It is pain coming from the spine and radiating outward. Typically, patients will feel this radiating pain in the leg, glutes, and possibly as far as the toes.
After age 30, our disc spaces start degenerating. If you fall or pull something, then the outer edge of the disc may rupture. The gel in the outer edge, that acts as a cushion, begins to come out, causing inflammation that effects the nerves.
These nerves radiate down the leg in a certain distribution. At an appointment, we ask you what part of your leg hurts to determine which disc is causing the issue.
The facet joints in the spine may become inflamed which would pinch the nerve. Essentially, the nerve is irritated, so the pain radiates outward.
It is important to determine treatment options within the first four to six weeks of incurring pain in the sciatica (ex. After a fall). After this time, pain can turn into numbness or tingling, then finally weakness. Once a patient has made it to this stage, it is much more difficult to effectively treat and reverse the pain.
- Give it a little time to heal itself
- Take an over-the-counter anti-inflammatory
- Use a steroid prescribed by your primary care physician
(used only for sciatica pain)
This five minute procedure is done in office under fluoroscopy (a type of Xray machine). The injection consists of Lidocaine (for numbing) and Cortizone (for anti-inflamation).
There are three places an epidural can be injected based on the cause of the sciatica pain as well as the integrity of the spine. The injection minimizes inflammation, thereby reducing the nerve irritation. Under the Xray machine, we first inject a minute amount of picture dye so we can verify the correct flow of medication, then we inject the actual medicine.
Within one to five days, a patient will achieve the maximum benefit of relief. From there, patients are referred to a physical therapist, who will teach them specific exercises to strengthen the spine. Typically, after four or five of these sessions, a patient will be ready to continue doing them on their own.
If an epidural does not work, then it may be necessary to asses the structural integrity of the spine. It may require surgery in some instances.
In this procedure, leads are placed in the epidural space to mask the pain. First, the leads are tried out for about 5-7 days, then if they work for you, they are implanted. You can watch a 3 minute video about a Spinal Cord Stimulator here.
The procedure is also done in office and lasts about five minutes.