Despite being a less common cause of low back pain, sciatica is still something I commonly see among patients. Primary care doctors can and should help about sciatica, for the reason that most individuals the body can fix the problem. My job is to assist you to manage the pain while the body does its job. When a patient’s symptoms do not improve, I introduce the role of surgery or an injection to hasten the healing process up.

What is sciatica?

Sciatica refers to the pain that is caused by the sciatic nerve that carries signals from the brain down the spinal cord to the legs. The pain of sciatica typically courses down one side from the lower back into the leg, often below the knee. The most usual cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like ligaments that sit between the bones of the spine. If the outer part of the disc tears, commonly due to routine pressure on the lower back, the jelly-like inner material might come out and pinch or inflame the nearby nerve. Sciatica is most common in people ranging from 30 to 50.

How do you know if it is sciatica?

The key to curing sciatica is a thorough historical and focused exam. Sadly, a lot of patients expect an x-ray or MRI, and doctors, often facing time pressure, even though we know that imaging tests don’t really help us cure early sciatica any better. The symptoms of sciatica are often worse with sitting or coughing and may be followed by numbness or tingling in the leg. A physical exam may confirm that the sciatic nerve is involved, and I look for weakness or decreased reflexes in the legs that suggest that the individual needs an early referral to a specialist. (This doesn’t happen often.) With this information, I can make a further diagnosis and start treatment.

Treating sciatica pain… and managing expectations

Many people think (understandably) that the worse the pain is, more likely something bad is going on. This isn’t true for sciatica. The body usually reabsorbs the disc material that is causing the symptoms, even for individuals with severe pain. So, treating sciatica focuses on controlling the pain and keeping the person as active as possible. If the pain is unbearable, lying down for short periods may help, but prolonged bed rest does not. So once the pain subsides, patients have to get up and start striding in short distances. Since sitting increases pressure on the discs in the lower back, It is recommended to avoid prolonged sitting or driving.

Many people try methods like physical therapy, massage, acupuncture, and chiropractic sessions, but evidence suggests that while these methods help typical low back pain, they offer minimal help for treating sciatica. Over-the-counter pain medicines like ibuprofen and naproxen may help. When they don’t I may recommend short-term use of stronger, prescription pain medicines.

The good news is that for most (roughly three out of four) people, symptoms improve in a span of a few weeks. Rarely, I’ll find a weakness on exams, such as a foot drop, and refer for immediate surgical assessment. For those without improvement after six weeks, surgery is an alternative.

We know surgery can hasten the recovery, but by six to 12 months patients who have surgery are normally doing about as well as those who choose to just give the body more time to heal naturally. Surgery involves removing the disc material that is affecting the nerve. It is usually a very safe procedure, and while complications are rare, they may happen. What’s more, 5% to 10% of people who have surgery will not be cured by it or may have worse pain after surgery.

Patients always ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with unbearable pain or for those with persistent, annoying symptoms who want to avoid surgery. Injections can give short-term relief. Like any other procedure, it has uncommon risks, including additional pain, and it doesn’t seem to remove the need for possible surgery.