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When Should You Seek Help for Sciatica? · Flourish- A Prisma Health Podcast

• 0:03
  Melanie Cole, MS (Host): Welcome to Flourish, a Prisma Health Podcast.
• 0:07
  I'm Melanie Cole.
• 0:08
  And today, we are learning about sciatica.
• 0:11
  Joining me is Dr.
• 0:12
  Taylor Girolamo.
• 0:13
  She's a neurosurgeon with Prisma Health.
• 0:17
  Dr.
• 0:17
  Girolamo, thank you so much for joining us today.
• 0:20
  We hear this term sciatica bandied about, and nobody's quite sure what it is.
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  Can you tell us what that term sciatica means and what
• 0:29
  causes that type of nerve pain?
• 0:33
  Dr. Taylor Girolamo:
• 0:33
  Yes, absolutely.
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  So like you said, sciatica is a general term that gets used a lot to
• 0:38
  describe shooting pains that come from the spine and travel down the leg.
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  Typically, sciatic nerve pain occurs when the sciatic nerve,
• 0:47
  which is one of the longest and thickest nerves in the body, becomes
• 0:50
  compressed or inflamed or irritated.
• 0:53
  This can be due to pressure or pinching on the nerve from the spine by conditions
• 0:58
  such as a bulging or herniated disc, or from narrowing in the spine from
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  bony overgrowth and degeneration of the discs and ligaments over time, a
• 1:07
  condition that we call lumbar stenosis.
• 1:10
  The nerve can also be pinched or inflamed by pressure from the surrounding muscles
• 1:14
  and soft tissues of the glutes and the leg as it passes through the leg to
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  its destination in the feet and toes.
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  And so, it's really a pretty broad condition and pretty broad range of
• 1:25
  causes that can cause the sciatic nerve pain that people describe.
• 1:29
  Melanie Cole, MS: Are there different types of sciatica?
• 1:31
  You just mentioned a few reasons, whether it's, you know, that piriformis
• 1:35
  muscle, everything in the glutes pressing or that stenosis that you mentioned.
• 1:41
  Are there different types, categories, ways that you categorize sciatica?
• 1:46
  Dr. Taylor Girolamo:
• 1:46
  Yes, there are.
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  The different types of sciatica can be determined by the source of the
• 1:51
  pressure on the nerve, such as from the muscles or from the spine, how long
• 1:55
  it's been going on, and also whether one or both legs are affected by the pain.
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  Sciatica most commonly affects one leg or the other, but involvement of both
• 2:06
  legs could indicate significant pinching of the nerves within the spinal canal.
• 2:10
  Acute sciatica is a term we use to describe new pain that's been
• 2:15
  going on for six weeks or less.
• 2:17
  This is most commonly treated with conservative measures such as activity
• 2:20
  modification, physical therapy, and medications, and it usually does get
• 2:25
  better and resolve with these measures.
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  Chronic sciatica is a pain that's been going on for three months
• 2:31
  or more, is refractory to those initial conservative attempts, and
• 2:36
  requires more dedicated evaluation.
• 2:39
  Melanie Cole, MS: So then, who is most likely to struggle
• 2:42
  with sciatic nerve pain?
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  And I have to say, Doctor, as an exercise physiologist who's worked with people
• 2:48
  for so many years with this, but then got it myself one time, I feel that you
• 2:53
  can't really appreciate the pain, the really true pain of back problems like
• 2:58
  this unless you have experienced them.
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  It is just wild how it feels.
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  So, who is at risk for this kind of thing?
• 3:06
  Dr. Taylor Girolamo:
• 3:06
  Yeah.
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  So, there are several risk factors that can increase the likelihood of
• 3:10
  experiencing this sciatic nerve pain.
• 3:13
  Disc herniations are most common in the 30 to 50-year age range, while the advanced
• 3:18
  degeneration and arthritis in the spine is most commonly seen after age 60.
