DEAR MAYO CLINIC: Three weeks ago I was diagnosed with sciatica. I didn’t have much pain initially, but it has been extremely painful the past few days — usually when I’m sitting. Would physical therapy be an option for treatment? I don’t like to take medications for pain. Are there other treatments I should try? Could surgery help?
ANSWER: Sciatica can cause significant discomfort. The good news is that time and treatment often successfully resolve this condition. In most cases, surgery is not necessary to treat sciatica.
Sciatica typically refers to pain from irritation of one of the spinal nerves in your low back. Although the source of the irritation is in your back, you feel the pain of sciatica along the affected nerve where it is located in your leg after it exits the spine, typically in the buttock and leg. Sciatica usually affects only one side of the body.
Sciatica pain is often a dull pain, but it also can be sharp and, at times, you may feel the pain travel or “shoot” down your leg. Symptoms of sciatica may include numbness, tingling or weakness along with the pain.
Sciatica develops due to a change in one of the cartilage pads in your spine, called discs. A small component of the disc pokes into the spinal canal, creating inflammation, or swelling. That, in turn, leads to inflammation of the nerve and triggers the symptoms of sciatica. Pressure on the nerve from the disc may contribute to sciatica, as well. Other less likely causes of nerve irritation include bone spurs, cysts or other lesions in the spine that grow near a nerve.
Physical therapy can be an excellent treatment option for sciatica. It often involves learning stretches to improve your flexibility, techniques for pain control and exercises to strengthen and condition the muscles that support your back. This type of physical therapy helps reduce sciatica pain and lowers your risk for future injuries. In addition to physical therapy, staying active in whatever type of physical activity you best tolerate can help ease pain and other symptoms, too.
Though you mention that you prefer to avoid medications, newer drugs are available that can work quite well for pain caused by sciatica. They are not potentially habit-forming like narcotic drugs, or opioids, can be. Drugs like gabapentin, duloxetine, nortriptyline and pregabalin can be useful for managing severe pain or pain that makes it hard to sleep.
Corticosteroids are another treatment option. These potent anti-inflammatory drugs are delivered via an injection that places the medication just where it is needed. You have an imaging exam, such as a CT scan or an MRI, before a corticosteroid injection, so your health care provider can see where the medication should go. Imaging also is used to guide the injection as it’s being delivered to ensure safety and accuracy.
In about 90 to 95 percent of sciatica cases, the problem is successfully resolved with time and conservative, non-surgical treatments. If sciatica persists despite these treatments, though, surgery may be considered.
Although uncommon, surgery may be recommended as a first step in treatment if weakness associated with sciatica is moderate to severe, if weakness gets worse over time, if symptoms affect both legs or if you are experiencing incontinence due to sciatica. Very rarely, sciatica can lead to extensive numbness in the buttocks and pelvic floor. When that happens, prompt surgical intervention is often required.
When sciatica is the result of a disc problem — as it is in most typical cases — and surgery is required, it can be quite effective. The procedure involves removing the portion of the disc that’s affecting the nerve. This surgery usually takes about 75 minutes and requires only one day in the hospital. — Dr. Randy Shelerud, Spine Center, Mayo Clinic, Rochester, Minnesota