If you’ve felt pain shooting down your legs, you probably already know what sciatica is. It’s a very common condition with pain starting in the lower back and running down the leg. Or you may feel numbness or tingling.
For some people, sitting makes it worse. For others, the pain increases when standing.
“Patients sometime think it’s a leg problem because they might experience the pain in their foot or calf,” says Thomas McGivney, MD, an orthopedic surgeon at Rush. “But there’s nothing wrong with their leg.”
Causes of sciatica
Sciatica is caused by damage to or pressure on the sciatic nerve, one of the two nerves in the leg. The longest, thickest nerve in the body, it is actually a bundle of nerves.
Of the many possible causes of sciatica, McGivney most commonly sees a ganglion cyst on the spine, the spine slipping forward (which is common in females) or a rupture of the fourth and fifth disc. Sometimes a person can experience a rupture a few days after they’ve hurt their back.
“A disc is like a stale jelly donut,” he explains. “The rupture is in the hard outer part. The gooey stuff in the middle will push out through the rupture.” That can put pressure on the nerve and cause pain.
Treatment for sciatica
The good news is that most of the time — 85%, he estimates — people with sciatica get better on their own within a year. “It heals without intervention, through nonoperative treatment,” he says.
Nonsurgical treatments include stretching or physical therapy, medication, spinal injections, and alternative therapies like yoga and massage. Some people can relieve their pain at home. Ice, heat and stretching can all help.
When a patient comes to him, McGivney may order a standing X-ray, which would show a slipped spine (when a bone in the spine slips out of place), or recommend therapy. If that doesn’t help, the next step is an MRI, which provides a three-dimensional image of the discs and nerves.
Because he treats conservatively, he often refers patients to a physical medicine and rehabilitation physician who will use nonsurgical treatments — from physical therapy to cortisone injections — to help patients manage pain. Epidurals can reduce discomfort by decreasing inflammation.
If those treatments are not successful, the final option is surgery to remove what is pinching the nerve. Studies show that surgery within three months of onset yields the best outcomes. So, if you’ve tried other treatments for four or five months and they haven’t been successful, McGivney recommends surgery.
You shouldn’t wait too long, he says, calling it a “catch-22.” The longer you wait, the longer the nerve is compressed and the less successful the surgery will be, he explains.
“Once a nerve is damaged, it can’t be fixed,” he says. “We take pressure off the nerve and hope it heals.”
What should you do and when?
McGivney recommends seeking treatment when sciatica pain is interfering with your life. Many of his patients with back pain come to him after going to the emergency room. Because they fear surgery, they delay seeking help.
If you experience numbness or weakness, you should see a specialist and get an MRI, he advises.
Knowing the cause of the problem is critical to finding the right treatment. If the problem is caused by arthritis, walking and exercises to strengthen the core are good.
“But if walking and standing make it worse, you can’t walk or work out,” he says. That can lead to additional problems, like weight gain and high blood pressure.
“Discovering where the nerve is pinched is crucial to knowing how to help it,” he says. “We need to find out what’s going on.”
