Sciatica Treatment Options

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Sciatica is nerve pain from irritation or injury to the sciatic nerve. Many people use the term “sciatica” as a general term to describe nerve irritation in the lumbar spine that causes radiating leg pain. In addition to pain, symptoms may involve numbness or tingling in your back and may radiate down your leg. The sciatic nerve is the longest and thickest nerve in the human body. Despite the name, the sciatic nerve is not just one nerve, it’s a bundle of nerves from your spinal cord. 

Having sciatica means you experience mild to severe pain with nerves that connect to the sciatic nerve. Your symptoms may affect your lower back, hips, buttocks or legs. Some symptoms may extend to your feet and toes depending on the specific nerves affected. 

Sciatica is a very common condition. About 40% of people in the U.S. experience sciatica during their lifetime. 

Sciatica symptoms may include: 

• Pain: Most people experience sciatica pain as an electric shock or burning sensation. This pain can shoot or radiate down the leg. Pain is typically worsened with coughing, sneezing, bending over or lifting your legs.
• Tingling or “pins and needles” sensation: This sensation is similar to when a leg falls asleep when sitting cross-legged. 
• Muscle weakness: This is a more severe symptom since the muscle command signals are having trouble reaching their destination in your legs or back. 
• Numbness: This is experienced when you cannot feel sensations on the skin in the affected areas of your leg or back. 

Incontinence: This is a very severe symptom, since it means that the signals that control your bladder or your bowels are not reaching their destinations.

Sciatica can occur because of any condition that affects the sciatic nerve. Conditions that can cause sciatica include: 

• Injuries 
• Pregnancy 
• Herniated disks 
• Spinal stenosis 
• Osteoarthritis 
• Tumors, cysts or other growths 
• Degenerative disk disease 
• Spondylolisthesis 
• Foraminal stenosis.
• Conus medullas syndrome.
• Cauda equina syndrome.

There are many potential risk factors related to sciatica that may cause you to be more likely to develop it, including: 

• Normal wear-and-tear
• Having excess weight or obesity 
• A job with heavy lifting or bending
• Using tobacco 
• Physical inactivity 
• Having a current or previous spinal injury 
• Having insufficient core strength 
• Poor posture when lifting 
• Having diabetes

Your doctor can diagnose sciatica with a variety of methods including a physical examination. The physical examination may include walking, a straight leg raise test and other flexibility and strength checks. 

In addition to a physical examination, several tests can help with diagnosing sciatica and ruling out other conditions. The most common tests include: 

• Spine x-rays or computed tomography (CT) scans 
• Magnetic resonance imaging (MRI) scans 
• Nerve conduction velocity studies 
• Electromyography (EMG)
• Myelogram 

Milder cases of sciatica usually get better with self-treatment. Please note that moderate or severe pain with numbness, tingling or muscle weakness are all symptoms that professional medical care is needed. If there is severe weakness or loss of sensation of the leg, or bladder incontinence, emergency evaluation by an expert is necessary,  

Self-treatment options may include:

• Over-the-counter medicines: Nonsteroidal anti-inflammatory drugs help to reduce pain, swelling and inflammation. 
• Stretching and activity: Stretching when you experience low back pain can be a major help. You may also be able to work on other general strengthening, such as aerobic exercises and core muscle strengthening. 

If the self-care treatment does not help after a few weeks, you should talk to a healthcare provider. Conservative treatments involve similar treatments to self-care but with your doctor guiding you. Conservative treatment may include the following:

• Physical therapy: Physical therapy helps you find movements that decrease sciatica by reducing pressure on the sciatic nerve. Stretching experiences or low-impact activities may help to treat pain. 
• Prescription medications: Painkillers and muscle relaxants may help with sciatica symptoms. 
• Spinal injections: Injections, such as corticosteroids, may help provide short-term relief, which typically lasts up to three months. 
• Alternative therapies: Alternative therapies may include seeing a chiropractor for spinal adjustments, yoga and acupuncture. Massage therapy may also help muscle spasms that occur with sciatica. 

In more severe cases, surgery may be the best option. Typically, doctors do not recommend surgery unless symptoms indicate nerve damage is imminent or currently occurring. Significant muscle weakness, loss of sensation are both indications for surgery. Incontinence is an indication for urgent or emergent surgery. Surgery may also be recommended if the pain prevents you from working or if your symptoms have not improved after six to eight weeks of conservative treatment. Surgical options to relieve sciatica may include the following: 

•  Discectomy: A minor surgical procedure that removes fragments or small sections of the herniated disk that are pressing on the sciatic nerve.
• Laminectomy: This surgical procedure involves removing a section of the lamina that is pressing on the spinal nerves.

Your recovery time from sciatica will be dependent on the specific treatment, the severity of your symptoms and their causes. In most causes, sciatica goes away within four to six weeks. 

In more severe cases, it may take weeks or months to feel better especially if you are experiencing more severe symptoms. It is important to note that waiting too long to receive treatment for sciatica makes good outcomes less likely. Do not wait too long to talk with your doctor. 

Patients who undergo surgical treatment, including discectomy and/or laminectomy usually feel relief quickly after surgery.

Milder cases of sciatica typically go away over time with self-treatment. Most people, up to 90%, with sciatica will improve without surgery. If your sciatica pain does not improve after a few weeks of self-treatment, you should talk to your doctor. 

If your symptoms and pain do not subside, your doctor may recommend more involved treatments, such as surgery. Your return to work and regular activities depends on several factors, such as your symptoms and the treatments you receive. 

Overall, the outlook for sciatica tends to be very good. Long-term issues are uncommon unless you experience more severe symptoms.