Resource Center

You or someone you know may have experienced the searing pain of sciatica. It comes along with a burning sensation and tingling that runs down your leg. The natural inclination is to sit down, but the expected relief does not materialize, and the pain is in fact worsened.

What causes this excruciating pain? It is from pressure on one of the nerve roots that make up the sciatic nerve. This nerve runs from the lower back, through the buttocks all the way down along the back of each nerve.

There can be several causes of sciatica. The good news is that it often clears up in days to several months with the help of non-surgical management. Along with various pain relief modalities, this includes careful muscle stretches, strengthening exercises and activity modifications.

The sciatic nerve is the largest nerve in the body. It is formed in the pelvis from several spinal nerves. Theses nerves emerge from the backbone's bony canal (vertebral column). The vertebral column is formed by many bones (vertebrae) and shock-absorbing disks that cushion the vertebrae.

Sciatica can occur when any one of the nerve roots that come together to form the sciatic nerve become compressed or inflamed. Many different conditions can compress or inflame the nerve. The most common cause of sciatica is a lumbar herniated disk. A disk becomes herniated when its gel-like contents push through or into its outer lining causing a bulge. This bulge exerts pressure on nerve roots that are a part of the sciatic nerve. Lumbar herniated disk is common among 25- to 45-years-olds.

Among the older individuals, sciatica may occur because of a narrowing (stenosis) of the spinal canal. The narrowing is on account of bony growths or degeneration of bone in the area where nerve roots emerge from the vertebral column.

Sciatica may also be a result of degenerative disk disease. With aging, disks shrink and weaken and, consequently, could either bulge (herniate) or narrow the region where the nerve roots exit the spinal canal. With changes over time, even small changes may cause the vertebra to slip forward narrowing the bony canal. Oftentimes, this slippage and narrowing, known formally as spondylolisthesis, can cause sciatica.

Sciatica can afflict any one at any age. In general, among younger people, sciatica is frequently associated with a herniated disk. In older adults, sciatica is more often because of stenosis associated with advanced arthritis or disk degeneration. What are the symptoms? Typically, sciatica is associated with one or more of the following symptoms:

* Pain radiating from the lower back down to the lower leg that becomes worse when sitting, bending forward or backward, or straining;
* Burning or tingling felt all the way along the leg;
* Constant pain on one side of the lower back;
* Shooting pain that impairs standing up;
* Muscle weakness, numbness or difficulty moving a leg or foot.

How is sciatica evaluated and treated? Ordinarily, a non-emergency evaluation consists of physical examination and muscle testing for strength, reflexes, and sensations to determine if the problem is a pinched nerve. In some cases, bed rest for a few to several days may be recommended to reduce inflammation around the nerve roots.

Pain relievers may be prescribed, including non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. A physician may also prescribe a muscle relaxant. In more severe cases, corticosteroid injections (epidural steroids) may reduce pain and inflammation, facilitating a stretching and conditioning program for the back.

Once the pain is under control, exercise and physical therapy may be indispensable. Along with exercise, nutritive approaches are beginning to figure prominently in the management of inflammatory response. Systemic enzymes have a long history and scientific corroboration to modulate the cellular mediators, or markers, known as cytokines that trigger or perpetuate inflammatory response. Among the most readily manageable cytokines are interleukin-(IL-)6 and tumor necrosis factor- (TNF-).

A precisely calibrated combination of the proteases bromelain, papain, pancreatin, trypsin and chymotrypsin, administered systemically, not only downregulates IL-6 and TNF-, but other proinflammatory cytokines as well.

If surgery is not necessary, people with herniated sciatica usually recover within as short a period of time as two months. Although recurrence cannot be ruled out, among the best deterrents physical exercise and systemic enzymes may be included.