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How is sciatica diagnosed?
If the symptoms of sciatica are mild and do not last longer than four to eight weeks, you are probably experiencing acute sciatica and medical attention is not usually necessary as it tends to resolve itself.
A complete medical history may help speed up the diagnosis. Doctors will also have you perform basic exercises (paying close attention to the legs) that stretch the sciatic nerve. A shooting pain down the leg while performing these exercises usually indicates sciatica.
If pain persists for more than four to eight weeks, imaging tests such as an X-ray or MRI may be necessary to help identify what is compressing the sciatic nerve and causing your symptoms.
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What are the treatment options for sciatica?
Most cases of acute sciatica respond well to self-care measures, which may include:
Over-the-counter (OTC) painkillers - relieve symptoms of pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, are recommended. Acetaminophen (Tylenol, paracetamol) is recommended for extended use. Not all painkillers are suitable for every patient; be sure to review options with your doctor.
Exercises such as walking or light stretching.
Hot or cold compression packs help to reduce pain. It is often helpful to alternate between the two.
Treatment of chronic sciatica usually involves a combination of self-care measures and medical treatment.
Prescription painkillers - Amitriptyline, gabapentin, codeine (a mild opiate-based painkiller), which is often prescribed in combination with paracetamol, and if sciatica symptoms are severe, diazepam.
Physical therapy - can teach you exercises to strengthen back muscles and improve flexibility, and how to prevent strain on your back.
Chiropractic treatment - can maneuver the spine to alleviate pressure on the nerves, consequently relieving pain
Cognitive behavioral therapy (CBT) - helps manage chronic pain by training people to react differently to their pain
Surgery may be an option if symptoms have not responded to other treatments and continue to intensify. Some options include:
o Lumbar laminectomy - widening of the spinal cord in the lower back to reduce pressure on the nerves.
o Discectomy - partial or entire removal of a herniated disc.
Depending on the cause of your sciatica, a surgeon will go over the risks and benefits of surgery and be able to suggest a suitable surgical option.
How can sciatica be prevented?
In some cases sciatica cannot be prevented. However, there are several lifestyle changes that can reduce the chances of developing it, including:
Regular exercise - focus on strengthening core muscles (in the abdomen and lower back) necessary for proper posture.
Proper posture - standing and sitting upright, lifting objects correctly, and selecting a mattress and pillow that support the spine.
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