Pain along the large sciatic nerve that runs from the lower back down the back of each leg is a common form of back pain known as sciatica. It is usually caused by pressure on the sciatic nerve from a herniated disc. The disc bulges from its normal position between vertebrae and puts pressure on the nerve root. The pain can range from infrequent and irritating to severe and debilitating. Sciatica usually affects one side of the lower body. The pain often radiates from the lower back through the back of the thigh and down through the leg all the way to the foot or toes.

Signs of sciatica include pain in the rear or leg that is worse when sitting, burning or tingling down the leg, weakness or numbness in the leg or foot, constant pain on one side of the rear, and shooting pain that makes it difficult to stand. Although sciatic pain may be severe, it rarely causes permanent nerve damage. Most sciatic pain results from inflammation and will improve in 2 to 12 weeks. Because the spinal cord is not present in the lower spine, a herniated disc in this area does not present danger of paralysis. Symptoms that may be considered a medical emergency include progressive weakness in the leg and loss of bladder or bowel control. These may be symptoms of cauda equina syndrome which requires immediate medical attention.

Although a protruding disc is a common cause of sciatica, any condition that impinges or irritates the sciatic nerve can cause sciatica. Other common causes include lumbar spinal stenosis, degenerative disc disease, isthmic spondylolisthesis, piriformis syndrome and sacroiliac joint dysfunction. Lumbar spinal stenosis is a narrowing of the spinal canal. It is more common over age 60 and results from enlarged facet joints putting pressure on nerve roots as they exit the spine. Degenerative disc disease is a natural process of aging. A weakened disc results in excessive micro-motion by the vertebrae. Proteins that cause inflammation are released from the disc. Isthmic spondylolisthesis occurs in 5-7% of adults. It occurs when a small stress fracture allows the L5 vertebra to slip forward, which pinches the nerve as it exits the spine. Piriformis syndrome involves irritation of the nerve as it runs under the piriformis muscle in the buttocks. Stretches, ice and heat, physical therapy, and electrotherapy (use of a TENS unit) can help with piriformis syndrome. Irritation of the sacroiliac joint can also irritate the L5 nerve, which lies on top of the joint, and cause sciatica. Treatments include injections into the joint, physical therapy, chiropractic therapy, and water aerobics.

The pain is caused by pressure and inflammation on the nerve root, which will usually improve on its own within 6 to 12 weeks. Treatment involves relieving these factors. Treatments include manual treatment (physical therapy or chiropractic) to relieve pressure on the nerve, medical treatments (non-steroidal anti-inflammatory drugs, oral anti-inflammatory steroids, or epidural steroid injections) and surgery to relieve both pressure and inflammation that is not relieved by either of the above.

Manual treatments include heat or ice packs applied for approximately 20 minutes and repeated every 2 hours. Most people use ice but some get more relief with heat. The two can be alternated. Surgical treatments are microdiscectomy or lumbar laminectomy. Both are elective procedures when pain has not been relieved by conservative care. Microdiscectomy has a 90-95% success rate of pain relief and lumbar laminectomy about 80%. Microdiscectomy involves removing small amounts of disc material that are protruding on the nerve root. Lumbar laminectomy involves also removing a small amount of bone as well as disc material to relieve pressure.

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