Sciatica

GENERAL INFORMATION:

What is sciatica?

• Sciatica is a condition where there is pain along the sciatic nerve. This occurs when the sciatic nerve is compressed, inflamed (swollen), irritated, or stretched anywhere along its length. Sciatica can be acute (sudden) or chronic (long-term). Acute sciatica occurs when the duration of the pain is less than six weeks. If the pain persists for more than 6 weeks, it is called chronic sciatica. Sciatica may be a symptom of other diseases, such as spinal and neurological (nerve) diseases.
  
  
• The sciatic nerve is the longest nerve in the body. A nerve is a pathway that carries electrical messages back and forth from the brain. The sciatic nerve starts from the spinal cord and runs through both sides of the buttocks. It then goes down the back of the thighs, and divides into two behind the knees. The two branches then go down the lower leg and finally end in the foot.

What causes sciatica? Sciatica may be related to certain activities, poor posture, and physical or psychological (mental) stress. Any of the following may cause or increase your risk of having sciatica:

• Diseases of the spine: A slipped disc (soft cushion in between the bones of the spine) is the most common cause of sciatica. Pain is felt as the disc pushes on the sciatic nerve. Tumors, slipping of one spinal bone over another, or narrowing in the spine may also cause sciatica.
  
  
• Muscle overuse: Sciatica may happen after lifting a heavy object, or after a fast, twisting movement of your back. Swelling because of sprained or irritated muscles in the buttocks, thighs, or legs may compress (press on) the sciatic nerve.
  
  
• Obesity or pregnancy: The pressure on your back and legs increases when you gain too much weight.
  
  
• Trauma: Direct blows on the buttocks, thighs, or legs, car accidents, or falls may injure the sciatic nerve.
  
  
• Others: Arthritis (swelling of joints), osteoporosis, or infection to the spine may also affect the sciatic nerve.

What are the signs and symptoms found with sciatica? Sciatica usually affects one side of your body. The pain often starts from the lower back and into the buttocks and back of the thigh. You may also have numbness or feel tingly, like pins and needles in the buttocks and legs. There may also be weakness or trouble moving or controlling your leg. Moving your foot or bending your knee may be very hard and painful. Simple things like standing, sitting, or stooping may cause your pain to become worse.

How is sciatica diagnosed? Your caregiver will take your health history. This may include details about your job, and history of any back pain, disease, or surgery you may have had. He may also do a straight leg raise test. This is done by simply raising your leg to check if it causes you pain. You may also need any of the following:

• Blood and urine tests: Samples of your blood or urine are collected and sent to a lab for tests.
  
  
• Electromyography (EMG): Electromyography is a test that measures the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.
  
  
• Imaging tests:
  
  
  • Bone scan: This is a test to look at your bones. You are given a small, safe amount of radioactive dye in an IV. Pictures are then taken of your bones. Caregivers can look at the pictures for broken bones, infections, or cancer in the bones.
    
    
  • Computerized tomography scan: This test is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your hips, thighs, and legs. Before taking the pictures, you may be given a dye through a small tube placed in your vein (IV). The dye helps the sciatic nerve, muscles, or blood vessels show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
    
    
  • Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures of your hips, thighs, and legs are taken. Caregivers use these pictures to look for damaged nerves, muscles, bones, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Myelogram: This is an x-ray picture of your spinal cord. Dye is put into your spinal column using a needle, and then x-rays are taken. The dye helps the pictures of the spinal cord and areas around it show up better.
    
    
  • X-rays: These are pictures of the bones and tissues in your back, hip, thigh, or leg. X-rays may show other problems, such as fractures (broken bones).
  
  
• Lumbar puncture: This procedure may also be called a spinal tap. During a lumbar puncture, you will need to lie very still. Caregivers may give you medicine to make you lose feeling in a small area of your back. Caregivers will clean this area of your back. A needle will be put in, and fluid removed from around your spinal cord. The fluid will be sent to a lab for tests. The tests check for infection, bleeding around your brain and spinal cord, or other problems. Sometimes medicine may be put into your back to treat your illness.
  
  
• Nerve conduction tests: This is a group of tests that are done to check how surface nerves and related muscles in the body respond to stimulation. Electrodes with wires or tiny needles are placed on certain areas, like the buttocks and legs, for these tests.

How is sciatica treated? Treatment for sciatica is aimed at treating its underlying cause. Caregivers decide how to treat sciatica depending on how long you have had it, and how severe it is. You may need to rest in bed for a few days, and make some lifestyle changes. You may also need any of the following:

• Assistive devices: Caregivers may tell you to wear a binder, brace, or corset. They may also tell you to use crutches, a cane, or a walker. You may need to use them until you can put weight on your leg without pain. Using these devices may decrease stress and strain on your lower back and leg muscles. Ask your caregiver for more information about assistive devices and how to use them correctly.
  
  
• Medicines: Medicines may be given to treat the pain or swelling. Other medicines are used to help your muscles relax. In some cases, an epidural steroid medicine may be offered to help manage pain. This is given as a needle. You may be offered this medicine if you have a herniated disk, or stenosis. You may also be offered it if there is pressure on a nerve causing your sciatica pain. Special medicines may also help to soften or shrink (make smaller) the damaged disc.
  
  
• Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.
  
  
• Surgery: Surgery may be done to correct problems such as removing a damaged disc, or a tumor in your spine. This is done to decrease the pressure on the sciatic nerve. Caregivers may also release the muscle that may be pressing into your sciatic nerve.
  
  
• Ultrasound therapy: Massaging the swollen or irritated muscle using a therapeutic ultrasound may relieve sciatica.

How can sciatica be prevented?

• Avoid too much pressure on your back and legs: Do not lift heavy objects, or stand or sit for long periods of time.
  
  
• Have good lifting techniques: Keep your back straight while bending your knees when picking up an object. Do not bend or twist your back when lifting.
  
  
• Keep a healthy weight: Talk to your caregiver about your ideal body weight. Ask him to help plan the best exercise program for you. Make a goal to exercise at least 30 minutes every day.
  
  
• Maintain proper posture: Always sit in a straight-backed chair with your feet flat on the floor.
  
  
• Sleep on a good, firm mattress: Try placing a piece of plywood under your mattress to help make it firmer. If you do not have a firm mattress, you may also sleep on the floor for a few days.
  
  
• Use warm-up or stretching exercises: Do some stretching or warm-up exercises on your lower back and leg muscles before exercising . You may also do some exercises that can make your trunk muscles strong. Ask your caregiver for an exercise program that can help you use your muscles effectively.

Where can I find support or more information? Having sciatica may be a life-changing condition for you and your family. Accepting that you have sciatica may be hard. You and those around you may feel sad, frightened, and anxious. These feelings are normal. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information about sciatica:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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