Dr. Miller: Sciatica. What is it? What do you do about it? We're going to talk about that next on Scope Radio.
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Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Ryan Spiker. He's an orthopedic surgeon and a spine specialist, and we're going to talk a little bit about sciatica. What is sciatica? What does that mean, Ryan?
Dr. Spiker: Sciatica is a pain that originates in the back but shoots down the legs, often just one of the two legs, often down the back of the leg and can go all the way to the foot.
Dr. Miller: What does that feel like? Is it a dull pain, shooting, electric . . . I mean, what would a person feel if they had sciatica?
Dr. Spiker: For most people it's kind of an electrical type sensation, a sharp pain that kind of shoots down the leg in a pretty clear distinct path that connects from the back all the way down into the leg.
Dr. Miller: Who gets sciatica? Would it only be somebody that has a traumatic injury or can it just happen?
What Causes Sciatic Nerve Pain?
Dr. Spiker: Sciatica is most common from degenerative conditions which are nontraumatic conditions where people are out working in the yard doing their normal activities and suddenly will feel this sharp pain. It can come from a disk herniation.
Herniated Disk and Sciatica
Dr. Miller: What's that? What is a disk herniation? We always hear about disk herniation, but what really is that?
Dr. Spiker: Yeah, that's a great question. So disk herniations are very common and fortunately they usually don't pinch nerves, but when they do, when a disk herniates from its normal position and pushes toward the nerve, it can cause nerve pain and that nerve pain can be described as sciatica.
Dr. Miller: So the disk is, it seems to me, to be kind of a shock absorber between the bones or vertebrae in the spine. Is that what that is?
Dr. Spiker: Correct, so the disk is between the two bones in the spine in each segment, and so our spine is full of different bones with discs in between and if that disk has damage to it, which can be traumatic but most likely is degenerative and most commonly seen in patients as they get older, they can start to rupture and have some of the material from inside the disk push out.
Dr. Miller: How do you describe the nerves traveling out of the spine? Do they travel out between the disks and the bones? What does that look like?
Dr. Spiker: Yes, between the bones are the disks and then between each level there's a nerve that will exit, so between each level of the spine there's a unique nerve that will exit and that nerve can be pinched from the disk.
Dr. Miller: Are there certain levels of the spine that are more susceptible to sciatica, or not sciatica but disk herniation that would cause a compression of the nerve?
Dr. Spiker: Yes, the lower spine, the lumbar spine is by far the most common, and even within the lumbar spine it's usually the bottom, the lowest part of the spine, in the L4, L5, S1, the very bottom part of the spine is the most common area, and that leads to compression of the nerve roots which shoot down the back of the leg and that's where we most commonly hear the symptoms of sciatica being, shooting down the back leg.
Sciatica Pain Can Happen to Anyone
Dr. Miller: You mentioned that this is due to a degenerative condition so would we more likely see sciatica in someone who is older or younger, or what?
Dr. Spiker: It depends on the cause. With disk herniation sometimes we do see that in younger patients, even in their 20s, 30s, 40s. Other causes where arthritis or kind of slow processes are causing nerve compression, we see that in older patients or what we think of as lumbar spinal stenosis which is kind of more generic stenosis than just from a disk, and we'll see that in older patients. We see the symptoms of sciatica in all age ranges but different causes.
Symptoms of Sciatica Nerve Pain
Dr. Miller: Sciatica is usually described as a pain, but can there be weakness associated with it?
Dr. Spiker: Absolutely, and that's something that is often missed by patients. When they initially describe their symptoms they'll have weakness in their leg without significant pain and it's unclear why, and it can come from nerve compression either in the lumbar spine or elsewhere.
Sciatica Pain Treatment at Home
Dr. Miller: So let's say a patient is out shoveling snow and all of a sudden they have this pain radiating down the side of their leg. It's pretty intense. What should they do?
Dr. Spiker: So first things first, taking a little bit of rest for a few days and if the symptoms aren't severe often they'll improve on their own. If it's persistent, getting worse day to day or associated with severe weakness or changes in their bowel or bladder function then they need to see someone immediately there in the emergency room or in clinic to get x-rays and get evaluated to see if there is significant nerve damage.
Dr. Miller: When you say rest, you mean they should just get in bed and lie in bed for a few days?
Dr. Spiker: Not necessarily lying in bed. As long as they're able we encourage people to be up and walking and moving as early as possible, but minimizing lifting, twisting, bending. The physical function is a little bit less aggressive in those first few days.
Dr. Miller: I think going to bed and just lying down used to be the old treatment, and it was found that people got pretty weak over time pretty quickly if they did that, so it got to the point of stay as active as you can as much as you can tolerate the discomfort.
Dr. Spiker: Absolutely, absolutely.
What to Take for Sciatica Pain
Dr. Miller: So should patients take any kind of medication for sciatica while they're waiting for it to naturally heal?
Dr. Spiker: If they can tolerate anti-inflammatories, it doesn't have any contraindications with their other diagnoses or medications, it's a great first-line treatment to calm down the inflammation and often helps with the symptoms and allows them to be functional, allow them to walk and move and heal on their own. There are other medications but that's probably the first step, and then getting into physical therapy as soon as possible to really get as much as we can out of our own bodies before we move on to more aggressive treatments.
Dr. Miller: More aggressive treatments would be . . .
Dr. Spiker: It includes injections, a steroid injection can help calm some of that inflammation, and in rare cases sometimes people do need surgery.
Quick Recovery for Most Patients
Dr. Miller: How many people who have sciatica eventually go on to surgery? It's not that many.
Dr. Spiker: Correct, it's a small percentage and it's hard to know because so much sciatica resolves before people even come to a physician, but even in people who come to see a spine surgeon like myself, it's by far the minority who end up needing spine surgery
Dr. Miller: That's really good news. So I think the bottom line for the listeners would be that if you have sciatica, it suddenly develops, to plan on waiting it out for a week or two because things generally progressively improve and to use nonsteroidal anti-inflammatories like ibuprofen, Naprosyn or aspirin to treat it, and then if it's not getting better to seek care from your primary care physician or perhaps even a physiatrist. Would that be right?
Dr. Spiker: Absolutely.
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updated: March 12, 2019
originally published: June 21, 2016
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