From toledoblade.com
Sciatica is a fairly common condition, brought on by human activity and age.
But sciatica is not a medical condition itself. In fact, it is a response to another problem in the body. Symptoms may present as pain, weakness, numbness, or even tingling in the leg.
According to Dr. Marshall Ochi, a family, sports, and regenerative medicine physician with ProMedica, sciatica is most commonly caused by issues with the lower back or lumbar spine and the discs involved with those areas.
“A lot of times the likely cause would be a disc that is either herniated or protruding that impinges on one or more of the nerves that eventually create the sciatica nerve,” he said. “Typically [it starts] somewhere in the low back to buttocks region because that’s where the sciatica nerve originates.”
Sciatica can also be brought on by a number of risk factors such as underlying medical diseases, cancers, diabetes, obesity, smoking, and infections.
“For infections it can be inflammatory in nature; the same thing with cancers, but they can also be anatomic as well,” Dr. Ochi said. “In terms of infection there are some diseases, like viruses for example, that can create inflammation that will just inflame the sciatic nerve or the surrounding structures that can lead to sciatica.”
While sciatica typically starts in the lower back region, it can spread to the leg and occasionally the foot. Dr. Ochi said that patients suffering from sciatica pain can start with at-home remedies before even visiting their doctor. These activities include stretching, home exercises, and resting.
He also says that using over-the-counter pain relievers can be helpful but you should check with your doctor first for guidance on what will work best for your circumstances.
“You can start with simple over the counter analgesics or NSAIDS, as appropriate for whatever particular patient. Obviously before you do that you probably want to consult with your primary care physician,” Dr. Ochi said.
If the pain persists
Dr. Hossein Elgafy, an orthopaedic surgeon and the chief of spine surgery at The University of Toledo Medical Centre, said that it is time to see your doctor when the pain or numbness does not respond to at-home treatments.
“I would say if their leg pain or numbness didn’t respond to modification of activities, anti-inflammatory, over-the-counter medications for like two to three days, [or if you] use a heating pad and anti-inflammatory medications for two to three days and you’re still having severe pain, then you have to go and see your primary doctor,” he said.
Diagnosis can come from physical exams, a look into the patient’s history, and sometimes x-rays or an MRI can be used for imaging purposes. Depending on the cause, getting imagery of the affected area from these scans can be helpful for a diagnosis.
Dr. Elgafy said sciatica is a very common issue but in most cases doctors will avoid surgery to treat the pain.
“This is one of the most common problems we see in our clinic. It’s been studied for [a long] time,” he said. “It’s been studied from our experience with published data that a majority of them don’t need surgical treatment, like 80 percent; they need conservative management and only 20 percent need surgical treatment.”
Dr. Darin Scribner is an interventional pain management physician with Mercy Health and he said that data shows that a high percentage of Americans deal with sciatica at some point in their life.
“It’s kind of staggering, almost 40 percent of Americans typically deal with some sort of bout of sciatica and the diagnosis of sciatica,” he said. “Typically patients are coming in to their primary care physicians, they’re going for their wellness check, and they may complain of these things to their primary care physician.”.
According to Dr. Scribner, the likelihood of having sciatica at a younger age is lower, but individuals of all ages can be impacted due to activities, underlying issues, and unhealthy habits.
“You kind of break it down into a number of things; typically when you talk about more of the younger generation, the more common things that people think about is a herniated or slipped disc,” he said. “That’s the most common thing that people think about, however, as we get older and as we get more arthritis, we start having things like degenerative disc disease.”
Treatment options
Misconceptions about sciatica and treatment can perpetuate individual concern around the topic. According to Dr. Scribner, the more that the public gets educated on the risks, diagnosis, and treatment of sciatica, the easier it will be to avoid long-term pain and issues down the road.
“There are lots of options for treatment, again, I think there is sometimes a misconception that ‘Oh my goodness, I have a sciatic nerve issue, I need surgery.’ That’s usually few and far between. Typically, most patients do really well with physical therapy, some very conservative treatments with maybe some anti-inflammatories, muscle relaxers, and they’ll come to me as a pain management doctor and get an epidural steroids injection which usually does very very well for patients.”
There are a number of ways to start working on your back and sciatic nerve health now to prevent issues down the line. According to Dr. Elgafy, individuals can start by staying healthy and working on lifting heavy items carefully or with assistance.
“How to avoid back problems; number one is to stay healthy so have good control of your weight, don’t smoke, regular exercise, swimming is wonderful for the back,” he said. “And above all, above all to protect your back. Try by all means to avoid lifting heavy stuff. If your job tells you to lift heavy, get some equipment to help you and if you have to lift heavy stuff you have to bend over on your knee, not through your trunk, and carry the weight close to your chest.”
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