Diagnosis & Treatment Sciatica
Diagnostic Testing for SciaticaDiagnostic Testing
The first step toward relief of sciatica pain is to find out where it's coming from. The spine experts at Och Spine at NewYork-Presbyterian may take the following steps to learn what is causing your sciatica symptoms.
- Medical history to learn about your symptoms: when did they start, what makes them feel better or worse, how do they limit your activities? The doctor will also ask you about your family medical history and your activities.
- Physical and neurological exams to assess your range of motion, muscle strength, pain, and sensation.
- Imaging exams such as X-rays and magnetic resonance imaging (MRI). MRI is the best imaging method to see the bones, discs, and nerves in and around your spine. It may help pinpoint the cause of your sciatica, such as a herniated disc or spinal stenosis.
- A myelogram is a special X-ray using dye injected into the spinal fluid. Combined with a computed tomography (CT) scan, it can show the bones and nerve roots.
- Electromyogram (EMG) and nerve conduction studies (NCS) measure electrical activity in the nerves and muscles. They may identify nerve damage or nerve compression.
Noninvasive Sciatica TreatmentNoninvasive Treatment
There are several ways you can treat sciatica at home. Many people achieve relief of symptoms by incorporating specific exercises into their day, as recommended by their doctor or physical therapist. Medications can also relieve sciatica pain through reduction of inflammation. Applying a heating pad or cold compress to the painful area can bring short-term relief as well.
Physical therapy for sciatica is commonly prescribed and can be very beneficial by reducing pressure on the sciatic nerve. Physical therapists help patients learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility. Components of physical therapy may include exercises you learn with your therapist to help treat sciatica and exercises you can do at home to stretch and strengthen your muscles and stabilize your spine. Your physical therapist will teach you the exercises that are most effective for you.
Specific exercises can be used to treat sciatica of the leg and foot and sciatica affecting the hip and back. Many people find value in practicing gentle yoga. Your therapist will teach you how you can:
- Strengthen the muscles of your spine as well as those in the hips, buttocks, lower back, and abdomen. These include abdominal crunches to strengthen your core, gently arching the back by lying on your stomach and supporting your upper body with your elbows ("sphinx pose"), and small leg lifts while lying on your stomach or your back.
- Increase flexibility of tight muscles through sciatica stretches—such as stretching the hamstrings (muscles in the backs of the thighs) through a gentle forward bend with straight legs. You can stretch tight lower back muscles through a "reclining twist"—where you lie on one side in a fetal position and then open your arms to a T position while keeping your knees together on the floor.
- Improve blood flow to your muscles and other tissues and enhance cardiovascular fitness through light aerobic exercise. Examples include water aerobics, swimming, and walking. Exercising often helps sciatica to feel better.
Medications and injections for sciatica pain treatment
Over-the-counter medications such as acetaminophen and ibuprofen can help relieve sciatic pain. You may receive a prescription medication to reduce sciatic nerve inflammation or gabapentin to treat nerve pain. Another possible treatment is the injection of the steroid drug cortisone directly into your spine to treat nerve inflammation. This injection is performed with the guidance of medical imaging so the physician can safely insert the needle into the precise location.
Treating sciatica during pregnancy
Up to 80 percent of women experience lower back pain at some point in their pregnancies. Here are some approaches you can do at home to relieve sciatica pain:
- Sleep on your side with a pillow between your knees to take pressure off the lower back.
- Do gentle exercises to stretch your hamstrings and lower back.
- Place a warm compress on the painful area.
Surgery may be needed if your sciatica persists despite nonsurgical treatments and is caused by another condition such as a herniated disc, spinal stenosis, bone spurs, or cysts. In that case, the surgeon will perform the operation to treat the underlying cause of your sciatica. At Och Spine, we use minimally invasive surgical approaches whenever appropriate, operating through very small incisions so your recovery can be quicker and you can get back to doing the things you enjoy sooner. Procedures that may be performed to help sciatica include:
- Surgery for a herniated disc
- Endoscopic discectomy or minimally invasive microdiscectomy to remove a small piece of the ruptured disc and relieve pressure on the sciatic nerve.
- Artificial disc replacement. The herniated disc is removed—decompressing the sciatic nerve—and replaced with a synthetic spinal disc.
- Spinal fusion. If other nonsurgical and surgical techniques are not options for effectively treating a herniated disc, fusing the two vertebrae together above and below the herniated disc prevents any motion between them. This reduces nerve pressure and pain.
- Laminectomy for spinal stenosis. The surgeon enters through the back of the spine and removes the lamina (the section of bone that covers the spinal canal) to relieve pressure on the spinal cord. This surgery is typically performed with a discectomy.
Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian
Sciatica is a painful condition and can vary from mild to debilitating. The spine specialists at Och Spine are highly experienced in diagnosing and treating sciatica and the conditions that cause it. We offer every type of treatment you may need—from physical therapy and non-surgical approaches to operations that directly relieve the pressure on your sciatic nerve. We'll personalize your treatment to your individual needs and preferences.
Every doctor at Och Spine has experience in various back and neck conditions and injuries. When you call us to make an appointment, we will work with you to identify the best physician for your specific need.
Make an appointment for a consultation.