Understanding Sciatica and How to Manage a Flare-Up

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“Causes of sciatica are multiple and sometimes difficult to pinpoint,” states Kaliq Chang, MD of Atlantic Spine Center, an interventional pain management specialist board-certified in anesthesiology. Sciatica is characterized by shooting pain, from mild to debilitating, radiating along the sciatic nerve, the longest single nerve in the body, extending from the lower spine through the buttocks and into the legs. The pain can be persistent or sudden and unpredictable, resulting in a “pins-and-needles” sensation, pain, numbness or weakness in a leg.

What is Sciatica and What Causes It

The problem initially develops when the sciatic nerve becomes pinched or compressed due, typically, to a herniated or bulging spinal disc in the lumbar (lower) region of the back. This happens in conditions like Lumbar Spinal Stenosis, a nerve compression disorder affecting older adults; Degenerative Disc Disease like Spondylolisthesis; Bone Spurs, an overgrowth of bone on the vertebrae; or an injury to the lower back, Dr. Chang explains.

Some flare-ups, however, are idiopathic in nature (an unknown cause) and sometimes blamed on carrying heavy loads, prolonged sitting such as at a desk job, driving a vehicle for extended periods, and “strange” sleeping positions. However, “there is a lack of conclusive evidence linking some of these ‘causes’ directly to sciatica,” says Dr. Chang.

He agrees that wear-and-tear on the spine due to advancing age, obesity which can increase pressure on the lower back, and diabetes can increase a person’s risk for the disorder. Shakespeare referred to sciatic pain as a “curse” in one of his plays, and early Germans called it “the witch’s slot” because they believed the pain could surely be linked to something demonic. Dr. Chang reassures the disorder is anything but supernatural. It is, instead, he says, a common physical malady affecting approximately 5 percent of men and 4 percent of women at some time in their lives and causing a significant number of lost work days. More than five million cases of sciatica are reported each year in the United States.

“Anyone who has experienced episodes of sciatica dreads its potential recurrence,” Dr. Chang says. “The pain is not necessarily disabling but oftentimes serious, difficult to endure and a source of anxiety.” Mild cases of sciatica clear up within a few weeks, with most doctors recommending self-treatment, including gentle exercises and low-impact aerobics like swimming and limited use of over-the-counter pain-relievers. More severe and chronic sciatica might require prescribed medications, corticosteroid injections, physical therapy or other conservative approaches.

The Symptoms of Sciatica

Only if sciatica pain is uncontrolled, worsening or leads to symptoms of concern like bowel and bladder dysfunction or leg weakness will surgery be warranted to correct the source of the pain, Dr. Chang states. A Massachusetts General Hospital study published in the May 2018 issue of the journal Pain indicates patients with chronic sciatica have been found with elevated markers for inflammation in their nervous system. The finding, authors say, indicates potential pathways of effective therapy for such patients, including direct treatment of the neuro inflammation in the spinal cord. Dr. Chang adds, “This is a great argument for why epidural steroid injections are an excellent treatment for sciatica, at least initially as opposed to surgery.”

Treatment Options for Sciatica

Treatment options for sciatica aim to alleviate pain, reduce inflammation, and address the underlying cause of the condition.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and relieve pain associated with sciatica. In more severe cases, a healthcare professional may prescribe stronger pain medications or muscle relaxants to ease discomfort.

Specific exercises and stretches can help improve flexibility, strengthen the back and core muscles, and reduce pressure on the sciatic nerve. Physical therapy can also provide guidance on proper body mechanics to prevent further aggravation of the condition.

Applying heat or ice to the affected area can be complementary therapies, as they help reduce inflammation and alleviate pain. Ice packs are usually recommended in the acute phase to reduce swelling, while heat therapy can help relax tense muscles and improve blood circulation.

In more severe or persistent cases, an epidural steroid injection may be recommended. This involves injecting a corticosteroid medication directly into the space around the spinal nerves to reduce inflammation and provide pain relief.

Chiropractors may use spinal adjustments or manipulations to realign the spine and alleviate pressure on the sciatic nerve.

Some individuals find relief from sciatica pain through acupuncture, which involves inserting thin needles into specific points on the body to stimulate healing and pain relief.

In severe cases where conservative treatments do not provide sufficient relief, or if there is a significant structural issue like a herniated disc that requires intervention, surgery may be considered. Surgical options for sciatica include discectomy (removal of the herniated portion of a disc) or laminectomy (removing part of the vertebra to relieve pressure on the nerves).

Preventing Sciatica: Tips and Strategies

Dr. Chang advises that the best course of treatment for sciatica is prevention. He offers these tips to reduce risks:

  • Exercise regularly and incorporate stretching to maintain a free range of motion of the spine
  • Ensure proper posture when sitting to avoid putting too much pressure on the back and sciatic nerve. Keep back straight, hips at an approximate 45-degree angle, feet slightly elevated if possible. Avoid crossing legs.
  • Use correct body mechanics. When standing for a prolonged time, for example, occasionally elevate a foot by placing it on a small stool or box.
  • If overweight, lose the extra pounds.
  • Eat a healthy diet.

Watch our 3D professionally animated video on Sciatica: https://www.youtube.com/watch?v=vumGp6HcdJg