Sciatica Can Be a Literal Pain in the Butt

A little over a year ago, I woke up one morning in such horrible pain that mere words can't describe it. It radiated down the right side of my body from my back area through the top of my leg. It hurt so much that I had to get my husband to help me out of bed. I couldn't stop crying.

We called our doctor, but she was booked solid. We headed to urgent care, where the physician gave me a prescription for an NSAID (non-steroidal anti-inflammatory drug) and had a tech give me a shot of one in my butt.

Unfortunately, it didn't help. During a three-day period, I had only been able to get about four hours of sleep — total.

So on the third night, I woke my husband up a little after midnight, sobbing, and said I wanted to go to the emergency room. I was diagnosed with sciatica.

Please know that while I was in excruciating pain, not everyone is. For some folks, it's not bad at all.

And, while many people can get by with NSAIDs or another medication to relieve the pain, along with physical therapy — which I'll get to in a minute — I needed to take an eight-day regimen of a high dose of steroids. I took the highest dose on the first day and was weaned off of it completely by day eight.

But because my case was so unusual, I wanted to include it here — as the ER doctor put me on one of the strongest painkillers available, and it didn't touch my pain, which scared me. With the steroids, though, I finally stopped crying after an hour, and within three hours, I felt a ton of relief. So I want to spread the word that if the other medications don't help, you might want to consult your health care provider about steroids. If you can take them, that is.

I ended up getting physical therapy for a few months, using a special cushion on my office chair (that I actually used in the car for a while as well), temporarily walking with a cane (I chose a purple sparkly one), and learned exercises that I can do while a passenger in the car on long rides.

That said, let's get into what sciatica is, how to treat it and other tips.

"Sciatica generally references pain that travels in the distribution of the sciatic nerve: buttock and down the thigh and leg," says Harvey E. Smith, M.D., associate professor of Orthopaedic Surgery, University of Pennsylvania; Penn Presbyterian Medical Center. "Symptoms are generally burning pain and may also include a sensation of muscles cramping; at times, numbness or tingling is associated. If the symptoms arise from compression of the nerves in the lumbar spine, they may be worse with standing and walking and alleviated with sitting or leaning forward."

An estimated 40% of Americans will experience sciatica in some form, but don't just assume that this kind of pain is sciatica; be sure to get a diagnosis from a health care provider.

"Diagnosing sciatica typically involves identifying the pain pattern first," explains Matthew Cifelli, founder of Attain Physical Therapy. "This means understanding the location of the pain, which typically starts in the lower back and radiates down into the buttock, hip or even calf and foot and usually affecting one side of the body. Unlike other lower back conditions, sciatica typically involves pain that peripheralizes or travels down and away from the spine radiating along the path of the nerve. Patients will often describe the nature of the pain being mild to sharp, at times burning or electrical and made worse by prolonged sitting, standing, sneezing or coughing."

For those who are experiencing pain, Cifelli recommends this: "If someone is experiencing sciatica, the first thing they should do is to begin modifying their activity. This means avoiding aggravating positions and certainly any unnecessary stress to the low back that involves bending, lifting or twisting. Some can find short-term relief with the application of ice every 15 minutes to help numb the pain and reduce inflammation.

After 48 hours, some may find that switching to a heating pad helps relax muscles and calm down the nervous system. An over-the-counter pain reliever can help manage pain and inflammation along with some gentle stretching to relieve tension. If pain and decrease in function continues, it's critical to seek the help of a physical therapist or qualified health care provider with experience in treating sciatica."

My primary care doctor recommended I get physical therapy, which would not only help with the pain, but also help me to regain my regular movement. When a part of your body hurts, the normal reaction is to stop moving it. But we need to keep moving — under a health care provider's instruction.

"The majority of patients will have relief with NSAIDs and lumbar spine physical therapy," Smith says. "In some cases, your provider may suggest a short course of oral steroids; if symptoms are due to compression of the nerves in the spine, your physician may recommend lumbar spine epidural steroid injection. These treatments aim to decrease the inflammation associated with the condition and to strengthen the core muscles around the spine and lumbar-sacral junction."

Cifelli adds, "Surgery is only considered if all other treatments have failed to provide any relief."

Something that my physical therapist told me, and Cifelli says as well, is don't just lie around in bed. As much as I hated it, I got up and walked around regularly.

"One of the biggest mistakes that we often see is that patients believe prolonged bed rest will help their symptoms," Cifelli says. "Short periods of rest may help initially, but too much inactivity can lead to muscle stiffness and weakness. Ignoring the pain and delaying treatment can potentially lead to chronic pain or even permanent nerve damage if the nerve compression is severe enough. This is why we stress early intervention with physical therapy or pain management."

That said, overdoing it can be just as bad as not doing anything at all.

"Another common mistake we see is that patients will continue overdoing physical activity like lifting heavy objects or performing activities of daily living that involve bending or twisting further aggravating the sciatic nerve," Cifelli adds. "We often see the use of pain-relieving medication as the sole treatment of sciatic pain. This does not address the underlying root cause of the problem and can mask symptoms, giving someone a false sense of confidence. Consulting with a physical therapist for a proper diagnosis and treatment plan is critical to ensure long-term relief."

To prevent sciatica in the future, keep up with the exercise routine the physical therapist suggests. Cifelli recommends maintaining good posture if you have to sit for long periods of time.

"Practicing good lifting mechanics if you must pick up heavy objects is important to avoid unnecessary stress on the lower back," he says.

Smith says that although many people will get sciatica, the vast majority will have a full recovery by using the aforementioned treatments.

"While distressing when it occurs, this condition has many management options and responds well to treatment," he says.

More than a year ago, I couldn't imagine my pain ever ending. By listening to my PT and keeping up with exercise, today I feel fine.

Michele Wojciechowski Michele "Wojo" Wojciechowski is an award-winning writer who lives in Baltimore, Md. She's the author of the humor book Next Time I Move, They'll Carry Me Out in a Box. Reach her at www.WojosWorld.com. Read More