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The sciatic nerve is the longest nerve in the body, beginning from nerve roots in the lumbar part of the spinal cord (lower part of the back) and extending through the buttock area to send nerve endings down to the legs.
The sciatic nerve connects the spinal cord and the leg and muscles, and pain that results from irritation of the sciatic nerve is called sciatica. It is a symptom rather than a disorder itself. It is important to understand this because it is the underlying diagnosis that needs to be addressed to relieve sciatic nerve pain. [1]
 
The clinical diagnosis of sciatica is referred to as a radiculopathy. Radiculopathy means that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve. This pressure is most commonly the result of a disc herniation, which compresses the L5 or S1 nerve root found in the lower spine, but any other irritation or inflammation of this nerve can also lead to the symptoms of sciatica. [2]
 
A mechanical compression of the sciatic nerve as a result of spondylolisthesis, arthritis or spinal stenosis may also cause the pain.
 
When the sciatic nerve is pressed, the pain that radiates along its path is typically felt at the back of the thigh and is usually difficult to ignore. Depending on where damage to the nerve occurred, the pain may be accompanied by symptoms such as numbness or tingling, a burning sensation or general weakness in the leg. [1]
 
There is no danger of paralysis because the spinal cord is not present in the lower (lumbar) spine. 
 
Over time, the nerve usually heals itself and pain gradually dissipates, given proper rest and care. 

Dealing with Sciatica Symptoms

Depending on the severity of pain, aspirin or ibuprofen, muscle relaxants or cortisone injections may be prescribed, along with a recommendation of regular exercise which helps ease inflammation. Gentle cold or hot compresses can also offer relief for aching muscles.  
 
There are a few sciatica symptoms that may represent a medical emergency. They are: 
  1. Progressive weakness in the leg
  2. Bladder or bowel incontinence or dysfunction
Patients with either of the above symptoms are suspected of suffering from cauda equina syndrome and are advised to seek immediate medical attention. [3]
 
To the so-called risk group who should contact their doctor if sciatica occurs, belong people who: 
  • Have been diagnosed with cancer
  • Take steroid medication 
  • Abuse drugs
  • Have unexplained, significant weight loss
  • Have HIV
Before jumping to treatment, here are some useful tips when suffering from sciatic nerve pain [4]:

  • Sciatica will usually get better on its own, within a few days, or possibly a few weeks.
  • If possible, stay at work and try to be active.
  • If the pain forces you to rest, know that rest is not a good treatment for sciatica. Try to limit time spent in bed. 
  • Simple painkillers, including paracetamol or ibuprofen, may come in handy. 
  • Do not necessarily put additional strain on your back.
  • If the symptoms are present for more than a few days, consider seeing a physiotherapist, chiropractor or osteopath.
  • An epidural injection into the spine may be helpful in cases of severe and disabling pain.
  • Complications arise in a minority of cases. Your doctor may suggest surgery if sciatica does not settle or complications occur.
  • Most commonly, symptoms of sciatica pain decrease after a few weeks or months with nonsurgical treatment.

Typical Sciatica Treatment

Depending on the nature of the diagnosed reason for sciatica, your doctor may recommend different treatment approaches. The root cause of sciatica needs to be eliminated to cure sciatica symptoms.  

Non-Surgical Treatment Options

Cold packs are used with minor irritations to the sciatic nerve. Cold packs reduce inflammation, muscle spasms, and pain when placed on the affected area by slowing down the blood circulation. Cold packs can also be used in addition to the main therapy or treatment in more serious conditions. [4]
 
Hot packs work by increasing blood flow (to get more blood in the area of application to generate more oxygen and drive more nutrients into the affected area).
 
OTC medications like aspirin or ibuprofen belong to the Non-Steroidal Anti-Inflammatory group of drugs. They act as painkillers and are helpful with reducing inflammation.
 
Prescription medications are stronger and prescribed in cases of chronic conditions or severe pain. These are muscle relaxants and antidepressants.  
 
Regular exercise should be easy and you should be able to do exercises at home. All activities need to be adjusted to suit an individual's needs. Your doctor may recommend swimming, walking, and even yoga. A therapist will first train his patient to perform regular exercises, so they will be able to do them alone in their homes later on. [5
 
Doctors suggest stretching and strengthening exercises. ​Stretching helps bring sustained pain relief. These types of exercises are focused on increasing flexibility in the disc, muscles, ligaments, and tendons. It is important to stretch those muscles that are not directly involved with the injured area, such as the arms and legs. [6
 
Strengthening exercises are very important in the management of low back pain. They are designed to strengthen the “core” or trunk muscles. Two common forms of strengthening exercises to treat sciatica are McKenzie exercises and Dynamic Lumbar Stabilization exercises. These exercises must be done regularly (typically two times daily) and correctly to be effective, so you need to make them a part of your daily routine. The duration of these exercises is progressive starting from short periods and low reps at the start and progressing to more time and more repetitions. 
 
Sciatica affects as many as 40% of people during their lives. Daily stretching and strengthening exercises may help to prevent flare-ups.[7]
 
Regular exercise is crucial for both current and recurrent episodes of sciatica and overall back health. In addition to exercises, patients with sciatica should minimize everyday stress on the lower back by maintaining good posture, making sure the lower back is supported while sitting and avoiding standing for long periods of time. [5,6,7] 
 
A sciatica patient is also likely to receive a complimentary diet program during the therapy sessions to help them accelerate the body’s recovery. 

Alternative Sciatica Treatments

Acupuncture bases its practice on the philosophy of achieving or maintaining well being through the open flow of energy via specific pathways in the body. The practitioner uses hair-thin needles and inserts them into the skin near the area of pain. The FDA and the National Institutes of Health have approved this kind of practice as a treatment effective in relieving back pain, including sciatica. [8]
 
Some forms of massage have been shown to have numerous benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins — the body’s natural pain relievers. [9]

Sciatica Surgery

Surgery should be the last solution. There are different types of surgeries depending on the diagnosed cause of sciatica. [1,2]
 
Microdiscectomy is a microscopic surgery performed through a very small incision with tiny instruments to remove either the whole or parts of a herniated disc.
 
Endoscopic Discectomy involves a tube-like structure that is inserted into the body. Recovery from endoscopic discectomy takes longer than microscopic.
 
Percutaneous Discectomy is a way to remove a herniated disc from the back bone. A surgeon may decide to remove the entire disc or only a part of it.
 
Laser Discectomy involves lasers to remove the herniated disk. Laser Discectomy is the most recent development in surgical treatments that are available for sciatica.
 
Lumbar laminectomy (open decompression) is offered to those patients who suffer from lumbar spinal stenosis that causes sciatica pain that waxes and wanes over many years. After this procedure, around 70% to 80% of patients typically experience relief from their sciatic nerve pain.