Sciatica (a shooting pain, tingling or numbness stemming from the sciatic nerve) is one of the most common causes of back and leg pain. It can be debilitating for many people. According to Avery L. Buchholz, M.D., an assistant professor in the Department of Neurosurgery at MUSC Health, conservative management such as physical therapy can effectively treat the vast majority of patients with sciatica.

Sciatica symptoms typically disappear over time, sometimes without any treatment, but Dr. Buchholz believes patients should not have to suffer. He says a partnership between spine surgeons and primary care physicians can help patients with sciatica symptoms find relief faster.

“I’d like to partner with primary care physicians to co-manage these patients. Sciatica pain can be very frustrating for patients, and we’ve found that they appreciate the benefits of a partnership approach to care,” says Dr. Buchholz.

Sciatica Pain Affects Wide Swath of People

Dr. Buchholz says sciatica pain can affect people of any age, but commonly affects older adults (ages 50 to 60) and women during pregnancy. Sciatica is characterized by a cluster of symptoms that affect the sciatic nerve.

Symptoms differ depending on the individual patient and the specific cause. They generally affect the lower back or legs and involve any combination of:

  • Sharp pain
  • Numbness
  • Tingling
  • A burning in the buttocks that travels down the leg (sometimes to the foot)
  • Weakness in the foot or leg

According to Dr. Buchholz, a number of factors or conditions can actually cause those symptoms, including:

  • Disk herniations that push on a nerve
  • Degeneration and boney overgrowth or osteophytes that push on a nerve root
  • Spinal stenosis that causes nerve irritability
  • Rarely, fractures, tumors and infections

Sciatica Treatment Options

Because sciatica pain can come on quite suddenly, Dr. Buchholz says patients experiencing a sudden onset of painful symptoms may seek care at an emergency center. But a conservative treatment approach works best for most patients, he says, especially as a first-line treatment option.

Many patients find sciatica relief after prioritizing rest. Avoiding exercises or positions that irritate the nerve (or otherwise cause pain) can also help. While sciatica often gets better with time, even disappearing entirely, Dr. Buchholz says physical therapy can help accelerate that process while giving the body time to adjust and heal.

“Physical therapy provides relief by strengthening the core (the belly and back muscles), which supports and stabilizes the spine. This action calms the inflamed sciatic nerve and reduces irritation, thus decreasing pain. Physical therapy is useful early on, helping to stretch some of the muscles around the sciatic nerve and decrease inflammation,” he explains.

When conservative therapies are not successful, Dr. Buchholz considers several other sciatica treatments. Based on individual patient circumstances, recommended next steps may include:

  • Steroids, which can help reduce inflammation of the nerve
  • Medication, such as over-the-counter anti-inflammatories or muscle relaxants
  • Injections, including epidural or transforaminal, which can reduce inflammation and pain in cases where an MRI shows a nerve is pinched
  • Surgery, in rare cases, to decompress the nerve root

A Comprehensive Sciatica Treatment Approach

Dr. Buchholz says he’s happy to see any patient who’s suffering from sciatica symptoms.

“Most of the patients I see do well with conservative therapies and never need surgery. Still, those patients often tell me they appreciate someone explaining the nuances of what’s causing their pain and the various treatment options. In the rare case that we are unable to treat a patient’s symptoms conservatively, we can easily discuss surgical options and provide access to specialized surgical procedures,” says Dr. Buchholz.

Dr. Buchholz says MUSC spine specialists are looking forward to partnering with primary care physicians to manage patients affected by sciatica. Primary care physicians are often best suited to identify sciatica from other sources of back pain, which is key. If symptoms persist past a few weeks and physical therapy isn’t providing sufficient relief, a referral to a spine specialist may be the next best step.

“We hope to be a useful resource for primary care physicians and patients with sciatica early in the treatment process, even before any advanced imaging is ordered. Some patients need a little extra reassurance and consulting regarding their symptoms — specifically regarding what to expect and how to move forward with it. We’re ready to be that resource for patients and physicians.”

For more information, contact Dr. Buchholz at buchholz@musc.edu.