Sciatica is irritation of the sciatic nerve, a major nerve that passes down the back of each thigh. The sciatic nerve originates in the lower spine and travels deep in the pelvis to the lower buttocks. From there it passes along the back of each upper leg and divides at the knee into branches that go to the feet. Sciatica typically causes pain that shoots down the back of one thigh or buttock.
Anything that causes irritation or puts pressure on the sciatic nerve can cause sciatica. The most common cause is probably a sprain or strain of muscles or ligaments in the area, and for this reason sciatica is often associated with low back pain. The cushions between the bones of the spine—the discs—can also cause sciatica when they bulge out of place or degenerate. Other causes of sciatica include spinal stenosis (narrowing of the spinal canal in the lumbar area), spondylolisthesis (slippage of a bone in the low back) and, very rarely, benign or malignant tumors.
Diagnosis of sciatica is made by symptoms, neurologic evaluation, and tests, such as nerve conduction study, x -ray, and MRI scan. Common symptoms include the following:
More serious symptoms that sometimes occur in sciatica include difficulty walking, standing, or moving; increasing weakness or numbness in the leg or foot; and loss of bowel or bladder control.
In most cases, sciatic pain resolves on its own without specific treatment. Bedrest, although still sometimes recommended, is probably not helpful.1,2 However, physical therapy techniques and steroid injections have shown promise. If permanent nerve damage is threatened, surgery may be necessary.
Attacks of sciatica tend to recur. Certain common sense steps that may help prevent recurrences include the following:
Acupuncture has shown promise for sciatica,3 but the research evidence supporting its use remains highly preliminary. Similarly, biofeedback, chiropractic, massage, and prolotherapy, while sometimes advocated for sciatic pain, have not been proven effective.
Alexander Technique, Feldenkrais, Pilates, Tai Chi, and yoga are thought to improve posture and movement habits. On this basis, these methods are advocated for preventing or treating sciatica, but again, proof of effectiveness is lacking.
1. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract. 1997;47:647–652.
2. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999;354:1229–1233.
3. Longworth W, McCarthy PW. A review of research on acupuncture for the treatment of lumbar disc protrusions and associated neurological symptomatology. J Altern Complement Med. 1997;3:55–76.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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