Sciatica pain is generally pain radiating down your legs, that's a result from an injury to the low back. And it can be any distribution in the legs, sometimes in the top of the legs, sometime in the bottom of the legs, but generally is due to a back injury.
Sciatica pain is caused, typically, by a herniated disc in the low back or a pinched nerve by a bone spur. Those are two different situations. Usually a herniated disc occurs in a younger population and a pinched nerve from a bone spur occurs in an older population. That's a result of arthritis in the spine. And both conditions can cause pain in the low back and pain, numbness or weakness in the lower extremities. The pain, weakness and numbness are typically signs of sciatica.
We treat sciatica with a combination of therapies. Generally we start with conservative treatments. We use anti-inflammatory medicines and physical therapy as our first line approach, unless somebody has profound weakness in their legs. If they have profound weakness in their legs, generally they should see a spinal surgeon right away for an MRI in consideration of surgery because when you develop weakness, it's a sign there's permanent nerve damage occurring.
If you don't have weakness, then we try physical therapy and anti-inflammatories. And we know at least 50% of the people will get better with those two treatments. If you get better, usually it's gone for life. If you don't get better, then we'll refer patients to pain management for an epidural cortisone shot. About three out of 10 people get better with the epidural shots. So overall, anybody with sciatic pain, 80% are improved with conservative treatment, leaving 10 to 20% needing surgical intervention.
Typically, when people have sciatic pain, 80% will recover within three months. If you don't recover within three months with conservative treatments, then you may need surgical intervention and nerves can take up to one year to recover.
When people have sciatic pain, it is generally not a sign of something much more serious. Only very rarely do we see somebody that has a very serious problem, not related to their spine with sciatic pain.
People with sciatic type pain generally have a family history of individuals with similar type problems. It's not uncommon for somebody to come into the clinic complaining of low back or leg symptoms and they say, "Oh. My mother had this. My father had this. My uncle has this." So it's not uncommon to have a genetic predisposition to a low back injury or low back pain.
There are several preventative measures that people can take to avoid back problems. They aren't 100%, but there's recent studies showing that people that lose weight, have a lower incidence and reduction in both neck and back pain. Additionally, people that smoke, it has been shown that nicotine reduces the blood flow to the vertebral column and that causes irritation of the nerves and increases nerve pain. So people that lose weight and don't smoke have a less chance of having low back pain or sciatic pain.
