Pain that starts in the low back and shoots down the leg is commonly called sciatica. “The classic form of sciatica involves pain along the length of the sciatic nerve,” says Russell DeMicco, DO, Associate Director of the Cleveland Clinic Center for Spine Health.
The sciatic nerve, the largest and longest nerve in the body, originates in the low back. It goes through the buttocks, down the back of the thigh, and continues down to the foot. Sciatica is a group of symptoms (such as shooting pain, numbness and tingling) that occur when this nerve is compressed or irritated.
Pain and other symptoms that are confined to the back or the buttocks would not be considered sciatica.
“Sciatica is usually related to a herniated disk in the spine that pinches the nerve,” says Dr. DeMicco. Spinal stenosis, the narrowing of the spinal canal, can also put pressure on the sciatic nerve.
Healing with Time
“People often ask if they need surgery, and I reassure them that most people with symptoms of sciatica do not need an operation,” says Dr. DeMicco. In fact, in most cases sciatica naturally improves.
“About half of people will be better in about two weeks, about 75 percent will be better in eight weeks, and about 95 percent will be better by 12 weeks,” says Dr. DeMicco.
Warning signs of something more serious include bowel or bladder dysfunction, progressive leg weakness and persistent fever. If you have these, see a doctor right away. Otherwise, you often can wait it out.
Many people want to expedite the process or at least get some temporary relief. “Treatment options are medications, an exercise program and injections,” says Dr. DeMicco.
Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), or acetaminophen (Tylenol).
If sciatica disrupts sleep, Dr. DeMicco may prescribe a muscle relaxant, such as cyclobenzaprine (Flexeril), to restore a good sleep/wake cycle. If the drug causes morning drowsiness, it can be taken one to three hours before bedtime.
If symptoms persist beyond six weeks, a medication that addresses nerve pain may be used. These include gabapentin (Neurontin), pregabalin (Lyrica) and duloxetine (Cymbalta).
It may be tempting to just rest. Years ago, bed rest was routinely recommended. “That’s bad advice,” says Dr. DeMicco. “You can become deconditioned and lose 1 to 2 percent of your strength per day.”
For back pain, aerobic activity, such as walking, swimming or bicycling, is recommended. Taking medications should help to relieve symptoms enough to allow you to continue normal activities and to exercise.
If symptoms have gone on for more than a week, see a physical therapist who will recommend exercises that decrease pain by reducing pressure on the nerve. Exercise is also aimed at improving flexibility and strength.
The other option is an injection of a corticosteroid (a powerful anti-inflammatory drug). “We look at injections like the relief pitcher in a ball game,” says Dr. DeMicco. “We do them if you aren’t getting the improvement we would expect with medications, physical therapy and home exercises.”
A steroid injection can reduce swelling that may be contributing to the nerve compression. “We do the injection to minimize symptoms to allow people to do the exercises that will help them get better,” says Dr.DeMicco.