Sciatica is a term used to describe pain that radiates down the back of the leg. The name comes from the main large nerve, the sciatic nerve, that travels from the pelvis down the back of the leg. The sciatic nerve forms from the nerve roots in the lumbar and sacral region of the spine, and it is home to the motor and sensory nerves of the leg. The term sciatica is used to describe the sensation of pain in the leg generally from the buttock to the foot.
Causes of Sciatica
The causes of sciatica are numerous, and they are often the same causes of most low back and leg pain. Any structure that relays sensation through the sciatic nerve can produce sciatica pain. Low back, gluteal (butt), and leg muscles when irritated or strained, tendons, bones, and nerves can all produce these sensations. The pain can be acute or it can be chronic. Everyone describes their pain in different terms, as it is a personal experience. Most of these pains are self-limited, temporary and often resolve quickly within days with rest and possibly over-the-counter medications, heat or ice.
If the pain is due to trauma or is not resolving in a week or two, then seeing a physician may be worthwhile. The benefit of seeing a doctor is to get a good treatment strategy to resolve the problem as quickly and easily as possible. A full medical history, a history about the onset and course of the symptoms, and what has been done in treatment is necessary. An accompanying exam will include looking at the low back, pelvis, legs, and evaluating all the structures, including performing test of muscles, joints, nerves, and overall neurologic status. From a history and exam, a good physician can determine a starting diagnosis and treatment plan. 98% of the issues should resolve with good conservative treatment such as ice, heat, over-the-counter medications, physical therapy, massage and manipulation or adjustments. X-rays, CT scans and MRI scans early on in treatment are usually not necessary.
If the sciatica is continuing despite conservative care for 6-8 weeks, then the skills of a Physical Medicine and Rehabilitation Pain Specialist can be especially beneficial. These physicians are experts in musculoskeletal medicine and can usually figure out what is wrong and the best treatment options for you that will help resolve the problems. They also can determine if further tests are necessary such as MRI scans or nerve studies, and they can also perform specialized injections that may speed the healing. There are many physicians that treat back pain, but a Physical Medicine Pain Specialist has the added expertise needed to help find the conservative options and guide the decisions for the more complex problems when issues are prolonged.
Sciatica pain can be especially challenging, especially since 85% of the population does have this problem at some point in their lives. If the simple treatment is not working, the best solution is finding the expert with experience. Every person has different circumstances, and a pain specialist has the broadest set of tools to find the matching solution to each puzzle.