My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.
What is sciatica?

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.
What are the symptoms of sciatica?

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

• Pain (e.g. pins and needles, burning or aching)
• Weakness (can progress to an outright inability to move)
• Numbness
• Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

• After sneezing, coughing or laughing
• After walking or bending backwards
• At night
• When standing or sitting

What causes sciatica?

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

• Bruise or fracture to one of your pelvic bones
• Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
• Infection (a rare but important cause in those with new fever and back pain)
• Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
• Pregnancy
• Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
• Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
• Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
• Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

• In some cases, no treatment is required and recovery occurs on its own.
• Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
• Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
• Reduced and limited activity is best for the first few days. Bed rest is not recommended.

• For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
• Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
• Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
• Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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