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more about Sciatica

  • Sciatica is a pain that occurs when the sciatic nerve is injured, entrapped, pressured (as from disk herniation), or inflamed from a disease process.
  • The sciatic nerve is a major nerve that comes out of the lower spine between the fifth lumbar (L5) and the first sacral (S1) vertebrae.  This nerve supplies and controls muscles in the back of the knee and lower leg, receiving sensory input from the back of the thigh, part of the lower leg, and the sole of the foot.

  • Numbness, tingling, or pain located in the lower back that radiates down the buttocks, the side of the leg into the knee, lower leg, ankle, and foot.  Pain may affect some or all of these body regions.
  • Weakness and partial to full paralysis in the lower leg or foot

  • Examination reveals:
    1. Weakness in muscles of foot or knee
    2. Ankle reflex may be decreased or absent.
  • EMG (nerve conduction testing) may be abnormal
  • Plain X-Rays are often normal, but they may be abnormal in certain conditions
  • MRI will rule out disk herniation.

  • If weakness is not present:
    1. May take anti-inflammatory medications or apply muscle relaxants
    2. Ice lower back for 24 hours if the pain is due to injury
    3. Heat lower back after 24 hours for all cases.  Warm, moist heat, such as from a jacuzzi, is especially helpful.
    4. Pain medications may be taken only if the pain is severe
    5. Physical therapy may be recommended if no improvement is seen in two weeks.
    6. Manipulation, osteopathic or chiropractic, is recommended, especially if no improvement is seen after two weeks.
    7. Epidural corticosteroid injection may be considered if no improvement is seen after four weeks.
  • If weakness is present:
    1. The individual will need immediate evaluation by a neurologist
    2. The same treatment described above may be tried if deemed safe by a specialist.  In some cases, surgery may be needed to prevent paralysis.

  • Without signs of weakness, 90 percent of sciatica cases recover completely, sometimes in the first four weeks.  Signs of weakness or paralysis may require intervention to prevent permanent paralysis.

more about Sciatica

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