The lower back or lumbar spine is made of a stack of 5 block-like bones called vertebrae with a triangular bone attached underneath. These bones are separated by five oval cushions called the ‘discs’ made of cartilage with a softer substance in the center. The tip of the triangular bone is the tailbone, or coccyx.
If the soft jelly-like center in the middle of the disc is pushed through the outer disc, a herniated disc occurs – sometimes called a disc protrusion, or ‘slipped disc’. A herniated disc may be the result of a lifting injury, or repetitive use of the low back in such a way that the discs become weakened. Even though the term slipped disc is used to describe a herniated disc, the disc does not actually slip out of place. When part of the disc pinches or compresses a nerve called the sciatic nerve, pain will to shoot into the buttocks or legs, and the condition is called sciatica. A medical term for this is lumbar radiculopathy. The leg pain may even be worse than the back pain from a disc herniation.
The symptoms of sciatica depend upon which level in the spine the nerve is being pinched. It may cause burning pain, numbness 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, and more often is just on one leg or the other. The pain may be worse with coughing, sneezing or with straining during bowel movements. Severely pinched nerves 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 of the lumbar spine are often not necessary for the diagnosis or to start treatment, but they may show other problems, such as if the spine is curved (scoliosis), if the discs are narrowed (degenerative disc disease) or if the spine is not in alignment (spondylolisthesis). They may also show unexpected conditions causing the pain.
Generally surgery is not necessary for sciatica. 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 legs. The best approach is the one that is individualized and provides the most relief, with the fewest side effects.