Sciatica

Sciatica

If you’ve ever run a vacuum, cared for children, or tossed a few baseballs in the school yard, you’ve probably experienced a lower-back ache or two. Most people do.

But sometimes, lower-back pain isn’t confined to the spine. It radiates, producing shooting pain or numbness into your buttocks and down your leg, below your knee, even into your foot and toes. When it does, you may be experiencing sciatica.

Sciatica is no respecter of circumstances, which is why its onset usually comes as a complete surprise. Maybe you’ve been weeding in the garden. As you rise to your feet, you suddenly feel as though someone has shot darts at your leg. Or perhaps you’ve been relaxing for an evening in your favorite reading chair with a cup of tea in one hand and a new novel in the other. But when you get up to refill that teacup, your lower-back pinches and your foot feels tingly. Either scenario portrays the beginnings of sciatica.

If you have sciatica, your symptoms are caused by irritation of the nerve that runs across your buttocks and into your thigh, calf, and foot, says John E. Thomassy, D.C., chiropractor in private practice in Virginia Beach, Virginia.

Sometimes, the rubbery disks between the back bones, or vertebrae, bulge and then press on a nerve root. This bulge may be referred to as a herniated, or slipped, disk. Poor posture, improper technique when lifting, and injuries may be contributing factors in this condition.

Over time, the disks experience more wear and tear. So by the time you reach retirement age, they’re eager for some kid-glove treatment. As wear and tear catches up with you during your senior citizen years, the disks become compressed, vertebrae grow bony spurs, and nerve irritation becomes more likely, explains Dr. Thomassy.

The discomfort may be worse when you sit, and the pain in your leg or knee may be more severe than the one in your back, says Steven Mandel, M.D., clinical professor of neurology at Thomas Jefferson University Hospital in Philadelphia.

Forty percent of people will experience sciatica some time in their lives. For most, the pain will subside on its own, often within one month, says Dr. Mandel.

As a rule, anytime you have back pain for more than two to three days, you should see your doctor to rule out serious illness or injury, suggests Sheila Reid, therapy coordinator at the Spine Institute of New England in Williston, Vermont. But once your doctor rules out other things and positively identifies sciatica, here are some ways to find relief and help prevent future attacks.

Try This First

Get a chill. To help reduce pain and swelling, apply ice where you feel sciatica pain, Reid says. To protect your skin, place a towel between your back and the ice pack. Ice may be used for 15 to 20 minutes every hour. Or switch to the warmth of a heating pad, shower, or bath, she says. Heat relaxes muscles.

Other Wise Ways

Please sit up. Prolonged sitting may aggravate your discomfort because it reverses the normal curve in your back, Dr. Thomassy says. Sitting may compress disks and weaken lower-back ligaments and muscles. When you sit, maintain good posture. Don’t slouch. Keep your knees level with your hips, your feet flat on the floor, and your back straight.

Get the angles right. If you are working at a desk or computer, adjust your chair so your elbows can be positioned at a 90-degree angle, with your forearms parallel to the floor, advises Dr. Thomassy. Tuck a small pillow behind your back to help you sit up straight and promote the normal curves in your spine.

Break things up. Take frequent breaks when you’re working, Reid says. Get up and walk around every half-hour. If you’re traveling in a car, avoid prolonged time behind the wheel or even in the passenger seat. Make frequent rest stops at least every hour or so.

Reach over the counter. Nonprescrip tion pain relievers such as acetaminophen, ibuprofen, or naproxen may help relieve temporary discomfort, Dr. Mandel says. But be sure to ask your physician first. Even over-the-counter medicines can have side effects.

Step right down. Wear comfortable, low-heeled shoes, Dr. Thomassy urges. Heels that are higher than 1 to 1½ inches push your body weight forward and your spine out of alignment.

Get some Z. Try the Z position, suggests Augustus A. White III, M.D., professor of orthopaedics surgery at Harvard Medical School, in the booklet “Back Care: How to Relieve and Prevent Pain from Low Back Problems.”

Lie on your back on a rug or exercise cushion with your knees bent and your feet propped on a low table or chair. Your thighs should be nearly parallel to the floor. To get more comfortable, put a thin cushion under your buttocks and a pillow under your head. Then relax.

This relaxing position often provides quick relief, writes Dr. White.

Stretch it out. For sciatica pain, try this stretch from Dr. White. Stand with your feet apart and your hands on your buttocks. Push your hips forward and gently bend backward while looking up. Keep your knees straight. Hold for several seconds, relax, and repeat. You can do this several times a day, and it’s especially helpful after sitting.

Lift safely. Even if your back feels better after an episode of back pain, you’ll need to lift correctly to prevent a relapse. “Lifting is when most people are injured,” Dr. Thomassy says. Whether you’re lifting a laundry basket or toolbox, make sure your feet are square to the object, then crouch with your knees and hips bent and your back straight. Bring the object close to your body and when you rise, continue to keep your back straight. If you have to twist, bend forward, or reach out for an object, take the time to get into the proper position before you try lifting.If that’s not possible, get help.

Get around. Stay as active as you can while you’re recovering from sciatica, even if you only walk around the house, Reid says.

After pain subsides, try gentle stretches and, later, mild aerobic exercise, Dr. Mandel suggests. Swimming and walking, for example, will help strengthen and condition your back and whole body. They may even make you less vulnerable to injury. “If people stretch and exercise,” Dr. Mandel says, “they will reduce their chances of having back problems.”