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Oh, My Aching Back!
Many people experience back pain in some form. One of the most common types is sciatica.
Sciatica is pain that travels down from the lower back and buttock and into your leg and foot. The pain travels along the course of the sciatic nerve. It is estimated that as many as 40 percent of people will experience it in their lives.
Sciatica is not a disease. It is caused by pressure or damage to the sciatic nerve, most commonly by disc herniation or a bone spur on the spine. The sciatic nerve may also become irritated by other structures near the nerve, which include bone, muscles, tumors, infections, direct injury, or bleeding.
Signs and symptoms
Sciatica signs and symptoms can vary widely. The main feature of sciatica is pain in the lower back, buttock, and leg, typically on one side of the leg. The pain can be a relatively mild tingling, a dull ache, a sensation like burning or an electric shock, or numbness. In some cases, the pain is so severe it can make any movement difficult.
Symptoms are worse when moving, coughing, or sneezing. Some activities can aggravate the symptoms further, such as bending forward from the waist or flexing the hip while the knees are straight. In severe cases, legs may become weak, and bladder or bowel function may be affected.
How is sciatica diagnosed?
Diagnosis is typically based on symptoms. Tests are not often needed unless the pain is severe, or it does not improve within a few weeks. An X-ray, MRI, CT scan, or electromyography (EMG) may be ordered to determine the underlying cause for sciatica.
How is it treated?
There is a wide range of treatment options for sciatica. A spine specialist can provide a comprehensive treatment plan specific to each patient. Most cases of sciatica can be treated successfully with nonoperative treatment.
Initial treatment is pain control by means of medication and physical therapy. Conservative treatment is the best in most cases.
1. Different types of medication, such as nonsteroidal anti-inflammatory drugs (NSAIDS), oral steroids, muscle relaxants, or neuropathic pain medications can be prescribed for pain control and anti-inflammatory effect.
2. A structured, spine-based physical therapy program will focus on strengthening the muscles supporting your back, improving flexibility, and training posture. Different treatments, such as dry needling, transcutaneous electrical nerve stimulation (TENS), and ultrasound can also be utilized.
3. Epidural steroid injections with imaging guidance can provide pain relief by reducing inflammation around the affected nerve.
4. Alternative therapies are commonly used. These include acupuncture, massage therapy, and chiropractic manipulation.
5. Fewer than five to ten percent of patients require surgery. However, surgery may be necessary when there is significant weakness in the legs, loss of bowel or bladder control, or when all other conservative treatments have failed. Surgeons can remove the portion of the disc or the bone spur that is pinching the nerve.
Pain typically improves within four to six weeks as the body recovers on its own and responds to self-care measures.
- Stretching exercises can help you feel better and may offer relief by easing pressure on the nerve.
- Apply ice or heat to the painful area. Try icing the area for the first 48-72 hours for 20 minutes at a time, several times a day. After two to three days, switch to a gentle hot pack or heating pad.
- Over-the-counter pain medications, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) are sometimes helpful for the pain.
There are things patients can do on their own to help alleviate the pain and discomfort associated with sciatica.
- Bed rest is not recommended.
- Reduce your activity for the first couple of days. Then gradually return to your usual activities.
- Avoid heavy lifting or twisting your back.
- Start exercising again after two to three weeks and include exercises to strengthen core muscles and improve spine flexibility.
- Maintain proper posture. Choose a seat with good lower back support, armrests, and a swivel base. Keep your knees and hips level.
- Use good body mechanics. Use your lower extremities when lifting heavy objects. Avoid lifting and twisting at the same time.
When should you see a doctor?
Call your doctor if self-care measures fail to relieve your symptoms, pain continues to interfere with your daily activities, or if your symptoms are lasting more than four to six weeks.
Seek medical attention immediately if you have:
- loss of feeling in the affected leg
- weakness in the affected leg
- difficulty controlling bowels or bladder
- unexplained fever with back pain
- redness or swelling on the back
- pain that is worse when you lie down or awakens you at night
- back pain after a fall or trauma
If you are experiencing sciatica, our Comprehensive Spine Center can help.
Su Gym Kim, MD
16 hours ago
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