Sciatica – Diagnosis and treatment – Mayo Clinic

Diagnosis

During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.

Imaging tests

Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.

• X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
• MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
• CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
• Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment

If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.

Medications

The types of drugs that might be prescribed for sciatica pain include:

• Anti-inflammatories
• Muscle relaxants
• Narcotics
• Tricyclic antidepressants
• Anti-seizure medications

Physical therapy

Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.

Steroid injections

In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.

Surgery

This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.

Lifestyle and home remedies

For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.

Other self-care treatments that might help include:

• Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
• Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
• Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
• Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.

Alternative medicine

Alternative therapies commonly used for low back pain include:

• Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
• Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.

Preparing for your appointment

Not everyone who has sciatica needs medical care. If your symptoms are severe or persist for more than a month, though, make an appointment with your primary care doctor.

What you can do

• Write down your symptoms and when they began.
• List key medical information, including other conditions you have and the names of medications, vitamins or supplements you take.
• Note recent accidents or injuries that might have damaged your back.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your doctor tells you.
• Write down questions to ask your doctor to make the most of your appointment time.

For radiating low back pain, some basic questions to ask your doctor include:

• What’s the most likely cause of my back pain?
• Are there other possible causes?
• Do I need diagnostic tests?
• What treatment do you recommend?
• If you’re recommending medications, what are the possible side effects?
• For how long will I need to take medication?
• Am I a candidate for surgery? Why or why not?
• Are there restrictions I need to follow?
• What self-care measures should I take?
• What can I do to prevent my symptoms from recurring?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Do you have numbness or weakness in your legs?
• Do certain body positions or activities make your pain better or worse?
• How limiting is your pain?
• Do you do heavy physical work?
• Do you exercise regularly? If yes, with what types of activities?
• What treatments or self-care measures have you tried? Has anything helped?