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Perhaps you’ve heard someone groan, “Oh, my sciatica!” It may sound as if they’re talking about a condition, or disease, but what they mean is that they have a problem with their sciatic nerve — the largest single nerve in the human body. The nerve starts from the base of your spine, and is composed of individual nerve roots that start inside the spinal chain. It then branches: one side of the nerve travels down your left buttock and leg; the other, you’re right. This common complaint, which affects, in varying degrees, about three million people in the US every year, can be caused by several different conditions.
Because the sciatic nerve divides the way it does, it is common to experience symptoms only on one side or the other. The condition sometimes presents as:
The reason sciatica presents in so many different ways is that it can have multiple causes, which affect different parts of the nerve. Sciatic conditions can be caused by a herniated disc or a bone spur on the spine that compresses the nerve; spinal stenosis can also show up as sciatica. These conditions can be caused, rarely, by disease or tumor; they can also be affected by pregnancy, depending on where the weight is being carried. Age (the condition is more prevalent as you get older), obesity (because of stress on the spine), and occupation (if you sit for long periods of time, or use twisting motions often in your work) are also factors.
“Luckily, sciatica often resolves itself within six to twelve weeks,” says Christopher Castro DO, a physiatrist at OINJ. “Home remedies like over-the-counter pain relievers, ice, or heat can help if the condition is minimal. We look to non-operative solutions first, especially in mild cases. We’ll probably do a series of physical tests that involve you moving around, or taking different positions, to see if we can locate the causal factor. For example, if walking on your toes or heels results in pain, it means one thing; if squats cause the pain, it means something else.”
“Along with that,” adds Michael Gutkin, MD, another physiatrist at OINJ, “we’ll ask you questions about positions that make you feel better or worse, the severity of your pain, and the length of time you’ve had it. A course of anti-inflammatories, muscle relaxants, or steroids might be prescribed. These can help in two ways: they’ll have a direct affect by allowing pain relief — and because the pain is relieved, you’ll be better able to complete exercises that will aid in recovery by helping you get stronger and more flexible.
For severe conditions, says Dr. Gutkin, “We would have some tests done. MRIs, x-rays, and CT scans can be helpful. There’s even a special test, called an EMG (electromyograph), which measures the electrical impulses produced by your nerves as well as the response of your muscles to those impulses.”
Exam, evaluation, and diagnosis will lead you to the right treatment for your condition