Sciatica is a painful condition caused by compression or irritation of the radicular nerve in the lower spine, which is part of the large sciatic nerve that also goes down the leg. For most people, sciatica resolves itself with time and treatment, and many different non-surgical treatments are effective. Some people experience chronic pain that eventually leads them to have surgery.
Sciatica has symptoms of pain in the lower back that radiates down the back of the leg. The pain can be severe, with sensations of burning, cramping and throbbing. Symptoms can also include tingling and numbness. Sciatica can be caused by a herniated (slipped) disc, bone spurs or a slight spinal joint displacement. It usually develops during middle age because of general wear and tear on the lower spine.
Prevention and Initial Treatment
Preventing future sciatica episodes and avoiding making a current problem worse are the first lines of defense. Pay attention to movements and activities that trigger sciatica. If you're overweight, losing weight can relieve pressure on spinal structures. In the case of severe back or leg pain, you can decide on complete rest for one or two days, but prolonged bed rest can actually aggravate sciatica. Alternating ice packs and heat can help.
Back exercises and stretching, such as yoga, are common sciatica treatments. Physicians often refer the patient to a physical therapist, who then teaches therapeutic exercises. The patient may be taught how to develop the core muscles at the waist for better spinal support. Physical therapists also use passive treatments such as ultrasound, which involve sending sound waves into tissues to increase circulation and reduce pain. Additionally, physical therapists use transcutaneous electrical nerve stimulation (TENS), a muscle stimulating machine which can control severe pain. Deep tissue massage is another method used by physical therapists to treat sciatica.
A person with sciatica can choose to go to a chiropractor for treatment instead. Chiropractors use massage as well as spinal mobilization and decompression to treat the back and leg pain. Like physical therapists, chiropractors teach therapeutic stretching and other exercises, and they also apply ultrasound therapy and TENS. Some prescribe herbal treatments as well.
Patients can take a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen to reduce inflammation and pain. If the pain is debilitating, physicians may prescribe a more powerful NSAID, an oral corticosteroid or a muscle relaxant. Chronic sciatica can also be treated with an epidural steroid injection. This decreases inflammation and pain for several days to several months, and some people only ever need one injection to cure the problem completely.
An alternative approach to sciatica comes from John Sarno, a medical doctor and professor of clinical rehabilitation medicine at New York University School of Medicine. Sarno views many back pain disorders, and certain other health issues, as psychosomatic conditions he calls tension myositis syndrome (TMS). The doctor describes ways to cure sciatica and other conditions in his 1991 book "Healing Back Pain," and subsequent books he has published as well.
According to the University of Cincinnati, about 10 to 20 percent of sciatica cases cannot be resolved by non-surgical treatments. To alleviate sciatica, physicians perform minimally-invasive lumbar microsurgery through an incision less than an inch long. The procedure can be performed on an outpatient basis and often takes only an hour or less. For some herniated discs, a needle is inserted into the disc to remove a small part of the internal portion, allowing the herniation to pull back to where it belongs.