askthedoctor Sciatic Pain T
Get Immediate Help Serious symptoms such as loss of blad- der or bowel control or increasing leg weakness or numbness suggest a progressive problem that can lead to perma- nent disability if not ad- dressed immediately.
48 MILITARY OFFICER SEPTEMBER 2016
About one-fourth of all people experience sciatica — pain resulting from irritation of the sciatic nerve — at least once during their lifetime. By Rear Adm. Joyce Johnson, D.O.
The sciatic nerves are the largest in the body, exiting the right and left sides of the lower spine and continuing all the way to the soles of the feet. Sciatic nerve pain — sciatica — is really a symptom, not a disease. It has many causes, including vari- ous diseases of the lower back. The discs that cushion the vertebrae can degenerate or rupture, or the spinal canal in the lower back can narrow, irritating the nerve. The sciatic nerve can be compressed by the piriformis muscle in the buttocks or by spondylolisthesis (when a vertebra slips over the one below it). Pelvic injury or a tumor also can cause sciatica, and diabetes can result in neuropathy that includes sci- atica. In some cases, the motor component of the sciatic nerve is damaged, resulting in weakness, numbness, or diffi culty moving the leg or foot or walking.
The classic symptom of sciatica is pain
from the lower back or buttock that reaches down the back of the thigh, perhaps as far as the calf, and sometimes all the way to the foot. Usually the pain is on only one side and ranges from minimal to so debilitating you can barely move. It might be stabbing, sharp, burning, a dull ache, or tingling. It can be either fairly constant or intermittent. It might get worse with body movements that compress the spine, such as changing position from standing or sitting; sneezing, coughing or laughing; or bending backward. Sciatica usually can be diagnosed from someone’s medical history, coupled with a physical exam that includes active and
passive range of motion and other parts of a basic neurologic exam. However, diag- nosing the specifi c cause of an individual case of sciatica might require additional testing, including blood tests, imaging (x-ray, MRI, or CT scan), and/or electro- myography (to assess electrical communi- cation between the nerves and muscles). Sciatica treatment can vary with the
specifi c cause. Initial treatment usually includes anti-infl ammatory medications. Some people fi nd relief with heat or cold packs. Movement is helpful, though it might be benefi cial to reduce activity for a couple of days, though bed rest gener- ally is not recommended. It is important not to strain your back, so avoid twisting and heavy lifting. Sciatica often resolves with minimal
treatment after a week or two, though if the underlying condition remains it can recur. Once the acute phase has resolved, exercise often reduces or eliminates recur- rence. Exercises to strengthen the back and core (trunk) are most useful; strengthening these muscles reduces stress on the back. A physical therapist can provide specifi c exercises. In rare situations, after a course of conservative treatment, more aggressive treatment such as spinal steroid injections or even surgery might be necessary.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at
www.moaa.org/wellness. For sub- mission information, see page 4.
PHOTO: STEVE BARRETT
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