Sciatica consists of pain, weakness, numbness or tingling in the leg. Injury or pressure on the sciatic nerve can cause it. Sciatica is a symptom; it is not a disease on its own.
Where is the pain located?
The pain can adopt different locations. For instance, it can either extend from the lower back to the heel. Or even the foot, descending the back or side of the thigh.
There is also lumbar back pain which can spread to areas beyond the lower back. Or it could even reach the lower limbs.
What is the cause?
The presence of sciatica suggests a lesion of the nerve roots that leave the lumbar spine. The nerve roots carry the sensation signals or control the contraction of muscles in the lower limbs through the sciatic nerve.
If the pain does not refer below the knee we should not speak of sciatica. That is because its cause probably not related to the injury of the nerve roots.
Can Sciatica and lower back pain be treated?
There are many treatments for sciatica.
- Low back pain and sciatica rarely require surgery.
- Physical therapy to gently stretch the nerves and improve the core muscles around the lower back can improve pain.
- Pain killers such as Anti-inflammatory medications and muscle relaxants
- Resting in a comfortable position
- Keep on doing some gentle activity but no lifting or twisting of your lower back.
When is surgical treatment necessary?
Of all patients with low back pain, only a minority are candidates for surgical treatment. The main indications are:
- A herniated disc that causes persistent sciatic pain that has failed to respond to conservative treatments (medication, heat and cold therapy, spinal injections etc). The presence of a herniated disc in Magnetic Resonance is not an indication of surgery. There must be characteristic, persistent and confirmatory symptoms.
- A herniated disc causing nerve damage. Symptoms will include progressive numbness and weakness.
- Damage to bowel and bladder nerves (Cauda Equina Syndrome). This manifests itself as numbness of the private areas, incontinence of urine or bowels, inability to pass urine voluntarily.
- Inability to tolerate pain and not wanting to wait 6 weeks for symptoms to resolve.
- Caudal Epidural, Nerve root injections, facet joint injections are methods of bringing immediate pain relief. They may not get rid of all your pain but in over 90% cases will bring significant pain reduction.
- They should always be tried before surgery as long as there is no progressive nerve damage.