The sciatic nerve is a bundle of nerves that runs from the low back into the middle of the buttocks, then separates into smaller nerves going into the front, back and side of the legs and feet.
When the sciatic nerve becomes pinched or compressed, pain may to shoot into the buttocks or legs, and the condition is called sciatica. A herniated or bulging disc in the low back is a common cause of sciatica.
Usually the pain is only on one side. It may cause a burning pain in the back of the hip, or numbness, tingling or electric shock-like pain into the front, back or sides of the legs. The pain may go all the way to the ankles or feet. The pain may be worse with coughing, sneezing or bending in certain positions. A severely pinched sciatica nerve may cause leg weakness. Difficulty controlling urine or the bowels is a sign of an emergency requiring urgent evaluation and treatment.
Usually a history and physical exam may strongly suggest that sciatica is present. X-rays may not be necessary for the diagnosis or to start treatment, but they may show other problems, such as if the spine is curved (scoliosis), if the spinal discs are narrowed (degenerative disc disease) or if the spine is not in alignment. X-rays may also show unexpected conditions causing the pain.
Generally surgery is not necessary for a pinched sciatica nerve. If one or two days of rest does not help, various treatments may be tried such as physical therapy, traction, aquatic exercise, ‘cortisone’ injections, chiropractic care, medications, and biofeedback. Surgery is considered and often helpful if other treatments fail, and if nerves are being pinched causing severe pain or weakness in the leg. The best approach is the one that is individualized and provides the most relief, with the fewest side effects.