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Sciatica



Back Be Nimble Newsletter - May 2001

Sciatica, or pain that runs down the sciatic nerve from the lower back and along the back of each leg - is one of the most common causes of pain in adults.

For some people, the pain can be chronic, severe and incapacitating. For others, the pain may not be severe and comes and goes, but has the potential to get significantly worse over time.

The sciatic nerve is the largest nerve in the body. It starts in the lower back at lumbar segment 3 (L3) and consists of the L3, L4, L5 and S1 nerve roots. The nerve roots exit the spine and run down through the back of each leg to the foot. Any condition that irritates or presses on the nerve roots from within the spinal canal, as the nerve roots exit the spinal canal, or as they run down the leg, can cause pain along the sciatic nerve.

Sciatica is a descriptive term and not an actual diagnosis for the underlying condition that is causing the pain. Lower back conditions that can cause sciatica include:
  • Disc herniation - the soft inner core of the disc presses through the fibrous outer core of the disc and the bulge places pressure on the nerve root.

  • Spinal stenosis - the facet joints become enlarged and place pressure on the nerve roots as they exit the spine.

  • Degenerative disc disease - as discs degenerate, the inflammatory proteins from inside the disc can become exposed and irritate the nerve root.

  • Isthmic spondylolisthesis - the nerve root can get pinched through a combination of the disc space collapse, fracture, and the vertebral body slippage associated with this condition.

  • Piriformis syndrome -The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttocks

  • Sacroiliac joint dysfunction - the sacroiliac joint can also irritate the L5 nerve, which lies on top of it, and cause sciatica.

Treatment options

While it is certainly unpleasant, sciatic nerve pain frequently will subside within six to twelve weeks. To help alleviate the pain, a variety of treatment options are available. Some people will need to try more than one treatment in order to find relief, and others will find that the sciatic pain resolves on its own over time. Treatment options include:

  • Heat/ice: For moderate pain along the sciatic nerve, heat and/or ice packs may be helpful. It is usually recommended to use ice in the acute phase of pain, and later heat and ice may be alternated as symptoms begin to subside.

  • Back Braces, Seat Wedges or Lumbar Supports for Seating: Proper support of the lumbar spine helps take pressure off the lumbar disks and can be a valuable adjunct in an overall treatment program for sciatica. Seat wedges can often better disburse pressure equally across the thighs rather than having a seat that applies localized pressure to the sensitive sciatic nerves.

  • Chiropractic or osteopathic manipulation: A chiropractor or osteopathic physician can develop a treatment program to relieve the pain and provide rehabilitation.

  • Physical therapy: An experienced physical therapist can develop an exercise program to help rehabilitate your back and prevent future recurrences.

  • Medications: There are a number of medications that can help alleviate pain and discomfort, such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen or COX-2 inhibitors), acetaminophen, or oral steroids.

  • Epidural steroid injections: If the pain is severe, an epidural and/or intradiscal injections can reduce the inflammation or swelling that may be putting pressure on nerve roots.

  • Surgical treatments: If the pain is severe and has not gotten better within six to twelve weeks, it may be reasonable to consider surgery. Depending on the cause and the duration of the pain, your surgeon may recommend either a microdiscectomy or a lumbar laminectomy.

  • Danger signs that may expedite the need for surgery: loss of bowel or bladder function, unbearable pain not relieved by medication or therapy, foot drop(inability to raise foot or use muscles of lower leg)


We hope that a better knowledge of the causes and treatment options of sciatica will help you better understand and/or manage your own back condition.

At Back Be Nimble, we bend over backwards to help your back be nimble again!

Best Wishes,

Dr. Brad Lustick
CEO and Ergonomic Supervisor


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