Why Is My Sciatica Not Going Away?

From healthline.com

Sciatica is a condition caused by an irritation, inflammation, pinching, or compression of your sciatic nerve. It can lead to moderate-to-severe pain and weakness in your lower back, buttocks, and legs.

Sciatica typically heals in 4 to 6 weeks, but for some people, it can last longer. In this article, we look at potential reasons why your sciatica pain is sticking around.

Why is my sciatica not going away?

Here are some of the reasons why your sciatica may be getting worse.

Injury and reinjury

If an injury was responsible for your sciatica, and if your symptoms get better and then worse, you may have re-aggravated the injury that originally caused your sciatica.

Sudden injuries and repetitive overuse injuries can lead to sciatic symptoms. Herniated discs are the most common cause of sciatica.

Age and underlying health conditions

In general, younger people heal more quickly than older people. But there are many underlying health conditions that can also slow your body’s ability to heal. Some conditions include:

• high blood pressure
• diabetes
• obesity
• heart disease
• alcoholism
• malnutrition
• smoking

Infections

An epidural abscess is a collection of pus that develops between the bones of your spine and membrane of the spinal cord. It may lead to swelling that puts pressure on your nerves and leads to sciatica.

Wear and tear

Wear and tear on your spine can lead to a condition called spinal stenosis, which is narrowing of the spaces within the spine. This narrowing can compress your nerve and lead to sciatica.

Lifestyle issues

Sciatica often responds to gentle exercise. It’s thought that mobilizing the sciatic nerve may help improve symptoms by decreasing nerve sensitivity. Gentle stretching and exercising may be recommended as a part of treatment.

Alternatively, a sedentary lifestyle and spending a lot of time sitting can potentially aggravate symptoms of sciatica.

Spinal mass or tumour

In rare cases, a cancerous mass can put pressure on your sciatic nerve. One very rare type of tumour that can develop is called a malignant peripheral nerve sheath tumour.

What to do if it’s getting worse

Sciatica often responds to home treatment, but you should see a medical professional first to make sure you’re dealing with sciatica. If you haven’t already tried treating your symptoms at home, you may find the following methods helpful:

• Cold. Try applying an ice pack or cold compress to the painful area for about 20 minutes several times a day.
• Hot. You can apply hot packs or heating pads to the sore area for 15 to 20 minutes several times per day after the first couple of days to stimulate blood flow to the injured area.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs like aspirin or ibuprofen can help you manage pain, swelling, and inflammation.
• Physical therapy, stretching, and exercise: A physical therapist can help you strengthen weak muscles and stretch tight muscles that may be contributing to your pain. The United Kingdom’s National Health Service recommends resuming normal activities and gentle exercise as soon as possible. Always perform these activities under the guidance of a professional.

Seeing a doctor

If you’ve already tried home remedies but your pain is getting worse, it’s a good idea to visit a medical professional.

Your doctor may prescribe muscle relaxers, stronger pain killers, or other medications. In some cases, they may recommend epidural steroid medications. These medications are injected into the area around your spinal cord to reduce inflammation.

In certain cases, surgery may be the best option. This includes instances of worsening pain, pain that hasn’t improved with other treatments, and severe weakness in muscles that results in loss of bladder or bowel control.

One option is a microdiscectomy, a minimally invasive surgery that often offers quick relief of symptoms. The procedure removes the disc material that’s putting pressure on your sciatic nerve.

A laminectomy may also be considered, which is a surgery that involves removing bone to ease pressure on the spinal cord.

How long does sciatica typically last?

Sciatica typically lasts about 4 to 6 weeks. But about 30 percent of people still have noticeable symptoms after a year.

It’s not always clear why some people develop chronic sciatica and others don’t. Some risk factors linked to chronic sciatica include improper lifting techniques and not engaging in regular moderate-intensity physical activity when possible.

Risk factors for recurrent herniated discs include:

• diabetes
• smoking
• disc protrusion

Will it come back?

Sciatica may recur, especially if the underlying cause isn’t treated. For example, if you use improper lifting techniques and developed sciatica after herniating a disc, continuing to use that same lifting technique puts you at risk of injuring your back again.

A 2016 study found that in a group of 341 people seeking non-surgical care for a lower back herniated disc, 23 percent of people with leg pain experienced pain again within a year, and 51 percent experienced pain again within 3 years.

