Dear Doctor Column, January 28, 2002
Question:
Is there treatment for sciatic nerve problems? It hurts when I walk or move. I would appreciate any information.
Answer:
Sciatic nerve dysfunction or damage is a form of peripheral neuropathy, and there are treatments that can help. It is usually caused by pressure on the sciatic nerve somewhere along its course from the spinal cord in the lower back though the buttocks to the back-and-outer side of the thigh, leg and foot.
The symptoms usually include aching, burning pain that begins in the low back and radiates along the course of the nerve. The pain may occur just in the back of the thigh or continue into the foot. Occasionally, numbness and tingling, decreased sensation over the nerve's distribution and weakness of muscles in the leg and foot occur.
A "ruptured" or herniated disc in the lower back is the most frequent cause of sciatica. The normal disc is designed to separate, cushion and allow for smooth and easy movement of the vertebrae or bones that make up the spine. Discs are composed of two parts - a tough outer shell of overlapping elastic ligaments and a central gelatin-like core that absorbs shocks.
Injuries, trauma, straining to lift an object, degenerative arthritis, and wear-and-tear over the years can flatten a disc so the gelatinous core bulges or protrudes through the fibrous outer coat. A protruding disc in the lower back can press on nerves to the legs as they leave the spinal column and cause pain down the leg. Pain from a ruptured disc is usually worse when standing or sitting for prolonged periods, coughing, sneezing, laughing or straining and better when lying down.
Occasionally, sciatica is caused by bony abnormalities of the vertebrae pressing on the sciatic nerve or narrowing of spinal cavity, called spinal stenosis, that occurs with aging. Sciatic caused by spinal stenosis is usually worse when bending backwards or when walking more that 50 to 100 yards. Rarely, infections or tumors in or around the spinal column can press on the sciatic nerve. Trauma to the buttocks or hips may also cause the problem. And men who wear tight pants and carry bulky wallets in their hip pockets sometimes develop sciatica caused by pressure of the wallet on the sciatic nerve.
To determine the cause of your leg pain, your doctor will perform a physical examination and may recommend x-ray or magnetic resonance imaging studies or studies of the sciatic nerve's ability to conduct impulses to confirm the diagnosis and determine where the problem lies.
Treatment is aimed at maximizing mobility and independence. If a ruptured disc is the cause for your sciatic nerve pain, your physician will likely initially recommend brief bed rest for a few days, heat, medication for pain or inflammation, and exercises or physical therapy. If nerve irritation and pain fail to respond to these conservative treatments, surgery may be necessary. The use of braces, splints, orthopedic shoes or other appliances may help to compensate for lost or impaired function.