• 3:24
  People that have jobs that involve prolonged sitting or heavy lifting and
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  twisting of the spine can also have increase in the overall strain that
• 3:33
  their low back experiences over time.
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  And other medical conditions such as diabetes, obesity, and even
• 3:40
  pregnancy can increase your chances of experiencing pain from the sciatic nerve.
• 3:45
  Melanie Cole, MS: Why would it be worse at bedtime?
• 3:48
  It would seem that when you get to go to sleep, that's when it would feel better
• 3:52
  Dr. Taylor Girolamo:
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  When we lie down to go to sleep, the pressure is taken off of our spine from
• 3:56
  gravity and the weight of carrying just our body upright, and disc herniations
• 4:01
  may swell and add pressure to the nerves, which is something that we wouldn't
• 4:05
  otherwise experience during the daytime.
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  Sleeping position can also play a role.
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  So, lying flat or side sleeping, especially with the legs straight,
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  puts additional pressure and tension on the normal lumbar
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  curvature and on the sciatic nerve.
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  Also, attempting to quiet our minds in preparation for sleep can make
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  us more aware of our body's internal pain signals, making nighttime
• 4:28
  particularly uncomfortable for patients experiencing sciatic nerve pain.
• 4:33
  Melanie Cole, MS: So, Doctor, once you've determined that this is what's going
• 4:37
  on, tell us about some of the common remedies and treatments, but start
• 4:41
  with the conservative measures first.
• 4:43
  You mentioned a few of them before.
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  If someone comes to you, expand a little what the first thing that you're gonna
• 4:49
  do with them is, and then we can move on to some more interventional modalities.
• 4:57
  Dr. Taylor Girolamo:
• 4:57
  Absolutely.
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  So, a lot of times, the first line of folks that are being
• 5:02
  seen for these conditions are a patient's primary care provider.
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  And especially in that acute phase, treatment for the sciatic
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  nerve pain is centered on that conservative non-surgical care.
• 5:14
  So, this includes interventions such as activity modification,
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  gentle stretching, walking, physical therapy, heat and ice application,
• 5:23
  and core strengthening exercises.
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  While it may be tempting to stay in bed and avoid all activity when
• 5:29
  you're experiencing this pain, it can actually worsen the overall
• 5:33
  condition and your mobility.
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  And so it's best to remain as active as possible.
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  Over-the-counter medicines like ibuprofen and Aleve can provide some relief, and
• 5:43
  then medical providers can also assist with prescriptions for medications
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  such as muscle relaxers, neuropathic pain medications like gabapentin or
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  Lyrica, and even courses of steroids when those are deemed appropriate.
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  Now, when the pain is resistant to these measures, further evaluation is
• 5:59
  warranted with imaging such as X-rays and MRI, and possibly a referral to a spine
• 6:04
  specialist based on those imaging results.
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  And based on those results, additional interventions like steroid
• 6:11
  injections targeted to specific nerves or surgery may be recommended
• 6:15
  to address the source of the pain.
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  And the surgery can involve anything from something we call a microdiscectomy,
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  where a disc herniation that's pinching the nerve is removed, or something like
• 6:27
  a laminectomy, where if it's from general more circumferential compression of
• 6:32
  the nerves by arthritis and thickened ligaments, it allows us to decompress
• 6:37
  the nerves more fully in order to relieve that compression and that pressure
• 6:42
  Melanie Cole, MS: So, there's so many more tools in your toolbox now in your
• 6:46
  armamentarium of options for patients that are suffering from sciatica.
• 6:51
  And thank you for telling us about some injections and some of
• 6:54
  the surgical options out there.
• 6:56
  Is there any way to reverse the causes of the pain or to undo it?
• 7:00
  And you said you want people to keep active.
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  Are there things such as weight loss or physical therapy, really activity
• 7:09
  that can undo or reverse this?
• 7:11
  Or is this something that's going to plague them?
• 7:14
  Dr. Taylor Girolamo:
• 7:14
  No, absolutely.
