Sciatica-Ask the Experts

Sciatica is a condition associated with pain in the hip and may include weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. Symptoms are usually on one side of your body only.

The sciatic nerve—the longest and widest nerve in the body—runs from the low back and down the leg to the foot. It’s actually a collection of nerves that begin in spine of the low back which later branch off to other nerves in the lower leg.

The Root Cause

Depending on to whom you speak, there are a number of different opinions as to the true cause of your symptoms.  The most common diagnosis, however, is that sciatica results from a problem with the discs or vertebrae in the lumbar spine. Alternatively, muscle tightness or spasms in the low back and hip region can create radiating symptoms that look very much like nerve pain.

The Right Course of Action

So how do you know when you should ‘watch and wait’ vs. seeking medical attention? And, which intervention is best? To answer this question, I spoke to several experts in the field to get their opinions and advice on how to correctly diagnose and treat sciatica.

John Welsh, M.D., Pain Management Specialist

Dr. Welsh recommends the following approach for treating sciatica: “Wait 3-4 weeks to see if  [the pain] resolves on its own. If not or it worsens, then it might be time to consult a physician.” In the early stages, he recommends conservative treatments like physical therapy, anti-inflammatory medications, and acupuncture. However, there are cases where symptoms may be of greater concern: “If there is significant weakness, buckling of the knee, or foot drop, “ Dr. Welsh recommends immediate intervention as this may be a sign of significant nerve impingement.

Kristen Shadduck, P.T., Physical Therapist

According to Kristen Shadduck, owner of PT Works, sciatica is often the result of “abnormal stressors on the spine from poor posture or [incorrect] body mechanics.”  In her practice, she uses therapies like traction, ice, and electrical stimulation to relieve sciatica symptoms and says there’s no substitute for “skilled hands-on care” of the tissues and joints. “A physical therapist will instruct in positions of comfort, proper posture, correct movement mechanics and exercises to strengthen the core,” says Shadduck. “My end goal is to reduce stress on the spine while allowing the healing to begin.”

Charmaine Tu, D.C., Chiropractor

“One myth I’d like to dispel is that you have to ‘racked and cracked’ when you see a chiropractor. That’s not the case at all—chiropractic can be both a gentle & effective sciatica treatment” Dr. Tu favors initial techniques like ice on the low back & stretching of the hamstrings and quad muscles. Dr. Tu says it’s important to find the root cause of the issue first, be it tight muscles, nerve root compression, or bony changes in the spine. “I first like to evaluate the pelvis and alignment of the spine before initiating treatment.” Dr. Tu says that getting rid of inflammation is often the first step.

Piriformis Syndrome

Sciatica may sometimes be caused a contracture of a muscle deep in the buttocks called the piriformis. The sciatic nerve runs just below this muscle and in some unlucky individuals, the sciatic nerve run through the Piriformis.

More on Nerve Pain

Signs of actual nerve impingement include lack of sensation to touch (numb patch), loss of muscle function, and sharp, shooting pains. Nerve pain is often described as feeling ‘electric’ in nature.

Acupuncture: A Combined Approach

In my clinic, I use acupuncture to improve circulation the muscles of the low back and the hip while, treating trigger points to release muscle spasm. In addition, acupuncture can often ‘calm down’ irritated nerves by blocking some of pain signals coming from the brain. Cupping is also a therapy that works well to release muscle spasms in the low back and hip region.

As with any modality, there is no one best approach. In treating sciatica, I typically encourage people to start with doctor or therapist they trust, and go from there.

Sciatica—Additional Considerations

• Physicians usually look to confirm a disc issues and changes to spine with an MRI or x-ray. They are looking for bony changes in the spine that could cause compression on the nerve root.
• When the cause of sciatica is due to a lumbar disc herniation, most cases resolve spontaneously over weeks to months.
• According to a 1999 study in the New England Journal of Medicine bed rest is not better than ‘watchful waiting’ when it comes to recovery.