Degenerative Disc Disease and Sciatica Facts

Article featured on MedicineNet
Sciatica can result from lumbar disc herniation (“ruptured disc”) or spinal osteoarthritis when nerves in the low back are irritated by the abnormal anatomy in the low back.

What is the design of the spine?

The vertebrae are the bony building blocks of the spine. Between each of the largest part of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae of the cervical spine), 12 vertebrae in the mid-back (thoracic vertebrae of the thoracic spine), and five vertebrae in the low back (lumbar vertebrae of the lumbar spine). In addition, in the mid-buttock beneath the fifth lumbar vertebra are five sacral vertebrae — usually fused as the sacrum bone followed by the tailbone (coccyx).

What is the purpose of the spine and its discs?

The bony spine is designed so that vertebrae “stacked” together can provide a movable support structure. The spine also protects the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a bony arch behind the spinal cord that shields the cord’s nerve tissue. The vertebrae also have a strong bony “body” in front of the spinal cord to provide a platform suitable for weight-bearing.
The spinal discs are pads that serve as cushions between each vertebral body that serve to minimize the impact of movement on the spinal column. Because the discs are situated between vertebrae, they are sometimes referred to as intervertebral discs. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) surrounded by a firmer ring of tissue (annulus fibrosus). With injury or degeneration, this softer component can sometimes rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Degenerative Disc Disease Symptom

Low Back Pain

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

What is degenerative disc disease? What causes degenerative disc disease?

As we age, the water and protein content of the cartilage of the body changes. This change results in weaker, more fragile, and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as degenerative disc disease, sometimes abbreviated DDD. Wear of the facet cartilage and the bony changes of the adjacent joint is referred to as degenerative facet joint disease or osteoarthritis of the spine. Trauma injury to the spine can also lead to degenerative disc disease.
Degeneration of the disc space and its contents is medically referred to as spondylosis. Spondylosis can be noted on X-ray tests or MRI scanning of the spine as a narrowing of the normal “disc space” between the adjacent vertebrae.

What are degenerative disc disease symptoms?

Degeneration of the disc tissue makes the disc more susceptible to herniation. Degenerative spondylosis is another name for degeneration of disc tissue. Degeneration of the disc can cause local pain in the affected area. Any level of the spine can be affected by disc degeneration. When disc degeneration affects the spine of the neck, it is referred to as cervical disc disease. When the mid-back is affected, the condition is referred to as thoracic disc disease. Disc degeneration that affects the lumbar spine can cause low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica). Lumbago causes pain localized to the low back and is common in older people. Degenerative arthritis (osteoarthritis) of the facet joints that can be detected with plain X-ray testing is also a cause of localized lumbar pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

What are the symptoms of radiculopathy and sciatica?

Radiculopathy refers to nerve irritation caused by damage to the disc between the vertebrae. This occurs because of degeneration (“wear and tear”) of the outer ring of the disc or because of traumatic injury, or both. Weakness of the outer ring leads to disc bulging and disc herniation. As a result, the central softer portion of the disc can rupture through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column.
It is important to note that many people have degenerative spines without having any symptoms. When nerves are irritated in the neck from degenerative disc disease, the condition is referred to as cervical radiculopathy. This can lead to painful burning or tingling sensations in the arms. When nerves are irritated in the low back from degenerative disc disease, the condition is called lumbar radiculopathy, and it often causes the commonly recognized “sciatica” pain that shoots down a lower extremity. This condition can be preceded by a localized low-back aching. Sciatica pain can follow a “popping” sensation at onset and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, lumbar radiculopathy can be accompanied by incontinence of the bladder and/or bowels.

How do health care professionals diagnose degenerative disc disease, radiculopathy, and sciatica?

Degenerative disc disease, radiculopathy, and sciatica are suspected when the symptoms described above are noted. The doctor can sometimes detect signs of irritated nerves during the examination. For example, increased radiating pain when the lower extremity is lifted supports the diagnosis of lumbar radiculopathy. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect the nerve irritation. Health care professionals can visualize degenerative spondylosis using plain film X-ray imaging of the spine, CAT, or MRI scanning. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.

What is the treatment for degenerative disc disease, radiculopathy, and sciatica?

