Sciatica, also known as lumbar radiculopathy, is a term that describes pain that radiates down the leg caused by a pinched nerve in the back.
What Causes Sciatica, and Who Gets It and What Does It Feel Like?
Sciatica is most commonly caused by a herniated disc, also called a ruptured or slipped disc. Some people use the term bulging disc, though this more accurately refers to a normal variation of the disc’s shape and not one that pinches the nerve. Most frequently, sciatica happens related to some type of injury, often just from day-to-day activities. These activities can include bending down to pick something up such as a case of drinks, leaning over to put a child in a car seat, doing exercise movements incorrectly, and even coughing or sneezing.
Discs are a form of cartilage with high water content. They are designed like jelly donuts and are made up of outer and inner layers, which work together, to allow for the many remarkable movements of the back. When someone sustains a back injury they usually tear the outer layer and may initially feel back pain or spasms. If the outer layer heals, the back pain will go away. This can take 3-6 weeks. If the outer layer does not heal the material on the inside of the disc, like the jelly in the donut, can move through the tear outside its natural space to a place where it pushes on the nerve. This is what is known as a herniation. When this occurs, the back pain usually improves but the leg starts hurting. It may feel like a deep, constant pain, and can come and go with activities including standing, sitting, bending and walking. Sometimes the patient may also feel leg tingling or weakness.
How Is Sciatica Treated?
Sciatica can be a real pain, but the good news is that the body has an incredible natural ability to heal. Most cases resolve without surgery. Treatment usually includes modified activity, therapeutic exercise, physical therapy, chiropractic care, medication, and occasional epidural steroid injections. When these options don’t work, surgery to remove the piece of disc pushing on the nerve is an option.
If you are currently experiencing sciatica the simplest way to start treating it is with a series of exercises following the McKenzie Method. These exercises can be extremely helpful and can be done on your own or with a physical therapist. In the setting of a herniated disc, the exercises consist of a back extension program that incorporates movements like the cobra pose in yoga. Light non-impact cardio can also be performed, especially as a warm up before the McKenzie exercises. This can include walking, swimming, or use of an elliptical machine. As the sciatica pain improves additional exercises such as core strengthening, light resistance, and stretching can be introduced. However as a general rule if the sciatica flares up after introducing any new activity it’s an indication that your body is not ready for that yet. If that's the case, stay at the level your more comfortable with and try again in 2 weeks. Time, combined with the right activities, will help make sciatica better.
Maintaining a Healthy Back
There is a well-known expression that says ‘An ounce of prevention is worth a pound of cure’. It’s much easier to live a healthy lifestyle than to try and get back to one once your health has declined. Maintaining a nutritious diet, participating in regular exercise using proper technique, and staying hydrated all play a role in preventing sciatica.
For more information on the McKenzie Method see your medical provider who can direct you to a PT or exercise guide.
Eric Laxer MD is a spine surgeon with the OrthoCarolina Spine Center. His interests include minimally invasive and robotic surgery.