A pain in the back: what is sciatica?

If you’ve ever had sciatica, you know it can be infuriating. Regardless of the position to which you shift your body, you can’t seem to get the pain or numbness to go away.

Patients often describe it to me as sharp, stabbing pain. It can be accompanied by numbness (reduced sensation), hypersensitivity (in which even light touch is uncomfortable), burning, or pins and needles (which are called paresthesias).

Sciatica is a condition that causes pain in your lower back that shoots down to your hips, buttocks and legs. The condition is named for the sciatic nerve, which runs along that section of the body in the leg.

Sciatica can be caused by a herniated disk, a bone spur on the spine, arthritis or spinal stenosis, which occurs as an area along the spine narrows and puts pressure on the spinal cord and nerves. Sciatica can also be caused by a mal-alignment or a slippage of one vertebra on another. Occasionally, sciatica causes pain only in the buttocks and thighs (and not below the knees). In that case it is called claudication.

Beyond just pain, some of the common symptoms are muscle weakness, numbness and tingling. It can express itself in different ways. Sometimes the pain might feel like an electric shock. Other times, it’s more of a burning sensation. Or it’s possible to have pain on one side of your body and numbness on the other. Claudication is usually worse with standing and walking. It is relieved by walking with bending forwards (such as while holding a shopping cart).

While these symptoms might seem like they would require extensive treatment, sciatica usually improves over time.

An over-the-counter pain medication such as ibuprofen or Tylenol is the first treatment.  Sometimes your physician will add another medicine, such as gabapentin or pregabalin, to directly help the nerves. Steroids also have a role in reducing the inflammation surrounding a herniated disc and in reducing the pain. Inflammation or swelling can be very painful.  Occasionally, we use steroids or cortisone to break the cycle of inflammation and help reduce your pain.  Consult your physician or other provider before you take any medication. Also discuss the possibility of physical therapy, or maybe even acupuncture, to relieve your symptoms.

Lying in bed probably won’t help. Resist the urge to stay in bed. Movement and stretching are critical to increasing your activity. Try to stretch and get into positions that lower the pressure on the sciatic nerve.

However, if you have a more severe case of sciatica, it’s important to see a doctor. Otherwise, you run the risk of permanent nerve damage. You should see your doctor about treatment options if you’re experiencing symptoms, including, but not limited to:

  • You suddenly start experiencing tremendous pain in your legs and lower back
  • You lose feeling in a leg completely
  • You start experiencing sciatica symptoms as a result of a sudden injury or accident, such as a car crash
  • You have difficulty lifting your knee, ankle, or foot
  • You have a dropfoot
  • You start having trouble controlling your bladder and bowels

If your sciatica symptoms last for about six weeks, your doctor might recommend surgery, but fortunately in most cases the symptoms of sciatica do not persist for that long.

There are a number of risk factors for sciatica. They include age – the older you get, the more prone you are to suffering spinal injuries that can lead to sciatica. People who are overweight put more stress on their spine, which can lead to sciatica and other physical ailments. A more sedentary lifestyle is also believed to have a correlation to sciatica; this can include people who drive for a living. On the other hand, people who have jobs that involve physical labor often develop sciatica. Pregnant women carry extra weight during their pregnancies, which can put them at greater risk. Those with diabetes have a higher risk of nerve damage, including sciatica.

If you need surgery, AtlantiCare offers: lumbar microdiscectomy, minimally invasive decompression, laminectomy, and fusion.

But we always encourage patients to work on risk factors they can control. Maintain a healthy weight. Use proper body mechanics when doing physical labor – whether on the job or at home. If you have symptoms, tell your primary care provider.

Kris Radcliff, M.D., is a fellowship-trained spinal surgeon at the Spine Institute at AtlantiCare Regional Medical Center, a member of Geisinger Health System. As part of the Rothman Institute at AtlantiCare surgical team, he also sees patients in the Rothman Institute offices in the AtlantiCare Health Park, Egg Harbor Township and in Manahawkin.