The treatment of degenerative disc disease, radiculopathy, and sciatica ranges from nonsurgical (medical) management to surgery. Medical management of radiculopathy includes patient education of the condition, medications to relieve pain (NSAIDs, analgesics) and muscles spasm (muscle relaxants), cortisone injection around the spinal cord (epidural injection), physical therapy (heat, exercises, massage, ultrasound, electrical stimulation), chiropractic manipulation and rest (not strict bed rest, but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (producing a small hole in the bone of the spine surrounding the spinal cord), laminectomy (removal of the bony wall adjacent to the nerve tissues), by needle technique through the skin (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

What is bony encroachment and spinal stenosis?

Any condition that results in movement or growth of the bony vertebrae of the spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foramen narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slipping of one vertebra relative to another), and spinal stenosis (narrowing of the spinal canal causing by compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). For example, lumbar spinal nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities.
Spinal stenosis (narrowing of the spinal canal) can occur at any level of the spine, but it’s most common in the lumbar spine of the low back. Symptoms depend on the level affected. For example, lumbar spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking poor circulation of the lower extremities).
Treatment of these conditions varies (depending on the severity and condition of the patient) from rest to epidural cortisone injection and surgical decompression by removing the bone that is compressing the nervous tissue.

What is the outlook (prognosis) of degenerative disc disease, radiculopathy, and sciatica?

The outlook of degenerative disc disease, radiculopathy, and sciatica depends on the severity of the condition, its precise cause, and the interventions used to treat the patient. When patients respond to conservative treatments, the result can be complete healing. Surgical repairs can require postoperative rehabilitation, including physical therapy.

Is it possible to prevent degenerative disc disease, radiculopathy, and sciatica?

Avoiding injury can prevent degenerative spondylosis and resulting nerve irritation. When the disease already exists, aggravation of existing symptoms can be avoided by limiting stressing or overusing the involved spine.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Why is my sciatica not going away?

Article featured on MedicalNewsToday and medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written by Zawn Villines on October 23, 2020

Sciatica is a type of nerve pain that radiates down the back into the hip and leg. It often goes away in a few weeks, but for some people, the condition is chronic.

The pain can feel like an intense cramp or burning electrical sensations.
Sciatica that lasts more than 3 months or that goes away and comes back may be chronic sciatica.
Chronic sciatica is a long-term condition that can cause ongoing pain. It is more difficult to treat than acute (short-term) sciatica, but several remedies can offer relief.
This article reviews what sciatica is, what causes it, and how to treat it.

Why is my sciatica not going away?

Sciatica happens when something presses on or traps the sciatic nerve.
The most common cause is a herniated disk in the lower spine.
Another risk factor is spinal stenosis, a condition that causes the spinal column to narrow.
Herniated disk
Doctors do not know why some cases of sciatica become chronic. Many acute and chronic cases happen because of a herniated disk. In most cases, herniated disks improve on their own within a few weeks. When they do not, this may cause chronic pain.
Injury
People with herniated disks often remember a specific injury that triggered the pain. An injury does not mean that the pain will be chronic. However, people who have a herniated disk from an injury may develop the same injury again, especially if they continue repeating the movements that led to it.
Inflammation
Inflammatory conditions can trap spinal nerves, causing sciatic pain. People with chronic inflammatory conditions, such as rheumatoid arthritis, may notice that their sciatica flares when their condition gets worse. Treating the underlying condition may help treat the sciatica.
Infection
An infection in or around the spine can cause an abscess, which is a swollen and infected mass. This abscess can trap spinal nerves, causing sciatica and, sometimes, other symptoms. A person with an abscess may develop a fever, have pain in other areas of the body, or find that sciatica begins after they have another infection.
Spinal mass or cancer
Any type of mass in or near the spine may trap spinal nerves, causing sciatic pain. Some masses are cancerous. In other cases, an epidural hematoma, which is a swollen blood spot near the spine, can cause the pain. It is important that people with sciatica see a doctor to rule out potentially dangerous conditions such as cancer, especially when sciatica does not go away.
Wear and tear
As a person ages, the normal wear and tear on their spine can cause the spinal column to narrow, resulting in spinal stenosis. For some people, spinal stenosis causes chronic or worsening pain.
Lifestyle issues
Several lifestyle factors may increase the risk of sciatic pain or extend the healing time. People with these risk factors may find that sciatica becomes chronic or recurs. Risk factors for sciatica include:

  • little physical activity and prolonged sitting
  • having overweight or obesity
  • smoking

As sciatica often follows an injury, people may also find that the symptoms do not improve if they continue the activity that caused the original injury.
Tuberculosis
Sacroiliac joint tuberculosis, which doctors call tuberculous sacroiliitis, is a rare form of tuberculosis (TB), a lung infection. It happens when the infection creates an abscess that spreads to the sacroiliac joint in the pelvis and lower spine. A person may also have symptoms of TB, such as breathing problems or coughing. TB is a very rare cause of sciatica, but if symptoms persist, and a person has a history of exposure to TB, testing is important.
Spinal misalignment
When the spine is not properly aligned, such as when a person has scoliosis or another chronic condition, it can put pressure on the space between the vertebrae. This pressure may cause herniated disks. It can also compress the sciatic nerve, causing nerve pain. Depending on the cause, a person may need surgery, physical therapy, or other treatments.

