Sciatica is a condition characterized by pain that extends along the entire length of the sciatic nerve (which runs down the lower back and outer side of the thigh, leg, and foot), radiating across the back of the pelvis through the buttocks and into the leg.

Cause

Sciatica is commonly associated with injury to or rupture of a lumbar disk, one of the cartilaginous disks located between the lumbar (lower back) vertebrae. When the injured disk exerts pressure against the sciatic nerve, pain radiates down it. There may be numbness and tingling in the afflicted area.

Symptoms

Sciatica symptoms vary in intensity, depending on the extent to which the injured disk presses on the sciatic nerve and how susceptible the individual is to pain. In mild cases, the pain may be a slight discomfort in the lower back and along the leg. In severe cases, the pain is excruciating and often completely immobilizing. Since the cause is frequently a ruptured ("slipped") disk, it is difficult to know when an attack will begin. A sudden cough may cause the disk to move and press on the sciatic nerve, resulting in pain. (It is common for sciatica patients to be free from pain one moment and in agony the next.)

Repeated problems with a ruptured lumbar disk can cause general inflammation of the sciatic nerve. In these cases, it is not a matter of pain that comes and goes. Depending on the inflammation, it may be a matter of having somewhat less pain at one time than at another.

Treatment

The primary treatment of sciatica is rest, to allow the inflammation of the nerve to subside. In an effort to alleviate the pain, various medications, such as analgesics and muscle relaxants, may be prescribed or anesthetic agents may be injected into the area around the spinal cord.

In cases that do not respond to such conservative measures, surgery may be necessary. Recently, new surgical techniques, such as microsurgery and percutaneous (through the skin without cutting, as with a needle) removal of disk fragments, have been developed. These techniques have considerably decreased hospital stays and loss of work time. So far, success at relieving pain and neurologic symptoms has been good. Not all individuals with disk problems, however, are suitable for this surgery.

Physical therapy is often used to relieve the pain of sciatica. This treatment includes hydrotherapy, in which a stream of water is directed at the affected area. Many therapists advise their patients to overcome the effects of a ruptured disk by developing the core muscles (the four muscle groups that form the waist) in order to provide a supportive column of muscle that will help keep the disk in place.