The researchers also found 28 percent of people with lower back pain experienced pain within a year, and 70 percent experienced pain within 3 years.

A 2015 review of studies found that nearly half of 609 people seeking treatment for leg and back pain experienced symptoms for more than 3 months. Just under 75 percent of the participants in the study had sciatica.

How to prevent a recurrent sciatica

Making lifestyle changes like the following may help you prevent recurring sciatica symptoms:

• Eat a balanced diet and exercise regularly.
• Minimize sitting, and sit with good posture.
• Avoid bending your back when lifting heavy objects.
• Choose exercises that are unlikely to cause lower back injuries.
• Avoid smoking.
• Minimize your chances of falling by wearing sturdy shoes and keeping the floors of your house free from clutter.

When to talk with a professional

Most of the time, mild sciatica will go away within 4 to 6 weeks. But you should talk with your doctor at the onset of symptoms to make sure you’re dealing with sciatica. You return to see a medical professional if:

• your pain is getting progressively worse
• your symptoms start after a sudden injury
• you have severe pain, muscle weakness, or numbness
• you lose control of your bladder or bowels
• symptoms last longer than 6 weeks
• pain interferes with your daily life
• you haven’t responded to treatment after your initial visit to see a health professional

After your initial visit to see a health professional, you should discuss a plan for when to return if symptoms haven’t gone away.

The bottom line

Most of the time, sciatic pain goes away within a couple months. It’s best to see a medical professional at the first sign of symptoms to develop a treatment plan.

Some people have pain that may last longer than average. To prevent recurrent sciatica, try not to bend your back while lifting. It’s also a good idea to consider exercising regularly and eating a balanced diet.

If you have severe pain, your pain is getting progressively worse, or if you notice anything else concerning, it’s a good idea to speak with a health professional.

https://www.healthline.com/health/back-pain/why-is-my-sciatica-not-going-away

Taming the pain of sciatica: For most people, time heals and less is more

From health.harvard.edu

By Steven J. Atlas, MD, MPH

Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up.

What is sciatica?
Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.

How do you know if it is sciatica?
The key to diagnosing sciatica is a thorough history and a focused exam. Unfortunately, many patients expect an x-ray or MRI, and doctors, often facing time constraints, order one even though we know imaging tests don’t really help us treat early sciatica any better. The Sciatica symptoms are often worse with sitting or coughing and may be accompanied by numbness or tingling in the leg. A physical exam can confirm that the sciatic nerve is involved, and I look for weakness or diminished reflexes in the legs that suggest that someone needs early referral to a specialist. (This doesn’t happen often.) With this information, I can make an initial diagnosis and start treatment.

Treating sciatica pain… and managing expectations
Many people think (understandably) that the worse the pain, the more likely something bad is going on. However, this isn’t true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So, once the pain diminishes, I tell patients to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, I recommend avoiding prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they don’t, I may recommend short-term use of stronger, prescription pain medicines.

The good news is that for most (roughly three out of four) people, symptoms improve over a few weeks. Rarely, I’ll find weakness on exam, such as a foot drop, and refer for immediate surgical evaluation. For those not improving after six weeks, surgery is an option. We know surgery can speed up recovery, but by six to 12 months people who have surgery are usually doing about as well as those who decide to just give the body more time to heal on its own. Surgery involves removing the disc material that is affecting the nerve. It is generally a very safe procedure, and while complications are rare, they can happen. What’s more, 5% to 10% of people who have surgery will not be helped by it or may have worse pain afterwards.

Patients often ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term relief. Like any procedure, it has uncommon risks including more pain, and it doesn’t seem to decrease the need for future surgery.

Staying patient-focused… and “hurt” doesn’t always mean “harm”
For most patients with sciatica, it’s worth seeing your primary care doctor. Patients who come in are often scared. Typically, it is pain the likes of which they may have never had. They want relief and, rightly, they want it now. That is the appeal of surgery and injections, but I also know that most will get better with time and can avoid even the uncommon risks of these procedures. When I see a patient in my office I can assess and identify the few who need immediate referral to a specialist. But for most, I try to reassure that hurt doesn’t mean harm, and that my treatments are geared to managing pain and keeping them active while the body fixes itself. For those not improving, I will get an MRI prior to referring for surgery or an injection, if the patient decides that speeding up recovery is right for them. For those who feel that they can manage the pain, I can reassure them that they can delay surgery for up to six months without risking long-term problems down the road.

https://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048