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Sciatica

Medical condition with pain down the leg from the lower back

Sciatica is pain going down the leg from the lower back. This pain may extend down the back, outside, or front of the leg. The onset is often sudden following activities such as heavy lifting, although it may also occur gradually. The pain is often described as shooting. Typically, symptoms occur on only one side of the body; certain causes, however, may result in pain on both sides. Lower back pain is sometimes present. Weakness or numbness may occur in different parts of the affected leg and foot. About 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots. Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors, and pregnancy are other possible causes of sciatica. The straight-leg-raising test is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. In most cases medical imaging is not needed. However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumor or infection. Conditions that can present similarly are diseases of the hip and infections such as early shingles (prior to rash formation). Initial treatment typically consists of pain medications. However, evidence for effectiveness of pain medication, and of muscle relaxants, is lacking. It is generally recommended that people continue with normal activity to the best of their abilities. Often all that is required for resolution of sciatica is time; in about 90% of cases, symptoms resolve in less than six weeks. If the pain is severe and lasts for more than six weeks, surgery may be an option. While surgery often speeds pain improvement, its long term benefits are unclear. Surgery may be required if complications occur, such as loss of normal bowel or bladder function. Many treatments, including corticosteroids, gabapentin, pregabalin, acupuncture, heat or ice, and spinal manipulation, have only limited or poor evidence supporting their use. Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women. The condition has been known since ancient times. The first known modern use of the word sciatica dates from 1451, although Dioscorides (1st-century CE) mentions it in his Materia Medica.