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Sciatica

Definition

The sciatic nerve begins from the lower spine on either side. It travels deep in the pelvis to the lower buttocks. From there, it passes along the back of each upper leg and divides at the knee into branches that go to the feet. Sciatica is an irritation of the sciatic nerve.
Sciatic Nerve Pain
Sciatica Nerve Pain
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Causes

Sciatica is caused by irritation or pressure on the sciatic nerve. This can be the result of:

Risk Factors

Sciatica is more common in men. Other factors that may increase your chance of sciatica include:
Lifestyle and personal health factors, such as:
Occupational factors, such as:
Health conditions, such as:

Symptoms

Sciatica causes symptoms that can range from mild to severe. In general, sciatica may cause:
More serious symptoms associated with sciatica that may require immediate medical attention include:

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will pay particular attention to your back, hips, and legs. The physical exam will include tests for strength, flexibility, sensation, and reflexes.
Imaging tests are used to evaluate the affected area:
Your doctor may also need to test your nerves. This can be done with a nerve conduction study .

Treatment

The goal of treatment is to reduce sciatic nerve irritation.
Treatment options include:

Activity

Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising.

Medication

Medications used to treat sciatica include:
  • Over-the-counter or prescription pain relievers
  • Muscle relaxers for muscle spasms
  • Corticosteroid injections in the back
  • Antidepressants or antiseizure medications for chronic pain

Physical Therapy

Physical therapy may include:
  • Cold packs or heat therapy
  • Stretching and strengthening exercises
  • Massage
  • Ultrasound treatments or electrical stimulation
  • Posture education and appropriate lifting instructions

Alternative Therapies

These therapies have not been proven by scientific studies to have an effect on sciatica. However, some people may find some pain relief from:

Surgery

Surgery may be done to relieve pressure on the sciatic nerve. This is performed in emergency situations or if other treatments fail. Common surgical procedures are microdiscectomy and lumbar laminectomy .

Prevention

Sciatica tends to happen more than one time. To help reduce your chance of sciatica:

RESOURCES

North American Spine Society http://www.spine.org

Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Allen C, Glasziou P, et al. Bed rest: A potentially harmful treatment needing more careful evaluation. Lancet. 1999; 354:1229-1233.

Sciatica. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351. Updated October 2007. Accessed November 26, 2013.

Sciatica. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed November 26, 2013.

Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract. 1997;47:647-652.

6/7/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Peul WC, van Houwelingen HC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.

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