Sciatica is a problem with the sciatic nerve, the largest nerve in your body. It controls the muscles in your knee, leg, and thigh. It is characterized by pain, weakness, numbness, or tingling. The pain and other symptoms tend to start in your lower back and then extend to your leg or down to your toes, usually on one side of the body.
Causes of sciatica include a ruptured intervertebral disk, spinal stenosis, injuries like pelvic fractures, artery issues, and nerve damage. There are also many cases where the cause cannot be identified.
The pain associated with sciatica generally starts in your back, then goes to your buttocks, down the leg, and can be in your thigh, calf, or other parts of the leg and foot.
If you have a neurological deficit that shows in your legs, like a weak leg, a blue toe, or if you are having trouble walking without using a walker or crutches, you might have sciatica.
The two tests for the diagnosis of sciatica are non-invasive arterial studies and MRIs. Arterial studies will show arterial blockages, and the MRI will show lumbar stenosis, bone overgrowth, and ruptured discs, all of which can be causes of sciatica.
Many patients can treat sciatica with anti-inflammatory drugs. If that doesn’t work, the next step is generally lumbar epidural steroid injections, which means drugs injected into your spine. With these treatments, the risks are very low, and the success rates are in the 30-40% range. Sometimes sciatica goes away on its own. Other treatments include exercise and surgery.
Many people do take anti-inflammatories like ibuprofen and naproxen sodium for sciatica. Be sure that you don’t have a bleeding problem or an ulcer before you try that – always consult with your doctor first.
For some people, sciatica goes away on its own. For others, it can go away with medical treatment, physical therapy, or surgery. This may take days, weeks, or even months (especially after surgery) to get full functionality back.
Not everyone needs surgery but for the patients with sciatica who can benefit from surgery, the procedure depends on the nerve causes. It could be a simple hour-long outpatient procedure with a small incision to remove a disc rupture, or it could be a longer, more invasive surgery for someone who has multiple levels of lumbar spinal stenosis. Fusion procedures are generally for patients who have either breaks in their spine or a misaligned spine.
For some people, acupuncture helps relieve sciatica-related pain. Physical therapy and chiropractic therapy can also be helpful for some patients. The effectiveness of these treatments varies by patient.
The main way to keep yourself from getting sciatica is to stay active by exercising 4-5 days a week. However, sciatica can be degenerative (occurs with age), and you cannot always prevent it.
Insurance generally covers sciatica, since it is a medical problem, but the extent varies based on your plan.
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