Sciatica

Age: 25 to 45 Injury such as: Lifting a heavy objectSuddenly moving or twistingFamily members with sciatica or low back problemsVibration from vehicles or heavy equipmentLack of regular exerciseObesitySmokingStress SymptomsSciatica causes symptoms that can range from mild to severe. Typical symptoms include: Burning, tingling, or a shooting pain down the back of one leg Pain in one leg or buttock that is worse with: SittingStanding upCoughingSneezingStrainingWeakness or numbness in a leg or foot More serious symptoms associated with sciatica that may require immediate medical attention include: Progressive weakness in a leg or footDifficulty walking, standing, or movingLoss of bowel or bladder controlFever, unexplained weight loss, or other signs of illness DiagnosisThe doctor will ask about your symptoms and medical history, and examine your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes.Other tests may include:X-raya test that uses radiation to take a picture of structures inside the body, especially bonesMRI Scan a test that uses magnetic and radio waves to make pictures of structures inside the body CT Scan a type of x-ray that uses a computer to make pictures of structures inside the body Nerve conduction study a test in which an electrical current is passed through a nerve to determine the health or disease of that nerve TreatmentThe goal of treatment is to reduce sciatic nerve irritation.

Treatment options include: Limited Physical ActivityProlonged bedrest is usually not advised. However, your doctor may recommend resting in bed for one or two days. Too much bedrest can weaken muscles and slow healing. Doctors generally recommend staying active within the limits of your pain and avoiding activities that worsen back pain. Medication Medications used to treat sciatica include: Pain relievers like acetaminophen (Tylenol), aspirin, or ibuprofenMuscle relaxers for muscle spasmCortisone pills or injections where the sciatic nerve comes out of the spineAntidepressants for chronic pain Physical Therapy Physical therapy may be done at home or at work. It may include the following: Hot or cold packsStretching and strengthening exercisesMassageUltrasound treatmentsElectrical stimulation Alternative Therapies These therapies have not been proven by scientific studies to have an effect on sciatica. However, some people may find some pain relief from the following: BiofeedbackAcupuncture Surgery Surgery may be done to relieve pressure on the sciatic nerve. This is performed in emergency situations or if conservative treatments fail. Common surgical procedures are microdiskectomy and lumbar laminectomy .

In a recent trial, 283 patients with severe sciatica for 6 to 12 weeks were randomly assigned to receive early microdiskectomy (within an average of 2.2 weeks) or conservative treatment (ie, combination of rest, physical therapy, and medications) with delayed surgery if necessary. Although after one year there was no difference in pain or disability between the two groups, those patients receiving early surgery reported significantly faster recovery. It is important to note that these findings do not necessarily apply to laminectomy, only microdiskectomy. * Prevention Sciatica tends to recur. The following steps may help keep it from coming back or, in some cases, from happening in the first place: Lose weight. Being overweight increases the risk of sciatica as well as other back, bone, and joint problems. The greater the weight problem, the greater the risk.When lifting, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.Practice good posture to reduce pressure on your spine.Sleep on a firm mattress.Exercise regularly, at least 30 minutes most days of the week. Good choices include walking, swimming, or exercises recommended by your doctor or physical therapist. Exercises that strengthen the abdominal muscles will also help by supporting the back. If possible, avoid sitting or standing in one position for prolonged periods.Use a low back support during prolonged sitting. Rest one foot on a low stool if standing for long periods.Consider job retraining if your work requires a lot of heavy lifting or sitting.If you smoke, quit. Smoking can damage your sciatic nerve. RESOURCES:

American Association of Neurological Surgeonshttp://www.neurosurgery.org Sciatica.orghttp://www.sciatica.org CANADIAN RESOURCES: Cure Back Painhttp://www.cure-back-pain.org/ Pain Relief Clinichttp://www.painreliefclinic.ca/ References: Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatmentneeding more careful evaluation. Lancet. 1999;354:1229-1233. American Association of Neurological Surgeons website. Available at: http://www.neurosurgery.org . Low back pain. The Merck Manual. 17th ed. 1999. Sciatica. Postgrad Med. July 1997. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice tostay active for acute low back pain. Br J Gen Pract. 1997;47:647-652. Updated Surgery section on 6/7/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256. Last reviewed November 2007 by Rimas Lukas, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.