I was researching some diagnoses and treatments for a client of mine who is suffering from Acute Sciatica. I came across a review paper from MD Consult identifying the effects of various treatment protocols.

The severity of Sciatica varies significantly between patients due to the cause of the Sciatic Nerve injury or impingement. The classic shooting pain, numbness, tingling or weakness down the back of the leg may stem anywhere from mild concerns with the Piriformis (a major muscle of the buttocks) to a severe herniated disc. It’s important to rule out ‘red flags’ and their more emergent conditions.

Common Causes of Sciatica:

• Piriformis syndrome
• Slipped disk
• Degenerative disk disease
• Spinal stenosis
• Pelvic injury or fracture
• Tumor
• Cauda equine syndrome
• Infection

Symptoms (often unilaterally down the back of the leg):

• Mild tingling
• Dull ache
• Numbness
• Burning sensation
• Shooting, sharp pain

**Symptoms are often worse after standing/sitting, at night, when sneezing/ coughing/ laughing, bending backwards. If you have any of these symptoms, always have your Medical Doctor determine the root cause of the sensations.

Red Flags (consult your doctor immediately)

• Unexplained fever with back pain
• Back pain after severe blow or fall
• Redness/ swelling on back or spine
• Pain traveling down legs below the knee
• Weakness/ numbness in lower extremities
• Burning with urination
• Loss of control of urine or stool
• Blood in urine
• Pain worse from lying down
• Severe pain without any relief
• Unintentional weight loss
• Back pain lasts longer than 4 weeks

After reading the review article ‘Treatment for Acute Sciatica’ I wanted to share the following chart:

Treatment	Likely to be beneficial	Unknown effectiveness	Unlikely to be beneficial
Nonpharmacologic	Spinal manipulation	Acupuncture; advice to stay active; exercise; application of heat or ice; massage; traction	Bed rest
Pharmacologic	—	Analgesics other than NSAIDs; antidepressants; muscle relaxants	Epidural steroid injections; NSAIDs
Surgical (for emergent conditions only)	Standard diskectomy (short-term effect); microdiskectomy (as effective as standard diskectomy)	Automated percutaneous diskectomy; laser diskectomy	—
NSAID =nonsteroidal anti-inflammatory drug.

(Markova et al., 2007)

Please note that this chart should not be used for self-prescription. Always consult with your medical doctor if you are displaying any of the symptoms above. Due to the varying causes of Sciatica, one beneficial treatment may be contra-indicated for in another type of sciatic pain. For example, spinal manipulation is not recommended for sciatica due to a disk herniation or tumor and can further exasperate the condition.

References

Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007;(2):CD003010.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the AmericanCollegeof Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Markova T, M.D., Dhillon DS, M.D., Martin SI. Treatment of Acute Sciatica from FPIN’s Clinical Inquiries. Am Fam Physician. 2007; 75 (1): 99-100.