Anyone who suffers from sciatica is regrettably familiar with the discomfort – described as “shooting” nerve pain along the lower back and down the leg. The severity can be variable, ranging from manageably mild to nearly immobilizing. Understanding how sciatica is treated and effective ways to avoid it can help people lead improved, healthier lifestyles.
UT Physicians orthopedic surgeon Eric O. Klineberg, MD, explained that sciatica pertains specifically to an irritation of the nerve roots that become the sciatic nerve. These roots originate from the spinal cord, and then exit out of the lower spinal column, and travel underneath the buttocks, and down the back side of the leg. He added that the irritation can stem from multiple different spinal issues, the most common being a disc herniation or bulge that presses on the nerve root in the spinal column. Other causes include direct injury to the sciatic nerve, including physical injury or trauma to the nerve, as well as cysts, tumors, osteoarthritis, or pregnancy. Causes from spinal disorders include conditions such as stenosis, scoliosis, or spondylolisthesis that compress the nerve roots.
“Sciatica can occur when the nerve is directly pinched or when stretched — for example, during pregnancy when there is relaxation along the spinopelvic ligaments,” said Klineberg, professor and chief of orthopedic spine surgery with McGovern Medical School at UTHealth Houston. “People feel pain as the first symptom, which can be followed by sensory deficits or numbness. If untreated, the condition can lead to motor function weakness.”
Diagnosis, pain management, and treatment
According to Klineberg, sciatic irritation can occur at various locations along the nerve bundle. A proper patient diagnosis will include a combination of methods and technologies to determine the appropriate treatment.
“Understanding the pathway of the nerve and localizing discomfort are essential. Hence, a physical exam should be conducted to determine where pain is occurring, including any movement which intensify or lessen a patient’s sciatic pain,” Klineberg said. “Diagnostic tests such as X-rays, CT scans, or MRIs can also be used to understand patient anatomy and the pressure being experienced. Once the diagnosis is understood, we need to think of things to decrease irritation.”
Klineberg said the first step in mitigating sciatic pain begins with activity modification. This can be as simple as reducing stressors to the body such as high-impact or excessively strenuous activity. Also, nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen can be prescribed to help with discomfort. Steroid injections and gabapentin can also be used to reduce symptoms and achieve nerve stabilization.
“Treatment will often depend on the patient’s symptoms. If conditions are relatively mild and can be controlled with medication, that can be enough. The human body has a tremendous capacity to heal itself,” Klineberg said. “If the identified problem is severe and an exact location where the nerve is being compressed can be determined, pressure can directly be removed through surgery. An operation can be curative, taking someone from excruciating pain to no pain at all, walking out of a hospital within the same day.”
Healthy living; preventive measures
Maintaining a fit lifestyle can be key to protect against issues of lower back and leg pain.
Klineberg recommends these useful practices for health and wellness:
- Smoking cessation. Nicotine increases risks to disc herniation and should be avoided.
- Weight loss. For each pound on the body, the spine sees 10 times this amount in pressure to sustain an upright frame. Even losing a few pounds can make a huge difference.
- Exercise and stretching. Core-strengthening exercise can help increase spine health, as well as programs like yoga and Pilates which improve balance and flexibility.
- Walking. This remains a simple, useful way to reduce and keep off excess weight.
“If you do develop sciatic symptoms, non-operative methods can be very successful,” Klineberg said. “But if pain persists or worsens, seeing a health care professional is important so timely treatment can be implemented that leads to relief and recovery.”