When to Suspect Your Lower Back Pain Is Actually Sciatica

Talk to your doctor for targeted treatment

Contributor: Teresa Dews, MD, Vice Chair, Department of Pain Management, and Division Chair Pain Management, Department of Anesthesiology, Cleveland Clinic Hillcrest Hospital

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If you feel like you’re often dealing with back pain, it’s important to talk to your doctor. There are often effective treatments besides surgery that will help, depending on your particular condition.

For example, a patient once came to see me for chronic pain originating in her lower back, which traveled down her left leg and into her foot. This had all the hallmarks of sciatica, which is typically the result of an irritated nerve in the spinal column.

To treat this problem, I encouraged lifestyle improvements (discussed below) and used a procedure call an epidural steroid injections to decrease her pain so she could exercise.

Steroids are strong anti-inflammatory agents — and injecting them close to a nerve helps to temporarily reduce back and leg pain.

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Other treatment alternatives when pain returns

But within a few years, this patient’s pain returned with a vengeance. She called it a “charley horse that had gone nuclear.” This time, a prominent disc herniation was causing nerve compression.

Treatment came in the form of non-narcotic medication management in addition to exercise and repeating the epidural steroid injections. This regimen was very effective, providing significant relief.

This patient dramatically improved and she is very typical of many patients that we see.  Treated appropriately, many can get help and return to their active daily lives.

After her treatment, this patient participated in a yoga class offered at her workplace. She continues to do yoga two times each week. She takes only over-the-counter pain medication on occasion, and she uses care when bending over, tying her shoes and picking things up.

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8 tips to help prevent sciatica

If you have degenerative disk disease or you’re pregnant, sciatica may not be preventable. But here are some things you can do to protect your back:

  1. Maintain good posture. If you start to feel sore or stiff, change your posture and modify your body mechanics. Your body will warn you, using pain as a signal, when your mechanics are improperly aligned.
  2. Use good body mechanics. Pay attention to how you sit, stand and lift. Try to keep your back straight and your shoulders back. When sitting, keep your knees bent and your feet flat on the floor. Don’t over-reach, and avoid twisting movements. When lifting, bend your knees and use your strong leg muscles to help balance the load.
  3. Don’t smoke. Tobacco interferes with blood flow to the spine and contributes to disk degeneration.
  4. Maintain a healthy weight. Excess weight is associated with increased inflammation and pain in different parts of the body. Diet choices that contribute to weight gain and obesity are also associated with more inflammation and poorer health status.
  5. Exercise regularly. This includes stretching to keep your joints flexible and your back and abdominal muscles strong. Also, avoid sitting for long periods of time.
  6. Pick sports with care. Choose activities and sports that don’t place your lower back at risk of injury. Swimming, walking and biking are good options.
  7. Practice safety measures to help prevent falls. This includes wearing shoes that fit properly and keeping stairs and walkways free of clutter.
  8. Be a defensive driver. Don’t text and drive and watch out for other impaired drivers on the road.

By taking these precautions, you can lower your risk for sciatica and lower back pain.

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