Causes and Symptoms of Sciatica: How to Get Relief

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I'm Deborah Howell, and today's guest is Jason R. Koh, DO, a physiatrist specializing in spine disorders at the Center for Spine Health at Orange Coast Memorial and co-medical director of rehabilitation services at Long Beach Memorial. Welcome, Dr. Koh.

Jason R. Koh, DO: Thank you. Good morning, Deborah.

Deborah Howell (Host): Good morning. So common lower back problems may cause sciatica symptoms, which can vary from mild and infrequent to debilitating and constant. Now when sciatica pain caused by lower back problems becomes intolerable, it may be time to seek out some treatment. So you're here to talk about recognizing the symptoms of sciatica, how to manage the pain, and also some treatment options available to treat lower back issues which cause sciatica. So first of all, let's get to the bottom of it. What is sciatica?

Jason R. Koh, DO: Well, sciatica is often described as an intense burning leg pain. And it's usually due to the injury to a spinal nerve in the lower back. When the spinal nerves of the lower back get injured, the pain tends to radiate down the sciatic nerve in the back of the buttock, thigh, and the leg. The actual medical diagnosis for this condition is lumbar ridiculopathy.

Deborah Howell (Host): Okay. That sounds very impressive. And what are some of, you went over some of them, but all the common symptoms associated with sciatica?

Jason R. Koh, DO: So patients with sciatica typically complain of pain, burning, numbness, tingling, and sometimes paresthesia, that feeling like your leg's falling asleep. They feel like their leg or foot may be on fire. It's very uncomfortable and oftentimes debilitating. In severe cases, weakness, even atrophy or wasting away of the muscles of the leg may also be present. Patients can have difficulty walking due to you know a foot drop. They can't pick up the foot. They tend to trip over the foot sometimes when they're advancing their leg during the walking, or they even may have difficulty standing on their tiptoes

Deborah Howell (Host): Wow. What are some of the risk factors for developing sciatica?

Jason R. Koh, DO: Well improper lifting, bending, or twisting, as well as prolonged sitting can predispose someone to developing lumbar reticulopathy or sciatica, as these activities may lead to disc injury or disc degeneration in the spine. Other risk factors would be pregnancy, obesity, occupation and also aging are also risk factors. But sorry folks, but the older we get the more likely we are to develop sciatica.

Deborah Howell (Host): And that's not gonna change.

Jason R. Koh, DO: No, unfortunately not.

Deborah Howell (Host): But are there certain things that people can do to prevent having this issue?

Jason R. Koh, DO: I think the easiest way to reduce your risk of developing sciatica is to avoid prolonged sitting. Many employers now offer standing workstations at job sites. I've even seen treadmill workstations here at MemorialCare.

Deborah Howell (Host): Yes.

Jason R. Koh, DO: I often recommend to my patients that have sedentary type jobs, desk jobs, computer-based work, to get up every thirty or forty five minutes and take a five minute walk. Most employers actually offer ergonomic evaluations of someone's workspace as well to reduce the risk of developing not only back pain, but other overuse type injuries, you know, like carpal tunnel, tendinitis or even muscle strain.

Deborah Howell (Host): And I've seen those desks that are, you know, they start flat and then they move upward so you're correct.

Jason R. Koh, DO: Alternating between sitting and standing.

Deborah Howell (Host): The key is to keep moving.

Jason R. Koh, DO: Yep.

Deborah Howell (Host): Are there treatments people can do at home to reduce and manage sciatic pain that you recommend?

Jason R. Koh, DO: Absolutely. I recommend physical therapy and a good home exercise program for all my back pain and sciatica patients. You know, instruction in the lumbar or core stabilization program, training in proper body mechanics, flexibility, and postural education by trained physical therapists or rehab physicians can actually help patients manage their sciatica symptoms and reduce pain. Other treatments that may help are simple modalities such as cold therapy with ice packs, heating pads when you're sleeping, the positioning of pillows under your knees if you're sleeping on your back, or if you sleep with a pillow between your knees if you sleep on your side. There's a device called a TENS unit. TENS is short for transcutaneous electrical nerve stimulation. It's just a fancy term for this device that can be ordered for home. And when used and applied, it actually can help alleviate some low back pain symptoms.

Deborah Howell (Host): Interesting. Now if someone is experiencing symptoms of sciatica, what are the steps they should take to seek out medical treatment?

Jason R. Koh, DO: First thing would be to contact your doctor. I recommend immediately if your sciatica is accompanied by bowel or bladder incontinence, or if you have sudden onset of urinary retention or the inability to urinate, if you have fever associated with your back pain, or if you have any kind of numbness in the groin area. These are what we call red flag symptoms and would indicate a potentially more serious cause of someone sciatica. So if any of these symptoms are present, please go to the nearest emergency room for evaluation.

Deborah Howell (Host): Okay.

Jason R. Koh, DO: If these red flag symptoms are not present, then you can go ahead and make an appointment with your primary care doctor for referral to either a rehab physician such as myself or another spine specialist.

