Sciatica describes persistent pain felt along the sciatic nerve, which runs from the lower back, down through the buttock and into the lower leg. This is the longest nerve in the body. Pain results when this nerve is irritated by inflammation, pressure on the nerve from arthritis growths or a displaced (herniated) disk in the lower spine.

Sciatica causes pain that begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain generally will feel dull, aching or burning. Sometimes, it starts gradually, worsens during the night, and is aggravated by motion. Sciatica also can cause tingling, numbness or muscle weakness in the affected leg.

Your doctor will review your symptoms and your complete medical history, and ask if you have low back pain that spreads to the leg and if you have muscle weakness in your leg or foot. He or she also will want to know if you've had any injury, fever, problems controlling your bowels or bladder, if you've had cancer of any sort in the past and whether you've been losing weight. These questions are important because if these symptoms are present, the cause of sciatica could be a serious condition, such as a bone fracture or infection.

Your doctor will examine you, paying special attention to your spine and legs. To look for problems in your spinal column and related nerves, your doctor may ask you to perform a series of tests that will check your muscle strength, reflexes and flexibility. Your doctor may send you for X-rays, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve.

The diagnosis is based primarily on your symptoms, although a physical examination is important to look for evidence of nerve injury or another explanation for the symptoms. However, a normal physical examination is common in people with sciatica. While testing may be important in some cases, the diagnosis can be made even when all test results are normal.

Sciatica usually goes away on its own after a period of rest and limited activities. Most people with sciatica feel better within six weeks. Pain that lasts longer than six to 12 weeks may require the attention of your physican and if symptoms are severe or prolonged, you may be referred to a doctor who specializes in treating back pain.

Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. A physical therapist can develop a complete, personalized program. Here are some steps you can take in the meantime:

• Practice good posture. Stand up straight with your ears aligned with your shoulders, your shoulders aligned with your hips and your buttocks tucked in. Your knees should be bent slightly.



• Do abdominal crunches. These exercises strengthen the abdominal muscles that help to support your lower back. Lie with your back on the floor, hands behind your head and knees bent. Press your lower back to the floor, lift your shoulders up about 10 inches off the floor, then lower them. Repeat 10 to 20 times, once a day.



• Walk/swim. Walking and swimming can help to strengthen your lower back.



• Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back.



• Avoid sitting or standing for extended periods. If you sit at work, take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day.



• Use proper sleeping posture. Take pressure off your back by sleeping on your side or on your back with a pillow under your knees.



• Stretch. Sit in a chair and bend down toward the floor. Stop when you feel just slight discomfort, hold for 30 seconds, then release. Repeat six to eight times.



• Avoid wearing high heels. Shoes with heels that are more than 1½ inches high shift your weight forward, throwing the body out of alignment.

Sciatica usually can be treated successfully by a brief period of resting and limiting activity, followed by exercises to improve mobility and strengthen the back. If symptoms persist, physical therapy can be helpful. To ease inflammation around the nerve, your doctor may recommend that you alternate using hot and cold compresses.

You also may need to take acetaminophen (Tylenol) for pain, or anti-inflammatory drugs, such as naproxen (Aleve, Anaprox), ibuprofen (Motrin, Advil and others) or aspirin for pain and inflammation. Medications used to treat chronic nerve pain may be helpful. They include amitriptyline (Elavil, Endep) or gabapentin (Neurontin). In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. These injections typically are performed in centers specializing in pain management. Rarely, surgery is required, such as when sciatica is caused by a bulging disc.

Contact your doctor if sciatica pain grows worse over a few days, or if it begins to interfere significantly with your daily activities. Call your doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. These symptoms may indicate that nerves leading to the pelvis are compressed. This condition can cause permanent damage if not treated promptly.

The vast majority of sciatica cases can be controlled with simple home care. For most people, basic preventive measures are enough to keep sciatica from coming back although it can be chronic or recurrent. A relatively small subset of people with sciatica eventually require surgery, such as those with severe or persistent symptoms caused by a bulging disk.

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd.
Rosemont, IL 60018-4262
Phone: (847) 823-7186
Toll-Free: (800) 346-2267
Fax: (847) 823-8125
http://www.aaos.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
Phone: (301) 495-4484
Toll-Free: (877) 226-4267
Fax: (301) 718-6366
TTY: (301) 565-2966
E-Mail: niamsinfo@mail.nih.gov
http://www.niams.nih.gov/

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Toll-Free: (800) 352-9424
http://www.ninds.nih.gov/