Tackling Angry Sciatic Nerve Pain

The sciatic nerve is the largest nerve in the human body and when everything works as it should, we never give it any thought. Forming in the lower spine and passing through the buttocks and down the thigh to the toes, its job is to connect the spinal cord with all the muscles of the leg and foot.

However, when it gets pinched and angry, it quickly makes its presence known.

The pain that results is called sciatica and the pain can vary from person to person, according to Vicki Stenulson, physical therapist and manager of outpatient therapy at Franciscan Health Dyer, Munster and Hammond.

Symptoms Of Sciatica

Sciatica comes in many different guises. Some people experience a mild pins-and-needles sensation running down their leg, while others feel a sharp, shooting pain. The pain may be mainly limited to the legs, or it can start in the back and run all the way to the toes. A severely compressed nerve can cause weakness and numbness in the leg. 

“Symptoms can include sharp pain, a burning sensation or even an ache in the buttocks area, the back of the leg and even the foot. Sometimes, numbness, tingling and weakness also occurs” Stenulson said.

The good news is that sciatica rarely lasts. According to a report from the American Academy of Orthopaedic Surgeons, 80 to 90 percent of people with sciatica eventually recover without having to resort to surgery. In most cases, sciatica resolves itself within a few weeks with simple at-home treatment.

But the bad news is the pain can be severe at first.

Causes of Sciatica

Sciatic nerve pain most commonly occurs when the nerve becomes compressed or pinched due to a herniated disk, bone spur (overgrowth of bone) or spinal stenosis (a narrowing of the spine):

• A herniated disk occurs when a portion of a spinal disk bulges out of the spinal column. When this occurs, it can push on the sciatic nerve.
• A bone spur is a small bony projection that can develop along the edge of a bone. When one develops on the spinal column, the excess bone can push on the sciatic nerve.
• Spinal stenosis is a narrowing of the spinal canal, which houses the spinal cord. When this space narrows, it can put pressure on the sciatic nerve.

Stenulson says another common cause of sciatica is not a structural problem, but a musculoskeletal problem such as muscle spasms and muscle tension that over time, put pressure on the sciatic nerve.

Other risk factors for sciatica include:

• Poor overall physical health
• Prolonged sitting
• Obesity
• Repetitive lifting of heavy objects
• Poor lifting mechanics.

“Those who sit a lot, such as office workers or truck drivers, can be at increased risk, along with jobs that require a lot of lifting and bending at the waist,” said Stenulson.

Finding Sciatica Relief

Most cases of sciatica go away on their own. You can speed the healing process by taking good care of your back. You may need to take it easy for a few days. Don't lift heavy objects, bend repeatedly, sit for long periods, or do anything else that might aggravate your back. But you don't want to become inert, either. Regular activity will help strengthen your back and promote healing. Your doctor or physical therapist can recommend specific exercises to speed the healing process and prevent future injuries.

Physical therapy can work to correct posture, strengthen muscles and improve flexibility, which can alleviate current symptoms and also prevent future injuries. In most states you can see a physical therapist without a doctor’s referral.

“Even if you are experiencing sciatica pain it’s important to maintain a level of activity,” said Stenulson. “Avoid activities that directly cause pain, but bed rest is not the best treatment.”

If home remedies for sciatic nerve pain don’t work within two weeks, Stenulson recommends taking the next step of scheduling an appointment with a physician and/or a physical therapist. Physicians have several additional tools to treat sciatica, including medications such as prescription-strength anti-inflammatories and muscle relaxants.

If this conservative treatment fails, the doctor may then order imaging tests, such as an X-ray, MRI, CT scan or an electromyography test (EMG).

In some cases, doctors may also recommend steroid injections that deliver a corticosteroid into the affected nerve root to reduce inflammation.

In extreme cases, surgery may be recommended. This is a last option only used when a compressed nerve causes significant weakness, loss of bowel or bladder control or when pain gets progressively worse and doesn’t improve.

Preventing Recurring Sciatica

While it’s not always possible to prevent sciatica from recurring, there are some prevention techniques to take note of.

• Get regular exercise and focus on building the core muscles of the abdomen and lower back. Having a strong core is essential for proper posture and alignment. Additionally, strong muscles help hold the spine and disks in their proper place.
• Maintain proper posture when sitting, especially when sitting for long periods of time. Choose a good chair with lower back support, armrests and a swivel base. It may help to use a lumbar pillow or roll up a towel to place in the small of your back. Since movement is important, Stenulson recommends setting a timer on your phone to stand up and stretch every 40-60 minutes.
• Pay attention to your body mechanics. Body mechanics refers to the way you hold your body as you move, including when you walk, bend over and lift objects. Think of this as having good posture while moving. Some good body mechanic tips include lifting objects with your legs and not with your back, partnering with another person to lift something heavy or awkward and carrying a heavy object close to your body.

Although it's hard to be patient when you're in pain and have difficulty getting around, time can be one of the best therapies for sciatica. With a little rest, gentle exercise, and some help from your doctor, you should be up and about before too long.

“Full relief from sciatica pain is possible,” said Stenulson. She stresses practicing an overall healthy lifestyle, maintaining an exercise program that focuses on endurance and strength and following proper lifting mechanics.

Surgery For Sciatica

For a small number of people with herniated disks, surgery may be the best way to cure sciatica. If signs of nerve damage -- numbness, tingling, and weakness -- grow steadily worse, your doctor may recommend surgery to remove the part of the disk that's pressing against the sciatic nerve. A herniated disk that interferes with bowel and bladder function also requires immediate treatment.

For other patients, doctors take a wait-and-see approach. If your sciatica lingers for six weeks or more despite your self-care efforts, you and your doctor may need to start thinking about surgery. In cases where the pain is not getting better, or where there is persistent numbness or weakness, surgery is often considered. In these cases, an MRI will be needed to determine whether your symptoms are amenable to surgery.

HealthDay News contributed information to this article.