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Sciatica: What Patients Should Know

Sciatica is a relatively common form of back pain that radiates along the sciatic nerve. The sciatic nerve is the largest single nerve in the human body; it runs from each side of the lower spine through deep in the buttock and back of the thigh, and all the way down to the foot, connecting the spinal cord with the leg and foot muscles.

The pain can be severe for some, for others it is infrequent and irritating, but has the potential to get worse. Sciatica usually affects only one side of the lower body, often radiating from the lower back down through the buttock and down the leg. The leg pain is often worse than the pain in the back. Depending on which part of the sciatic nerve is affected, the pain may also extend into the foot or toes.
The most common causes of sciatica are usually pressure on the sciatic nerve from a herniated disc (also referred to as a ruptured disc, pinched nerve, slipped disk, etc.) or spinal stenosis. The problem is often diagnosed as a “radiculopathy”, meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root).

Symptoms
Any of the following sensations may occur with sciatica:

  • Pain in the buttock or leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the buttocks
  • A shooting pain that makes it difficult to stand up

While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most of the pain results from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.

Most cases of sciatica will get better with time and conservative care. However, some sciatica symptoms may indicate a potentially serious injury to the nerve:

  • If weakness is present, the nerve may be damaged and it is important to seek attention from a health care professional. If the nerve is compressed and the pain and symptoms are severe, surgery may be warranted.
  • If there is bowel or bladder incontinence (inability to control the bowel or bladder) and/or progressive weakness or loss of sensation in the legs, the condition may be serious and immediate medical attention should be sought.

Diagnosis
Sciatica is a symptom and not a diagnosis. The term literally means that a patient has pain down the leg from compression on the sciatic nerve. The diagnosis is what is causing the compression (such as a disc herniation or spinal stenosis). The vast majority of sciatic episodes heal themselves within 6 to 12 weeks. If it doesn’t get better on its own, various treatment options can be considered.