Signs and Symptoms
Sciatica usually affects one leg. Common symptoms include:
- Burning, electric or shooting pain from the buttock down the back of the thigh, sometimes into the calf or foot
- Numbness or tingling (pins and needles) in the leg or foot
- Weakness when lifting the foot or pushing off the toes
- Leg pain that is often worse than the back pain
- Pain that increases with sitting, coughing, sneezing or bending forward
What Causes It?
The sciatic nerve forms from several nerve roots that leave the lower spine. When one of those roots is squeezed or inflamed, pain travels along the path of the nerve. The most common cause is a herniated disc, where the soft center of a spinal disc pushes out and presses on a nerve. Others include spinal stenosis (narrowing of the spaces around the nerves), bone spurs from arthritis, and a vertebra slipping forward on the one below it (spondylolisthesis).
Risk factors include age-related disc wear, heavy lifting, prolonged sitting, extra body weight and diabetes.
How We Diagnose It at POPB
Dr. Baskin reviews your symptoms and examines your back and legs, testing strength, reflexes, sensation and nerve tension (for example, a straight leg raise). This helps identify which nerve root is involved.
If symptoms last more than several weeks, if you have weakness, or if an injection is being planned, an MRI can show the discs and nerves. X-ray and MRI are available in our office. Nerve testing may be arranged when the diagnosis is unclear.
Non-Surgical Treatment Options
Most people with sciatica get better without surgery. Options include:
- Staying active with gentle walking and avoiding long periods of sitting
- Physical therapy in our office, including nerve mobility exercises, core strengthening and posture work. Your therapist shares your chart with Dr. Baskin.
- Anti-inflammatory medications or nerve pain medications when appropriate
- Lumbar transforaminal epidural steroid injections, where Dr. Baskin uses fluoroscopy (live X-ray) to place anti-inflammatory medicine next to the irritated nerve root
An injection does not fix a disc, but by calming inflammation it can reduce pain enough for you to make progress in therapy while the body heals.
Surgical Options
Surgery, such as removing the part of a disc pressing on the nerve (microdiscectomy), may be considered if leg weakness is significant or worsening, or if severe leg pain continues despite a full course of non-surgical care. Dr. Baskin does not perform spine surgery. When a surgical opinion is appropriate, he refers you to a spine surgeon and shares your imaging and records so you do not start over.
Recovery
Many people with sciatica from a herniated disc improve substantially within six to twelve weeks. Numbness and tingling can take longer to fade than pain. Relief after an epidural injection typically begins within several days and lasts a variable length of time. Physical therapy usually continues for several weeks, followed by a home program. Timelines vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover evaluation, imaging, physical therapy and epidural steroid injections when medically necessary. Many plans require prior authorization for MRI and injections, and some ask for a period of physical therapy first. HMO and managed-care plans need a referral in our office before your visit. Our staff verify benefits when you call.
When to Be Seen
Call our office if leg pain lasts more than a couple of weeks, keeps you from sleeping or working, or comes with numbness or weakness.
Go to the emergency room or call 911 if you have loss of bladder or bowel control, numbness in the groin or inner thighs (saddle numbness), leg weakness that is getting worse, fever with back pain, or back pain after a major trauma. These can be signs of serious nerve compression or infection.
