DR. JOHN WATSON: One of the most confusing medical terms that patients often inquire about is sciatica. Most people would say that any pain shooting down the back of their leg is sciatica, although this is not always the case. Sciatica is actually a symptom and not a diagnosis, so figuring out what is causing the symptoms of sciatica is usually the first step in the treatment process.
Sciatica can start in a very specific location and shoot down the leg in a very predictable pattern, whereas other times it can be felt shooting in multiple patterns.
Common symptoms of sciatica include cramping or shooting pains from the buttock down the leg, burning sensations in the thigh or some type of tingling or “pins-and-needles” sensations in the legs. In addition, patients with sciatica may notice a worsening of their symptoms with actions such as coughing, sneezing or squatting. These maneuvers can increase pressure around the nerve roots in the spine and intensify the symptoms of sciatica.
Sciatica can affect just about anyone, but it is typically more common in the 30 to 50 year old population.
The most common cause of sciatica is a disc herniation, although there are other common conditions that contribute to sciatica including spinal stenosis, spondylolisthesis and piriformis syndrome.
To determine the actual cause, your physician will take a careful history and obtain tests including x-rays, a lumbar MRI and an EMG. The lumbar MRI helps to give a snapshot of the spine or a picture of the anatomical structures, while the EMG provides objective evidence as to how the nerves are functioning and which ones may need steroid injections or possibly decompression.
Once the nerves that are creating the sciatica are discovered, a focused injection of cortisone (epidural steroid injection) is used to both confirm the diagnosis and help with minimizing the pain.
Once the pain subsides, exercises and physical therapy are extremely helpful and can help strengthen the muscles around the spine in order to prevent any reoccurrences in the future.
Most people (90 percent) fully recover from sciatica without surgery. In most cases, the nerves are not permanently damaged, and individuals recover anywhere from 3-weeks to 3-months.
Just remember the next time you experience a pain in the butt, it may be sciatica!
Dr. Watson is a board-certified physician at the Orthopedic Center of Illinois. His clinical focus is on the evaluation and management of non-operative musculoskeletal disorders, particularly spinal pain and sports injuries.