Will my sciatica come back?

Sciatica can and does come back, especially when a person has a chronic medical condition.
People who do not make lifestyle changes to prevent more sciatic pain may also redevelop symptoms. However, for most people, sciatica heals on its own within a month or two.

Exercises for sciatica

Exercise can help ease the sciatic pain. The following exercises might help a person with sciatica:

  • Aerobic exercise promotes fitness and can help a person reach and maintain a moderate body weight. Try low impact exercises, such as swimming or walking.
  • Stretch the hip flexors by standing straight in front of a chair. Bend the knee to a 90-degree angle and put the foot on the chair. Lean forward to stretch for 30 seconds.
  • Kneel with the buttocks resting on the heels, then put the chest to the ground with the arms elevated straight above the head and flat on the ground. Hold for 30 seconds.
  • Lie on the back and bring the knees to the chest. Hold for 30 seconds. Some people find additional relief by rocking from side to side in this position.
  • Lie on the back, with the knees bent and the feet flat on the floor. Lift alternating legs up, as if marching, for 30–60 seconds.

Other symptoms of sciatica

The most common symptoms of sciatica include:

  • electrical sensations along the side of one leg
  • pain that radiates from the lower back to the hip and down the leg
  • intense leg cramps
  • pain when walking or moving
  • numbness in the legs, hips, or lower back
  • pain when sneezing or coughing

When to see a doctor

Sciatica usually goes away on its own, with or without treatment.
A doctor can diagnose the cause of sciatica and may prescribe treatment to speed healing.
However, sciatica is not a medical emergency, and it is fine to wait to see whether the symptoms resolve on their own before visiting a doctor.
It is advisable to see a doctor if:

  • sciatic pain interferes with daily functioning
  • sciatica lasts longer than 3 months
  • sciatica goes away and then comes back
  • the pain is unbearable or gets steadily worse

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What to know about lower back pain when sitting

What to Know About Lower Back Pain When Sitting

Medically reviewed by Emelia Arquilla, DO— Written by Hana Ames on October 14, 2020. | From Medical News Today

The cause of pain in the lower back while sitting may involve posture, an injury, or a health condition.

Back pain is one of the most common medical problems in the United States. About 1 in 4 adults in the country have at least 1 day of back pain in any 3-month period.

Here, we describe the causes, treatments, and prevention of lower back pain while sitting.

What does it feel like?

Back pain may be acute, in which case it comes on suddenly and usually lasts a few days or weeks. Or, the pain may be chronic, lasting longer than 12 weeks.

Pain in the lower back may be sudden and sharp or a dull, constant ache.

Causes

A variety of factors can cause pain in the lower back while sitting, and the best approach to treatment depends on the cause.

The treatment plan might include over-the-counter pain relief medication, physical therapy, a new exercise routine, surgery, or a combination.

Posture

Poor posture can cause or worsen lower back pain. Improving posture involves changing a person’s position as they sit or stand. It can often ease or relieve the pain.

Injury

A person might injure their lower back while lifting something incorrectly, leading to a strain or sprain in the area.

The injury might instead result from trauma, sustained during sports or from a car accident, for example.

Sciatica

Sciatica happens when something presses on the sciatic nerve, which travels through the buttocks and extends down the back of the leg, and the issue can cause pain throughout the area.

The pain may be intense and feel like an electric shock or be a dull ache.

Herniated disk

A herniated disk refers to a disk in the spine bulging outward and pressing on a spinal nerve. Any disk in the spine can be affected.

Treatment for this condition usually involves medication and physical therapy.

Lumbar disk disease

Lumbar disk disease, also known as degenerative disk disease, is not actually a disease. Usually, it results from aging.

It occurs when the disks between the vertebrae of the spinal column wear down.

Spondylolisthesis

Spondylolisthesis involves a vertebra of the lower spine slipping out of place and pinching nearby nerves.

Home care strategies

A person may not need professional treatment for lower back pain while sitting.