Deborah Howell (Host): I'm gonna have you go through those red flag symptoms one more time if you would.

Jason R. Koh, DO: Sure. So if you have the sciatica and it's accompanied with bowel or bladder incontinence, or if you have difficulty urinating, you have urinary retention, if you have any sort of fever associated with your back pain, or even if you have any kind of numbness in the groin area. Those would be the red flag symptoms that we're more concerned about.

Deborah Howell (Host): Okay, that's crystal clear now. Okay. So what are some of the treatment options for patients once they've actually been evaluated and diagnosed with sciatica?

Jason R. Koh, DO: So in addition to what I mentioned before, the physical therapy and home exercise programs, there are medications specifically for nerve-related pain associated with sciatica. There are also topical creams, balms, as well as medicated patches that we use to help symptom management. If the sciatica symptoms are relatively new, what we call acute, then epidural steroid injections are available which can help reduce the inflammation around the spinal nerve and alleviate the pain. These injections are typically performed by a rehab or anesthesia pain doctor and we usually use X-ray guidance to guide the needle to the location where the nerve root is affected.

Deborah Howell (Host): And sometimes are there multiple sites?

Jason R. Koh, DO: Absolutely, yes. People can have multiple levels of the lumbar spine that are the nerves are being impinged upon, and then they can go ahead and inject both sides. Surgery is also a last resort, but if necessary, it is effective in alleviating the compression of the spinal nerve root.

Deborah Howell (Host): Walk us through a typical surgery.

Jason R. Koh, DO: So I'm not a surgeon myself, but I can go ahead and comment on some of that. So typically, the surgeon has to identify what is being the pain generator. So if it is a spinal nerve root, hopefully it's only one nerve root. Maybe it's because of a disc that's bulging and pressing on the nerve root, or it could be due to arthritis. Arthritis is typically called bone spurs. And the bone spurs can actually spur and jet out into the canal where the spinal nerve root is. So whatever the cause of that impingement on the spinal nerve root, that's what the surgeon's gonna target. If it's the disc he can do a disc dysquectomy, which is basically scooping out the extruded portion of the disc, or he can go ahead and basically kind of ream out that hole where the nerve root comes out to shave away some of the bone.

Deborah Howell (Host): And is this done robotically?

Jason R. Koh, DO: It can be, yes. There are minimally invasive techniques where they use a long camera with a little scope. So the incisions are actually quite minimal, maybe an inch or so, and patients recover typically very quickly because there's less damage caused in the muscles during the surgical procedure itself.

Deborah Howell (Host): But also they go for the old school in certain situations as well.

Jason R. Koh, DO: Yes, depends on the surgeon's preference and comfort and the training level. I'm sure different surgeons have different preferences for the technique to operate.

Deborah Howell (Host): Okay. And how can someone get this evaluation process started with the Orange Coast Memorial Center for Spine Health?

Jason R. Koh, DO: So they can call the Center for Spine Health directly. The number there is seven one four eight six one four eight three zero. Our nurse navigator will answer and ask some basic questions regarding patient symptoms and ask also for the insurance information, just because certain insurances may acquire an authorization prior to you being seen at the clinic. The Nurse Navigator will then make an appointment for the patient to be evaluated by myself within two business days. We do ask that if patients have had previous imaging, x-rays, MRIs, or CAT scans, or any prior work of such as nerve testing, to please bring in copies of these images, preferably on a CD. I myself like to look at the film and images myself rather than rely on a radiologist's report. Once I've examined the patient and reviewed the pertinent imaging, I can kind of determine what the patient's pain generator is and then develop a diagnosis-specific treatment plan moving forward. So my role is really to educate the patient about their condition, make sure they understand their treatment options so that they can play an active role in the decision-making process

Deborah Howell (Host): Fantastic. And of course it is very important to have those baseline figures for you. So do hang onto any x-rays. This is in any modality of your life, because they help establish a baseline for the physician who's treating you next.

Jason R. Koh, DO: It's helpful for me to see the images, and compare them to prior images that may have been done in the past so that I can assess how rapidly this condition is progressing.

Deborah Howell (Host): The bottom line is get help. If you're having these problems, don't suffer. The first step is always to contact your own personal doctor and he'll take it from there.

Jason R. Koh, DO: Correct.

Deborah Howell (Host): Thank you so much for being on our program, Dr. Koh. Do you have any final thoughts for us?

Jason R. Koh, DO: No, I'd just like to say that the Center of Spine Health at the Orange Coast Memorial, they've really put together a dedicated and talented team of therapists, nurses, rehab and pain physicians, as well as surgeons to really best meet the needs of the community. It's really an honor for me to be a part of this team.

Deborah Howell (Host): Well, it's been an honor to have you on our show. Thank you so much, Dr. Koh.

Jason R. Koh, DO: Thank you, Deborah, appreciate it.

Deborah Howell (Host): Really informative show. To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Thanks for listening and have yourself a wonderful day.