Sciatica

What Is It?

Sciatica is extremely common and can be defined as nerve pain from irritation of a large nerve (the largest in the body) that begins in the lower back and runs down the back of the leg.
Pain is typically felt in the low back and and travels through the buttock and down past the knee, sometimes into the foot. Numbness, tingling and weak muscles on the back of the leg also may be symptoms of sciatica.
Sciatica is also often confused with muscle trigger point referral pain which unlike sciatica, is pain that is caused by a muscle injury or spasm and NOT nerve irritation. The biggest difference between the two is that sciatica usually travels all the way down the leg past the knee and muscular referral pain only travels into the buttock, hip, or back of the thigh. It is important to differentiate because these two have completely different treatments.

Sciatica is caused by anything that may put pressure on the sciatic nerve, causing it to become irritated.
The most common cause of sciatica is a herniated disc. This is where a jelly-like substance (disc) that acts as padding between two vertebrae is squeezed out from between them. This often results in the nerve becoming irritated from the disc.
Other less common causes of sciatic nerve irritation and sciatica include vertebral osteophytes (out-growths of bone), degenerative joint disease, muscle tightness irritating the nerve (e.g. piriformis syndrome), infection, or tumor.
Degeneration of intervertebral discs, injury, arthritis, smoking, and older age are all risk factors for sciatica.

If you are experiencing sciatic pain you should first be evaluated by a trained health care professional like a primary care medical doctor, chiropractor, or doctor of physical therapy. This will ensure a proper diagnosis and that no underlying condition is missed.
Conservative care is recommended as the first line of treatment and surgery is only recommended in extreme circumstances or if conservative care fails to provide relief after 6-8 weeks (1).
With sciatica, it is important to stay active as bed rest is not recommended and does not result in a faster recovery (1).

Chiropractic Spinal Manipulation has been shown to reduce leg pain due to herniated discs (sciatica) in a large randomized controlled trial (4), and is recommended as an early intervention for low back pain (2).
Physical therapy exercises have been shown to be effective in addition to primary care provider management for sciatica (5). A common type of therapy that has had great success for sciatica is flexion-distraction technique which is commonly performed by chiropractors. Flexion-distraction consists of slow and controlled movements of the low back while the patient is lying on a specialized table and aims to decrease pressure on the intervertebral disc and improve symptoms of nerve irritation.
Acupuncture was shown to be effective in improving sciatica symptoms compared to placebo in a small double-blind study (6).
Heat therapy is recommended and may help with acute pain episodes (2). It also may help with any muscle spasm in the surrounding musculature.
NSAIDs like ibuprofen and Advil are likely not effective in pain reduction compared to placebo and may cause side effects (2).
Systemic steroid injections are also likely not effective in pain reduction and may lead to increased adverse events (3).
Epidural steroid injections may provide some relief after a few weeks but also may worsen pain after 3-6 months and cause negative side effects (2).
Surgery is the last line of treatment but may be needed if symptoms persist (2)

Always remember that you are in control of the type of care you receive and do not hesitate to listen to multiple opinions from different health care professionals.
Conservative treatments like exercise, physiotherapy, chiropractic spinal manipulation, and acupuncture are recommended as the first treatment option before considering surgery (2).
Sciatica can be a painful and disabling condition but the prognosis is usually good. Pain is likely to resolve in 2-4 weeks and most disc herniations heal after 8 weeks with conservative management and no surgery (2)
If pain is persistent for longer than 8 weeks after conservative management it may be good to consult with a orthopedist for another opinion and treatment option.