Podcast No. 2 – Sciatica

Have you ever had a sharp sense of “lightning” go down your leg? For most people this will be an occasional occurrence, but for some, it grows into persistent pain. When it becomes severe, it’s bad enough to send people to the ER. Today’s podcast shares some experiences my patients have had with sciatica.

The sciatic nerve is a big bundle that comes together in your pelvis, joining a number of different nerve roots from your lower lumbar spine. It travels out of your pelvis, behind the bones that you sit on (although somewhat protected). It courses through your leg muscles, behind your knee, then splits and goes through your calf and into the foot.

Pain can start as high up as the spine, for example, from a herniated disc, bony overgrowth, or scar tissue from a prior surgery. It can occur in the pelvis, from pregnancy, or a large fibroid. It can also occur where the sciatic nerve comes together and exits the pelvis, as it passes through the deep muscles of the buttock.

The pain may feel the same, but the story behind it will be different for each underlying cause. The history is very helpful diagnosing sciatica, but it’s not the entire picture. Each cause has characteristic exam and imaging findings—or lack thereof. A full discussion is beyond our scope here, but a visit to the office is the right way to begin.

Treatment starts with conservative care, and the tincture of time. For mild sciatic symptoms, core exercise and stretching learned in PT may be all that’s needed. Over the counter analgesics tend not to be very helpful. For moderate or severe sciatica, it’s wise to get help early. See your PCP, who may give you a course of oral steroids and send you to PT. If you’re still not getting better your PCP will probably order x-rays and an MRI. Depending on what’s found, a referral to a clinic like mine, or ortho/neurosurgery is next.

One of the benefits of coming to Portland Pain Solutions is that we’re a small, boutique practice. You won’t wait weeks to get in, and we are 100% focused on YOU. Expect a timely evaluation, orders for any needed imaging, and effective treatment. If you need a referral to surgery, we have contacts who can expedite your care. One of the most serious concerns our patients tell us is how they wish communication with their caregivers were more effective and transparent. My commitment to you is 100% understanding of what my thoughts are, how I am planning your care, and what to expect.

I’ve suffered with sciatica myself, so I know what it feels like. We’ll get though it together.