Often, a person can take steps at home to relieve the pain and keep it from returning. Some strategies include:

Staying active

It can be tempting to rest as much as possible, but the medical community recommend keeping active to ease lower back pain.

Try not to do too much at once, however. Instead, try coupling physical therapy or a recommended form of exercise below with other home treatments.

Using heat and cold

Alternating between heat and cold can often help ease lower back pain.

Taking a hot bath or using a hot water bottle may help alleviate the pain. Heat can also increase blood flow to the area and promote healing in the muscles and tissues of the back.

Applying ice packs or bags of frozen vegetables to the area can also ease pain, but ensure to wrap them in a cloth first.

Heating or cooling sprays are also available over the counter, and they can stimulate the nerves in the area.

Taking pain relief medication

Nonsteroidal anti-inflammatory drugs, or NSAIDs can help ease pain in the lower back. Many, such as ibuprofen, are available without a prescription.

People tend to take these medications orally, but they also come as creams, gels, patches, and sprays.

Stretching and exercising

Exercises and stretches can help strengthen the lower back and prevent the pain from occurring.

Routines that focus on working the core, or abdominal, muscles may also help speed recovery from chronic lower back pain.

Yoga, for example, can help relieve pain in the lower back and neck, and other forms of exercise that may help include:

  • swimming
  • walking
  • Pilates

Stretches that can help alleviate lower back pain include:

  • Deep lunge: Kneel on one knee, with the other foot in front. Facing forward, lift the back knee up. Hold the position for 5 seconds.
  • Back stretch: Lie on the stomach, using the arms to push the upper body off the floor. Hold the position for 30 seconds before allowing the back to relax.
  • Sagittal core strengthening: Standing 3 feet away from a wall with the feet should-width apart, tighten the abdominal muscles, then reach through the legs to touch the wall, keeping the hips and knees bent. Use the hips to push the body back to a standing position, then extend arms and reach over the head and slightly backward.

Prevention

Lower back pain is more common in people with obesity and people who smoke.

Also, people who are infrequently active are more likely to have lower back pain, as are people who tend to be inactive but occasionally engage in strenuous exercise.

The best sitting position

The Department of Health and Human Services warn against slouching and recommend sitting up straight, with the back against the back of the chair and the feet flat on the floor.

They also recommend keeping the knees slightly higher than the hips when sitting.

Diagnosis

To determine the cause of back pain, a healthcare provider will ask the person about their medical history and perform a physical examination.

If the pain is acute, further tests are usually not necessary, unless the pain results from an injury.

The treatment for chronic pain depends on the cause, and surgery may be an option.

When to see a doctor

Seek medical attention if lower back pain is severe, lasting, or does not improve with stretches, exercises, and other home care techniques.

Also, contact a doctor if the pain results from an injury.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Causes of Sciatica

Common Causes of Sciatica

What is Sciatica and what are some of the common causes?

From Medical News Today

Sciatica is a type of nerve pain that radiates down the back into the hip and leg. It often goes away in a few weeks, but for some people, the condition is chronic.

The pain can feel like an intense cramp or burning electrical sensations.

Sciatica that lasts more than 3 months or that goes away and comes back may be chronic sciatica.

Chronic sciatica is a long-term condition that can cause ongoing pain. It is more difficult to treat than acute (short-term) sciatica, but several remedies can offer relief.

This article reviews what sciatica is, what causes it, and how to treat it.

Why is my sciatica not going away?

Sciatica happens when something presses on or traps the sciatic nerve.

The most common cause is a herniated disk in the lower spine.

Another risk factor is spinal stenosis, a condition that causes the spinal column to narrow.

Herniated disk

Doctors do not know why some cases of sciatica become chronic.

Many acute and chronic cases happen because of a herniated disk. In most cases, herniated disks improve on their own within a few weeks. When they do not, this may cause chronic pain.

Injury

People with herniated disks often remember a specific injury that triggered the pain.

An injury does not mean that the pain will be chronic.

However, people who have a herniated disk from an injury may develop the same injury again, especially if they continue repeating the movements that led to it.

Inflammation

Inflammatory conditions can trap spinal nerves, causing sciatic pain.

People with chronic inflammatory conditions, such as rheumatoid arthritis, may notice that their sciatica flares when their condition gets worse.

Treating the underlying condition may help treat the sciatica.

Infection

An infection in or around the spine can cause an abscess, which is a swollen and infected mass. This abscess can trap spinal nerves, causing sciatica and, sometimes, other symptoms.

