What causes sciatica?
The sciatic nerve is formed by nerve roots that leave the lower lumbar spine and sacrum. Anything that compresses or inflames those roots can produce sciatica. The most common causes are:
- A herniated lumbar disc (the most common cause in adults under 60)
- Lumbar spinal stenosis from arthritis and thickened ligaments
- Spondylolisthesis, where one vertebra slips forward on another
- Bone spurs from degenerative disc disease
Symptoms
Sciatica usually affects one leg. Patients describe burning, electric or aching pain from the buttock to the calf or foot, often worse than the back pain itself. Numbness, tingling, or weakness lifting the foot (foot drop) may occur. Sitting for long periods often makes it worse.
Diagnosis
A focused exam, including a straight-leg-raise test and checks of strength, reflexes and sensation, tells Dr. Ferachi which nerve root is affected. An MRI is ordered when symptoms persist beyond several weeks, when there is weakness, or when surgery or injections are being considered.
Treatment
Most sciatica improves within weeks with a combination of short-term rest, walking, anti-inflammatory medication and physical therapy. When pain lingers, a targeted epidural steroid injection can reduce nerve inflammation and help you participate in therapy.
If pain continues beyond about six to twelve weeks, or if you develop weakness, surgery can directly relieve the pressure. Depending on the cause, that may be a microendoscopic discectomy, a lumbar decompression (laminectomy), or a minimally invasive fusion when the spine is unstable.
Common questions
Should I see a spine surgeon or a primary care doctor for sciatica?
Start with your primary care doctor for new, mild sciatica. See a spine specialist if pain lasts more than six weeks, keeps returning, or comes with leg weakness or numbness. Seeing a surgeon does not mean you will need surgery; most patients Dr. Ferachi evaluates are treated nonsurgically first.
Is walking good for sciatica?
Generally yes. Gentle walking keeps the spine moving and reduces stiffness. Avoid prolonged sitting, heavy lifting and bending until pain settles.