you suddenly start feeling pain in your lower back or hip that
radiates to the back of your thigh and into your leg, you may
have a protruding (herniated) disk in your spinal column that
is pressing on the roots of the sciatic nerve. This condition
is known as sciatica.
may feel like a bad leg cramp that lasts for weeks before it goes
away. You may have pain, especially when you sit, sneeze, or cough.
You may also have weakness, "pins and needles" numbness,
or a burning or tingling sensation down your leg.
are most likely to get sciatica between the ages of 30 and 50
years. It may happen as a result of the general wear and tear
of aging, plus any sudden pressure on the disks that cushion the
bones (vertebrae) of your lower spine.
disk (side view and cross-section)
The gel-like center (nucleus) of a disk may protrude into or through
the disk's outer lining. This herniated disk may press directly
on the nerve roots that become the sciatic nerve. Nerve roots
may also get inflamed and irritated by chemicals from the disk's
Approximately 1 in every 50 people will experience a herniated
disk at some point in their life. Of these, 10% to 25% have symptoms
that last more than 6 weeks.
In rare cases, a herniated disk may press on nerves that cause
you to lose control of your bladder or bowel. If this happens,
you may also have numbness or tingling in your groin or genital
area. This is an emergency situation that requires surgery. Phone
your doctor immediately.
begins with a complete patient history. Your doctor will ask you
to explain how your pain started, where it travels, and exactly
what it feels like.
A physical examination may help pinpoint the irritated nerve root.
Your doctor may ask you to squat and rise, walk on your heels
and toes, or perform a straight-leg raising test or other tests.
Most patients with sciatica have compression of the L5 or S1 nerve
roots. X-rays and other specialized imaging tools such as magnetic
resonance imaging (MRI) may confirm your doctor's diagnosis of
which nerve roots are affected.
The condition usually heals itself, given sufficient time and
rest. Approximately 80% to 90% of patients with sciatica get better
over time without surgery.
Nonsurgical treatment is aimed at helping you manage your pain
without long-term use of medications. First, you'll probably need
at least a few days of bed rest while the inflammation goes away.
Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin,
or muscle relaxants may also help. In addition, you may find it
soothing to put gentle heat or cold on your painful muscles.
Find positions that are comfortable, but be as active as possible.
Motion helps to reduce inflammation. Most of the time, your condition
will get better within a few weeks.
Sometimes, your doctor may inject your spine area with a cortisone-like
As soon as possible, start physical therapy with stretching exercises
so you can resume your physical activities without sciatica pain.
To start, your doctor may want you to take short walks.
You might need surgery if you still have disabling leg pain after
3 months or more of nonsurgical treatment. A part of the herniated
disk may be removed to stop it from pressing on your nerve.
The surgery (laminotomy with discectomy) may be done under local,
spinal, or general anesthesia. You have a 90% chance of successful
surgery if most of the pain is in your leg.
Avoid driving, excessive sitting, lifting, or bending forward
for at least a month after surgery. Your doctor may give you exercises
to strengthen your back.
Following treatment for sciatica, you will probably be able to
resume your normal lifestyle and keep your pain under control.
However, it's always possible for your disk to rupture again.
This happens to about 5% of people with sciatica.