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Sciatic nerve pain caused by spinal problem

EDITOR'S NOTE: This weekly column by reporter Bill Kettler answers readers' questions about topics of general medical interest with information provided by doctors from PrimeCare, Jackson County's independent practice association.

What can be done about sciatica. I had a terrible case, and a cortisone shot didn't seem to help at all.

- Marie K., Ashland

Sciatica is one of those nerve problems that can be painful enough to put some people in bed, says Dr. Doug Morrison, an Ashland orthopedist.

"Nerve pain is real uncomfortable," Morrison says. "Think of hitting your funny bone real hard and doing that all the time."

Although sciatic pain occurs in the leg, it's caused by a spinal problem. The vertebrae in the spine are cushioned by soft discs. "The disc is like a jelly donut," Morrison says. "If the jelly stays inside you're OK, If the jelly pushes out, you're in trouble."

If a disc ruptures, it can pinch nearby nerves. Sciatic pain is caused when a disc ruptures near the sciatic nerve, which exits the spine and goes down the leg. Symptoms may include leg pain that is worse while seated; burning or tingling down the length of the leg; shooting pains that make standing difficult; or muscular weakness that makes moving the leg or foot more difficult.

Patients have used words such as "shooting," "stabbing," "burning," "ripping," "tearing" and "gouging" to describe the pain, Morrison says.

"Everybody responds to pain differently," he says. "Some gimp around and limp around with it. Others see their doctor."

Morrison says muscle weakness associated with sciatica can be a serious problem for some people. A condition known as "drop foot" may develop, in which the muscles on the front of the lower leg no longer pull the ankle up. The ankle hangs down and the toes catch the ground when the patient tries to walk.

Sciatica usually develops in one of two scenarios. Some people develop back pain that never really goes away, and sciatica develops over time. Others suffer a disc injury after a sudden movement or an external stress.

The injury can be caused by "something as simple as sneezing, picking something up off the floor, or bouncing the grandkid," Morrison says.

Sciatica can happen to anybody, but people over age 35 are the most likely candidates. People in sedentary occupations are most vulnerable, and truck drivers seem especially prone to sciatica.

Morrison says about 90 percent of people troubled by sciatica get better with conservative care - anti-inflammatory drugs, physical therapy, behavior changes, and the passage of time. Cortisone injections can help to shrink the injured disc and ease the pain for some people.

Surgery can help some cases, but surgeons are generally slow to propose surgery because scar tissue can cause problems to resurface later.

"You don't want to leap into spinal surgery," Morrison says.

To prevent sciatica, physicians recommend strengthening the abdominal muscles that help hold the spine in proper alignment. Stronger muscles can help prevent the excess pressure on the discs that can cause them to rupture.

Call Bill Kettler with your medical questions at 776-4492, or e-mail them to: bkettler@mailtribune.com or send them to: Mail Tribune, Ask Your Doctors, P.O. Box 1108, Medford OR 97501.