What to expect from sciatica treatment

What to expect from sciatica treatment 1024 535 Best Practice Health TV

Sciatica is a specific pain that travels along your sciatic nerve. The nerve extends from the lower back through the hips and buttocks, then down each leg. The sciatic nerve forms from 5 nerve roots (L4 – S3) in the lower back and sacrum. Sciatica is almost always not from the nerve itself, but rather a symptom caused by something that’s irritating or damaging the L4, L5, or S1 nerve root in the back.

The cause of sciatica, severity of pain, and best treatment varies widely. However, sciatica is treatable in virtually every case, But you must know what kind of doctor to see and when.

If you have sciatica, read this article to the end to find out when sciatica is an emergency, what to expect if you do see a doctor, when to get an MRI, and what choices you have for appropriate treatment.

Symptoms of Sciatica Pain

Sciatica pain can show up anywhere along the nerve, but it typically stems from the lower back and only affects the right or left leg. Pressure on the (L4 to S3) nerve roots that give rise to the sciatic nerve causes pain and inflammation in the lower back, and often extends to pain and numbness in the buttock and the back of the thigh and calf.

Health hack!
Not all back pain that radiates to the leg is sciatica. Facet joint pain due to arthritis goes to the outer thigh. In addition, electrical pain in both legs is not typically sciatica —doctors call leg pain that is caused by walking, relieved by bending forward claudication, which is due to spinal stenosis.

Pain from sciatica can range from a mild ache to unbearable pain. It can feel like a burning sensation or like electricity. And is made worse by coughing, sneezing, or stretching.

You might also experience tingling, numbness, or weakness. In extreme cases affecting multiple nerve roots on both sides, you may have urinary retention or loss of bladder control.

When Sciatica is an Emergency

If you’re feeling a manageable level of sciatica pain, then it’s okay to try home care before visiting the doctor. However, there are some signs that mean you should get help immediately.

See a doctor right away if the pain starts following a serious injury like a car accident. Even if you haven’t had an accident, see a doctor if you experience a sudden and severe onset of pain in the lower back, or in one leg and numbness or weakness in the leg.

Additionally, see a doctor if the pain is accompanied by an unexplained fever, unintentional weight loss, redness, swelling, or issues with your bowels or bladder.

Diagnosing Sciatica

If your sciatica pain is not an emergency, but it’s still persistent after 3 weeks of home care, you should see a medical or chiropractic doctor.

In order to diagnose sciatica your doctor will perform a physical exam and order imaging, usually an X-ray. These scans act as an important tool for informing your physical therapy plan.

Physical Examination and Imaging

Sciatica pain symptoms are similar across patients, but both the cause and severity vary significantly. In order to find the cause of your sciatica, a doctor will need to hear your story and perform some tests.

Get ready for the straight leg raising test. Your doctor straightens your leg while you’re lying down or seated. Straightening your leg puts tension on your sciatic nerve. If one of the nerve roots is compressed or irritated, stretching the nerve will make your leg pain worse.

Your doctor will also have you walk on your heels and toes to see if you have weakness. Let your doctor know if you have numbness in your inner ankle, big toe, or the outside of your foot. Each of those areas corresponds to nerve roots that make up the sciatic nerve.

A physical exam helps confirm that your pain is coming from your lower back. But your doctor will need imaging to get a better idea of your condition. The first step is usually x-ray. If your sciatic is severe or causing significant numbness or weakness the doctor will obtain an MRI right away as well.

Sciatica Pain Treatment Timeline

Even though the pain can be intense, sciatica typically gets better by itself without the need for intervention. It just takes a long time. If we tracked 100 people with sciatica, around 80 would be pain free by 6 weeks, and over 90 by 12 weeks.

The lasting solution to persistent sciatica hinges on addressing, and permanently alleviating, the underlying problem.

Weeks 1-3

Don’t forget the red flag survey above. In the vast majority of cases that will be negative. So, while you wait for your sciatica to resolve, there’s some home care measures you can take to reduce inflammation and pain.

Bed rest is not typically recommended for sciatica. Instead, you should limit physical activities and completely stop exercising, heavy lifting, or twisting your back.

In addition to reducing activity, start by applying ice to the area for a few days, then switch to heat. You can also take over-the-counter pain relievers (if they are safe for your body) such as ibuprofen or Tylenol.

Weeks 3-6

If sciatica doesn’t resolve itself, you’ve ruled out an emergency, and home care isn’t working, then your doctor will likely recommend an x-ray and possibly MRI without contrast of your low back.

MRI is the most sensitive test for a herniated disc. If your scan confirms a herniated disc or bone spur is the cause of your sciatica, and over-the-counter medications aren’t sufficiently relieving pain, then the most dependable method for swift sciatica pain relief is epidural steroid injection. Epidural injections provide about 100 hours of relief from sciatica while the steroid is active.

There are two ways epidural injections in the lower back can be administered, but today’s best practice is the transforaminal approach. Epidural steroid injections must always be performed under X-ray guidance to ensure precise needle placement. And they should always be performed by doctors who are board certified in pain management.

After 6 Weeks

All this is usually enough to relieve sciatica pain. But for some, the pain can reach debilitating levels. In cases where nothing relieves your pain or it’s so severe that it’s preventing basic activities, surgery is the last resort.
Like all sciatica treatments, what surgery you can get to treat your pain depends on its cause. Two of the most common surgeries for sciatica are microdiscectomy (herniated disc) and laminectomy (bone spur).

Finding a Doctor

If your sciatica is persistent and severe, you might need a specialist or even a spine surgeon.

For chronic sciatica pain, especially when caused by a traumatic injury, a physiatrist can help with ongoing recovery and pain management.

Epidural injections are done by pain management doctors. Like all specialists, you typically see a pain management doctor on referral from your primary care or chiropractic doctor, but most take appointments directly.

What kind of doctor you see depends on your specific case, so consult your primary care doctor on their recommendation for a specialist.

For surgery, Best Practice’s recommendation is to find a board certified orthopedic or neurosurgeon who specializes in spine and has extensive experience in minimally invasive surgery.

Alternative Therapies

When it comes to sciatica, epidural injection and surgery are the only interventions proven to be helpful. Many have tried alternative therapies like yoga, acupuncture, or massage without good evidence of success.