Recognizing and treating painful sciatica

Ever had a throbbing pain shoot from your lower back, down through your rear end and continue straight down one particular leg, tingling all the way? If this sounds painfully familiar, and gets worse when you’re sitting, you may be experiencing sciatica.

Sciatica is back and leg pain that stems from a problem in your spine, which then affects your sciatic nerve. The largest nerve in the body, the sciatic nerve branches at your lower back, then runs through your hips and buttocks, and down each leg.

Sciatica happens when one or more of the nerve’s roots become compressed from a problem originating in your spine, and generally affects one leg or the other. Although common in individuals who are not active enough, it can also affect active people whose muscles are strained.

Dr. Vikram Udani, a neurosurgeon affiliated with Sharp Grossmont Hospital, says the most common cause of sciatica is a herniated disc. “Herniated discs are very common in people with weak abdominal and paraspinal muscles, which comes from lack of exercise,” says Dr. Udani. “As a result, their spines are excessively strained from even simple activity, like bending over to pick up something off the floor.”

This weakness can lead to a herniated disk, which can pinch the nerve and bam — sciatica kicks in. How? The injured disk contains a soft, inner material that leaks out — or herniates — and irritates the nerve root.

Another common cause is muscle strain — common in physically active people and athletes — which leads to inflammation that then irritates the nerve. Pregnancy can also be a trigger, due to weight gain and the shift of one’s center of gravity.

Treatment
Because it’s nerve-related, sciatica can come and go quickly. But if it’s recurrent, says Dr. Udani, you should have it checked out. “When symptoms are persistent for more than six weeks, you should see a doctor.”

Dr. Udani recommends initially seeking advice from your primary care doctor, who will most likely recommend conservative treatment first, such as:

Stretching and strengthening exercises
Physical therapy
Acupuncture
Anti-inflammatory medications
Epidural steroid injections

When treatment doesn’t work
If sciatica persists after these treatments, your doctor may schedule an appointment with a neurosurgeon, which could include an MRI and other procedures to test nerve roots.

“We generally advise surgery as a last resort,” says Dr. Udani. “However, if a patient has severe numbness, motor weakness or loss of bowel/bladder function, surgery should be considered immediately.” For simple disc herniations, this surgery is typically a one-hour outpatient operation.

The best advice to avoid sciatica? “Stay active but don’t overdo it, and keep your core strong,” says Dr. Udani.