagnoses are not being overlooked and that the course of treatment is the most efficient and effective possible.

Treatment for Recurring Sciatica Pain

For most people, the symptoms of sciatica typically resolve on their own over the course of a few days to weeks.

Most cases of sciatica resolved with conservative care over the course of 6-12 weeks. Once a person has obtained initial relief, an ongoing program of physical conditioning and stretching should be used to avoid recurrent episodes of this pain.

Interventional  Pain Management for Sciatica:

For cases of sciatica that do not respond to more conservative options, evaluation and treatment by a board certified interventional pain management physician may be helpful. The interventional pain management physician has several minimally invasive options to diagnose and directly treat the particular structure causing the symptoms. Some of these options include epidural steroid injection, sciatic nerve block, ultrasound guided piriformis injection, and sacroiliac joint (SIJ) injection.

These injections are focused on using precision guided needle placement to play small amounts of local anesthetic and/or anti-inflammatory medications such as corticosteroids directly on the pain generating structures. This helps with both diagnosis and treatment of the symptoms. These injections are usually performed using image guided instruments such as ultrasound or fluoroscopy.

Epidural Steroid Injection:

This fluoroscopic guided precision injection places local anesthetic and anti-inflammatory corticosteroid medication around inflamed nerve roots and discs. The goal is to decrease inflammation and shrink down swollen tissues in order to relieve pain from these structures. While the benefit of this injection may be used on an ongoing basis for chronic pain, in an acute or subacute situation, this injection can decrease pain long enough for a person to participate more effectively in a physical therapy program. In some cases, simply reducing the inflammation and shrinking down the tissue that is swollen and allow the person's body to heal on its own. The usual duration of benefits from an epidural steroid injection can range from a few days to several months or even longer.

 

Sciatic Nerve Block:

A sciatic nerve block involves injecting local anesthetic and corticosteroid anti-inflammatory medication around the inflamed sciatic nerve to decrease inflammation and pain. This injection is usually guided with the assistance of ultrasound or fluoroscopy visualization. As with the epidural steroid injection, the goal of this injection is to decrease the inflammation and pain so a person can more actively participate in a physical therapy program as well as assisting the body in its own natural healing process.

Sacroiliac Joint Injection

A sacroiliac joint injection is a fluoroscopic flea guided precision injection that instills local anesthetic and anti-inflammatory corticosteroid medication into the sacroiliac joint. The sacroiliac joint is the joint formed between the iliac crest and the sacrum. Although not technically part of the hip-joint , many people call these two bones the “hip bone” and "tailbone”. The goal of a sacroiliac joint injection is both diagnostic and therapeutic. By anesthetizing (numbing) the joint, the interventional pain position can determine whether or not the pain is coming from the joint. The corticosteroid in the injection decreases inflammation within the joint and hopefully reduces the associated pain. This injection can help in identifying the underlying cause of the persistent pain as well as help formulate the best treatment course.

Piriformis muscle injection:

The piriformis muscle is a muscle in the buttocks that is responsible for externally rotating the same. This movement rotates the upper leg outward. In many people, this muscle has two parts, one on each side of the sciatic nerve. If this muscle goes into spasm, it can pinch the sciatic nerve, causing pain in the buttocks, low back, and all the way down to the foot. This is known as piriformis syndrome. This problem usually responds well to physical therapy but occasionally requires injection of the muscle to resolve the issue. In rare cases, surgery is necessary.

Sciatica Nerve Pain, Piriformis Syndrome, Sciatic Nerve

"Sciatica" can be caused by piriformis syndrome

Surgical Treatments for Sciatica:

for those patients who have tried the more conservative options for treating their sciatic nerve pain but are still suffering, surgery may be necessary. The surgery that is most appropriate will be determined by your spine surgeon. Various options are available, depending on the structure causing the symptoms. Some patients get great benefit from minimally invasive options. Others require more extensive surgery such as a lumbar laminectomy, lumbar discectomy, lumbar disc fusion, lumbar disc replacement, or sacroiliac joint bone fusion.

Sciatica Relief:

As can be seen above, there are many causes of the condition known as sciatica. There are also many treatments that may be indicated depending on the specific cause of the problem.  In most cases, sciatica is a temporary problem that will resolve with a short period of time and conservative care. For those cases that last more than a few weeks, symptoms will usually respond very well with complete or near complete resolution of the symptoms following appropriate care by a physician or multidisciplinary team experience in treating problems like this. For some of the more severe cases however, only partial relief can be obtained. For these patients, treatment by a multidisciplinary team including a board-certified pain management physician is helpful in optimizing their quality of life and maintaining their highest long-term functional level. The ultimate goal is to effectively treat the source of the pain and maximize a person's quality of life in the most efficient manner possible.

References:
Diseases and Conditions: Sciatica- Mayo Clinic
Sciatica Symptoms, Causes, Treatments, Exercise - WebMD
Sciatica: Causes, Symptoms, and Diagnosis - Healthline
Sciatica Exercises: Stretches for Pain Relief - Healthline
Sciatica: What You Need to Know About Sciatica - Spine-Health
Sciatica - Mayo Clinic
Sciatica Causes, Treatment, Symptoms & Exercises - MedicineNet
Sciatica - Wikipedia
Sciatica Causes, Diagnosis, & Treatment | Cleveland Clinic
Sciatica- Topic Overview- Web MD
Sciatica, Sciatic Nerve, Sciatica Nerve Pain, Radiculopathy

Lumbar Radiculopathy pain is often referred to as "Sciatica"

About the Author
Dr. John B. Adams is board certified in Pain Management by the American Board of Medical Specialties and the American Board of Interventional Pain Physicians. With almost 2 decades of experience, he offers patients access to state-of-the-art pain management, emphasizing a multidisciplinary approach to pain management utilizing precision injections, neuromodulation technology, physical therapy, behavioral medicine and judicious use of medications including help with patients titrating off opiates (narcotic pain medications).

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