A person with an abscess may develop a fever, have pain in other areas of the body, or find that sciatica begins after they have another infection.

Spinal mass or cancer

Any type of mass in or near the spine may trap spinal nerves, causing sciatic pain.

Some masses are cancerous. In other cases, an epidural hematoma, which is a swollen blood spot near the spine, can cause the pain.

It is important that people with sciatica see a doctor to rule out potentially dangerous conditions such as cancer, especially when sciatica does not go away.

Wear and tear

As a person ages, the normal wear and tear on their spine can cause the spinal column to narrow, resulting in spinal stenosis.

For some people, spinal stenosis causes chronic or worsening pain.

Lifestyle issues

Several lifestyle factors may increase the risk of sciatic pain or extend the healing time.

People with these risk factors may find that sciatica becomes chronic or recurs. Risk factors for sciatica include:

  • little physical activity and prolonged sitting
  • having overweight or obesity
  • smoking

As sciatica often follows an injury, people may also find that the symptoms do not improve if they continue the activity that caused the original injury.

Spinal misalignment

When the spine is not properly aligned, such as when a person has scoliosis or another chronic condition, it can put pressure on the space between the vertebrae.

This pressure may cause herniated disks. It can also compress the sciatic nerve, causing nerve pain. Depending on the cause, a person may need surgery, physical therapy, or other treatments.

Will my sciatica come back?

Sciatica can and does come back, especially when a person has a chronic medical condition.

People who do not make lifestyle changes to prevent more sciatic pain may also redevelop symptoms. However, for most people, sciatica heals on its own within a month or two.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Taming the pain of sciatica: For most people, time heals and less is more

Taming the pain of sciatica: For most people, time heals and less is more

Article by Steven J. Atlas, MD, MPH | Article Featured on Harvard Health

Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up.

What is sciatica?

Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.

How do you know if it is sciatica?

The key to diagnosing sciatica is a thorough history and a focused exam. Unfortunately, many patients expect an x-ray or MRI, and doctors, often facing time constraints, order one even though we know imaging tests don’t really help us treat early sciatica any better. The symptoms of sciatica are often worse with sitting or coughing, and may be accompanied by numbness or tingling in the leg. A physical exam can confirm that the sciatic nerve is involved, and I look for weakness or diminished reflexes in the legs that suggest that someone needs early referral to a specialist. (This doesn’t happen often.) With this information, I can make an initial diagnosis and start treatment.

Treating pain… and managing expectations

Many people think (understandably) that the worse the pain, the more likely something bad is going on. However, this isn’t true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So once the pain diminishes, I tell patients to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, I recommend avoiding prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they don’t I may recommend short-term use of stronger, prescription pain medicines.

The good news is that for most (roughly three out of four) people, symptoms improve over a few weeks. Rarely, I’ll find weakness on exam, such as a foot drop, and refer for immediate surgical evaluation. For those not improving after six weeks, surgery is an option. We know surgery can speed up recovery, but by six to 12 months people who have surgery are usually doing about as well as those who decide to just give the body more time to heal on its own. Surgery involves removing the disc material that is affecting the nerve. It is generally a very safe procedure, and while complications are rare, they can happen. What’s more, 5% to 10% of people who have surgery will not be helped by it, or may have worse pain afterwards.

Patients often ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term relief. Like any procedure, it has uncommon risks including more pain, and it doesn’t seem to decrease the need for future surgery.

Staying patient-focused… and “hurt” doesn’t always mean “harm”

For most patients with sciatica, it’s worth seeing your primary care doctor. Patients who come in are often scared. Typically, it is pain the likes of which they may have never had. They want relief and, rightly, they want it now. That is the appeal of surgery and injections, but I also know that most will get better with time and can avoid even the uncommon risks of these procedures. When I see a patient in my office I can assess and identify the few who need immediate referral to a specialist. But for most, I try to reassure that hurt doesn’t mean harm, and that my treatments are geared to managing pain and keeping them active while the body fixes itself. For those not improving, I will get an MRI prior to referring for surgery or an injection, if the patient decides that speeding up recovery is right for them. For those who feel that they can manage the pain, I can reassure them that they can delay surgery for up to six months without risking long-term problems down the road.

Sources

  1. Herniated lumbar intervertebral diskNew England Journal of Medicine, May 2016.
  2. Evaluating and managing acute low back pain in the primary care settingJournal of General Internal Medicine, February 2001.
  3. Epidural corticosteroid injections for radulopathy and spinal stenosisAnnals of Internal Medicine, September 2015.