What is sciatica?
Sciatica is pain resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb.

What are causes of sciatica?
While sciatica is most commonly a result of a disc herniation directly pressing on the nerve, any cause of irritation or inflammation of this nerve can reproduce the symptoms of sciatica. These causes include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and other causes.

What are symptoms of sciatica?
Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down.

How is sciatica diagnosed?
Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health-care practitioner to diagnose sciatica. Sometimes, X-rays, films, and other tests, such as CT scan, MRI scan, and electromyogram, are used to further define the exact causes of sciatica.

Exams and Tests?
Sciatica might be revealed by a neuromuscular examination of the legs by a physician

There may be weakness of knee bending or foot movement, or difficulty bending the foot inward or down. Reflexes may be abnormal, with weak or absent ankle-jerk reflex. Pain down the leg can be reproduced by lifting the leg straight up off the examining table.

Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, MRIs, or other tests and procedures

Signs and tests
Sciatica might be revealed by a neuromuscular examination of the legs by a physician. There may be weakness of knee bending or foot movement, or difficulty bending the foot inward or down. Reflexes may be abnormal, with weak or absent ankle-jerk reflex. Pain down the leg can be reproduced by lifting the leg straight up off the examining table.
Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, MRIs, or other tests and procedures.

Expectations (prognosis)
If the cause of the sciatic nerve dysfunction can be identified and successfully treated, full recovery is possible. The extent of disability varies from no disability to partial or complete loss of movement or sensation. Nerve pain may be severe and persist for a prolonged period of time.

Possible Complications
• Partial or complete loss of leg movement
• Partial or complete loss of sensation in the leg
• Recurrent or unnoticed injury to the leg
• Side effects of medications

How is sciatica treated?
To gauge the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and 12 weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.

The results, reported in the New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the aggravation of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers concluded that "among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes, conventional wisdom is not as wise as research!

Other treatments for sciatica include addressing the underlying cause, medications to relieve pain and inflammation and relax muscles, and physical therapy. Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine.

When to Contact a Medical Professional

Call your doctor right away if you have:
• Unexplained fever with back pain
• Back pain after a severe blow or fall
• Redness or swelling on the back or spine
• Pain traveling down your legs below the knee
• Weakness or numbness in your buttocks, thigh, leg, or pelvis
• Burning with urination or blood in your urine
• Pain that is worse when you lie down, or awakens you at night
• Severe pain and you cannot get comfortable
• Loss of control of urine or stool (incontinence)
Also call if:
1. You have been losing weight unintentionally
2. You use steroids or intravenous drugs
3. You have had back pain before but this episode is different and feels worse
4. This episode of back pain has lasted longer than 4 weeks
If any of these symptoms are present, your doctor will carefully check for any sign of infection (such as meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem.

Prevention
Prevention varies depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.