What is the Sciatic Nerve?
The sciatic nerve is the largest and longest nerve of the body. It travels from the lower back to the toes. The sciatic nerve provides motion and sensation to hips and lower extremities. Sciatica is defined as pain that radiates along the path of the sciatic nerve. Typically, sciatica affects only one side of the body. Pain that radiates from the lumbar spine to the buttock and down the back of the leg is the hallmark symptom of sciatica. As a spine doctor, Ernest Braxton, MD, offers non-surgical and surgical treatment options for patients suffering from sciatica.
What Causes Sciatic Nerve Pain?
Sciatica is caused by the sciatic nerve being pinched or compressed. Compression of the sciatic nerve can be caused by:
- Degenerative disc disease
- Disc herniation
- Bone spurs
- Acute injury
Degenerative changes to the spine can lead to sciatic nerve pain. The physical burden of carrying extra body weight can cause changes to the normal spine leading to conditions that trigger sciatic nerve pain. Long periods of sitting, carrying heavy items, or repetitive twisting may contribute to sciatica. There is an increased risk of nerve damage for patients who have diabetes; any sudden pressure to the back may also result in sciatic nerve pain.
How Do I Know I Have Sciatica?
The symptoms of sciatic nerve pain involve a radiating pain from the lumbar spine, through the buttocks, down one or both legs. In some cases, the radiating pain can continue into the feet and toes. Any location along the nerve route may be impacted. The pain can range from mild to severe and the radiating sensation can burn, shock, or be sharp.
Some patients also report a tingling, numbness or weakness. Location and pain type may vary and change such as numbness in one area of the leg and severe pain in a different part. Pain may increase with sitting, squatting or coughing. In severe cases, bowel or bladder changes can occur.
How is Sciatica Diagnosed?
Dr. Braxton can provide a diagnosis for patients suffering from sciatic nerve pain. He will collect a health history and perform a physical exam. During the exam he may ask questions to determine:
- Onset of pain
- Location(s) and intensity of pain
- Unusual sensation in legs and feet
- Activities that increase or decrease pain
- Treatments to date, including pain management
The physical portion of the exam is to evaluate spinal alignment, curvature, muscle spasms, areas of tenderness, range of motion, posture, and simple movements that trigger pain. Patients may be asked to tiptoe or heel walk, squat, and lift one leg at a time when lying down; the exam will also evaluate muscles strength, reflexes and nerve abnormalities. Diagnostic imaging such as X-ray, MRI, and CT scan may also be used.
Does Sciatica Go Away?
Although pain associated with sciatica can be severe, most cases resolve with non-surgical treatment in several weeks. Dr. Braxton may prescribe these non-surgical treatments for sciatic nerve pain:
- Rest
- Medication
- Physical therapy
- Therapeutic injections
- Cold/heat therapy
- Slow movement stretching regimen
- Acupuncture or chiropractic treatment
Most commonly, patients find that modified activities and rest often facilitate a successful recovery. Corticosteroid injections can also be used to help diminish inflammation at the irritated nerve. Once beyond the acute pain period, Dr. Braxton may prescribe physical therapy to help prevent further sciatic nerve pain. Patients who have severe sciatica that is associated with significant leg weakness , bowel, or bladder changes might be candidates for surgery.
When Does Sciatica Need Surgery?
For patients with severe sciatica symptoms or those who do not see improvements with non-surgical treatments, Dr. Braxton may recommend surgical treatment. He will work closely with each patient regarding a recommendation for surgery. Increased pain and weakness, loss of bladder or bowel control, or other evidence of a compressed or pinched sciatic nerve, including herniated disc or bone spur growth, are indicators he may recommend surgery. Dr. Braxton’s advanced minimally invasive surgical procedures are designed to return the patient to their preferred activities and lifestyle as quickly as possible.