• 7:16
  The initial conservative steps that we've discussed can help reduce the load on the
• 7:20
  spine and improve the inflammation around the nerves, and things like weight loss
• 7:25
  and physical therapy techniques can help correct posture and spinal load-carrying
• 7:30
  causes of the sciatic nerve pain.
• 7:33
  Even small disc herniations can be reabsorbed by the body over time.
• 7:38
  Larger disc herniations or significant degenerative causes in the spine
• 7:43
  may require surgery to correct, but even these can be corrected
• 7:46
  with a carefully selected approach.
• 7:50
  Melanie Cole, MS: So if it doesn't resolve on its own, does it
• 7:52
  sometimes resolve on its own, Doctor?
• 7:55
  Dr. Taylor Girolamo:
• 7:55
  Yes, absolutely.
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  About 80% to 90% of those non-surgical sciatica cases can
• 8:00
  resolve with the conservative measures that we've discussed here.
• 8:04
  Melanie Cole, MS: And if someone is waiting for it to resolve
• 8:06
  on its own, how long should they wait to see if it doesn't?
• 8:09
  And what happens if they don't go and get help for it?
• 8:13
  Dr. Taylor Girolamo:
• 8:13
  So, I would usually say that these initial conservative measures should
• 8:17
  really be attempted for the first, like, four to eight weeks, while you're
• 8:20
  still in that acute sciatica window.
• 8:24
  But definitely, as we span into the three months or longer,
• 8:27
  that's when that additional intervention is really warranted.
• 8:31
  Severe compression of a nerve without a proper treatment could
• 8:35
  lead to symptoms such as weakness, worsening or permanent numbness, loss
• 8:39
  of sensation in the groin area, or loss of bowel and bladder control.
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  And these are a group of symptoms that we call red flag symptoms, and they should
• 8:49
  be evaluated by a provider immediately.
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  And if you're unable to get an urgent appointment with someone,
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  we recommend that you go to the emergency room to be evaluated for
• 8:58
  any of those red flag symptoms.
• 9:00
  Melanie Cole, MS: Do you have any final thoughts that you'd like to
• 9:02
  leave listeners with about sciatica?
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  the red flags you just mentioned, but the symptoms they might experience
• 9:09
  that would send them to the doctor in the first place, that groin pain that
• 9:13
  you mentioned, all of those sorts of things, can you summarize for us and
• 9:17
  give us your best advice for someone that is suffering this type of pain?
• 9:23
  Dr. Taylor Girolamo:
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  Sciatica is certainly something that can be, life-changing, debilitating for
• 9:27
  someone that's experiencing this pain.
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  And so anyone that's experiencing this, whether it's new and acute after something
• 9:34
  that happened here recently or something that you've been experiencing for a long
• 9:38
  time, I would really encourage you to get in with either your primary care doctor
• 9:43
  or a referral to a specialist so that we can truly get to the bottom of what could
• 9:48
  be causing the pain that you're having, because there are definitely options that
• 9:53
  run the spectrum, as we've discussed, of conservative measures up to and including
• 9:59
  surgery for people that do have spinal conditions and degenerative changes that
• 10:05
  are causing the pressure on the nerves.
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  And so, there is hope and there is relief, and we just wanna make
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  sure that we are here as a tool to you to help you reach that level of
• 10:15
  function that you want to get back to.
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  Melanie Cole, MS: Thank you so much for joining us and sharing your incredible
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  expertise for something that so many people suffer from and really, as you
• 10:26
  said, can affect the quality of life.
• 10:29
  So, thank you so much again.
• 10:30
  And to hear more podcasts from our experts and to learn more, please visit
• 10:35
  our website at prismahealth.org/podcast.
• 10:38
  I'm Melanie Cole.
• 10:39
  And we'd like to invite our audience to download, subscribe, rate, and review
• 10:43
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• 10:49
  Thanks so much for listening to Flourish from Prisma Health.