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

Medically accurate illustration of a painful sciatic nerve

Sciatica refers to ache brought on by the sciatic nerve that carries messages from the mind down the spinal twine to the legs. The ache of sciatica sometimes radiates down one facet from the decrease again into the leg, usually under the knee. The commonest trigger is a bulging (“herniated”) disc within the decrease again. Discs are tire-like constructions that sit between the bones of the backbone. If the outer rim of the disc tears, normally as a consequence of routine strain on the decrease again, the jelly-like interior materials can come out and pinch or inflame the close by nerve. Sciatica is commonest in folks 30 to 50.

How are you aware whether it is sciatica?

The important thing to diagnosing sciatica is a radical historical past and a targeted examination. Sciatica signs are sometimes worse with sitting or coughing and could also be accompanied by numbness or tingling within the leg. A bodily examination can verify that the sciatic nerve is concerned. If there’s muscle weak spot or diminished reflexes within the concerned leg, an imaging take a look at resembling a again MRI may be helpful and assist information a choice for early surgical procedure.  

Treating sciatica ache… and managing expectations

Many individuals assume (understandably) that the more severe the ache, the extra seemingly one thing dangerous is occurring. Nonetheless, this isn’t true for sciatica. The physique can reabsorb the disc materials that’s inflicting signs, even for these with extreme ache. So, remedy focuses on controlling ache and preserving folks as energetic as attainable.

If the ache is excruciating, mendacity down for brief intervals may help, however extended mattress relaxation doesn’t. So, as soon as the ache turns into manageable, it’s vital to rise up and begin strolling brief distances. Since sitting will increase strain on the discs within the decrease again, keep away from extended sitting or driving. Many individuals strive remedies like bodily remedy, therapeutic massage, acupuncture, and chiropractic manipulation, however proof means that whereas these approaches might assist typical low again ache, they’re much less useful for sciatica. Over-the-counter ache medicines like ibuprofen and naproxen may help. After they don’t, short-term use of stronger, prescription ache medicines could also be wanted.

The excellent news is that for many (roughly three out of 4) folks, signs enhance over just a few weeks. For these not enhancing after six weeks, surgical procedure is an choice. We all know surgical procedure can pace up restoration, however by six to 12 months individuals who have surgical procedure are normally doing about in addition to those that determine to only give the physique extra time to heal by itself. Surgical procedure entails eradicating the disc materials that has effects on the nerve. It’s typically a really protected process, and whereas issues are uncommon, they will occur. What’s extra, 5% to 10% of people that have surgical procedure won’t be helped by it or might have worse ache afterwards.

Sufferers usually ask about spinal injections — the place steroid drugs is injected into the affected space. It’s value contemplating for these with uncontrolled ache or for these with persistent, bothersome signs who wish to keep away from surgical procedure. Injections can present short-term sciatica aid. Like several process, it has unusual dangers together with extra ache, and it doesn’t appear to lower the necessity for future surgical procedure.


Herniated lumbar intervertebral disk. New England Journal of Drugs, Could 2016.

Evaluating and managing acute low again ache within the main care setting. Journal of Basic Inner Drugs, February 2001.

Epidural corticosteroid injections for radiculopathy and spinal stenosis. Annals of Inner Drugs, September 2015.

Tailored from a Harvard Well being Weblog put up by Steven J. Atlas, MD, MPH

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