An aching back

Mark Smulson of Northwest has had problems with his back for at least a decade. Through the years, sciatica — pain running from the back of the thigh down the leg — and lower-back pain have invaded his life. His difficulties most likely originated with a ruptured disc. Since then, he has had numbness in his right foot and ankle and loss of muscle mass in his left leg. Two surgeries have improved the condition.

“I was having major back pain,” says Mr. Smulson, 68. “I was trying to stand on my left leg, and I was falling down. It was an emergency situation.”

Each year, about 80 million cases of sciatica and lower-back pain occur in the United States, according to the U.S. Agency for Healthcare Research and Quality. The problems can involve pain, burning and tingling feelings, mostly in the lower back, buttocks and legs. Although most people recover through physical therapy, surgery is available in more severe instances. Some sciatica patients find chiropractic care and acupuncture helpful.

Patients should not relate pain in the upper body to sciatica, says Dr. Robert Laureno, chairman of the department of neurology at the Washington Hospital Center in Northwest. Symptoms are confined to the lower body.

“Usually people get better by themselves,” Dr. Laureno says. “Most of the time, the injury isn’t that bad, or it is [very] bad. And most of the time, there isn’t any surgery.”

Perhaps the cause known best among laypeople is a herniated disc, which can pinch the sciatic nerve running from the buttock to the heel, says Dr. Fraser Henderson, director of neurosurgery of the spine and craniocervical junction at Georgetown University Hospital in Northwest. People who sit at a desk all day and those who drive a lot are at a greater risk of developing a herniated disc and sciatica.

“When you’re sitting with poor posture, your discs tend to take a beating,” Dr. Henderson says. “Sit up straight and get exercise several times a week. Get up and move around every hour. … Drink a lot of water. Get eight hours sleep at night, which is when the discs restore themselves.”

Being careful when performing twisting and bending movements, such as placing a child in a car seat, can help prevent injury. When not played correctly, golf, which involves tremendous rotational movements, can cause damage to the sciatic nerve, he says.

However, Dr. Steve Scherping, assistant professor in the department of orthopedic surgery at Georgetown University Hospital, says sciatica and lower-back pain may not always be preventable.

“It has more to do with your genetics,” he says. “Certain people are programmed to get more or less troubles with the discs in your neck and back. … It’s not always necessarily the case that you have a lumbar herniated disc because you lift a lot. It’s not something you can completely control.”

About 90 percent of patients with sciatica or lower-back pain have it because of musculoskeletal problems, such as arthritis or stiff bones, says Dr. Loren Fishman, assistant clinical professor at Columbia University in New York City.

The other 10 percent have had an injury to the fibers that make up the sciatic nerve in the lumbar spine, which includes those people who suffer from a herniated disc and conditions including spinal stenosis, piriformis syndrome and trauma. Dr. Fishman, a specialist in the field, runs the Web site www.sciatica.org. He also is the author of the book “Back Pain.”

Spinal stenosis, the thinning of the pathway in the body from the head to the lower back through which the spinal cord travels, also can initiate the problem. When this happens, there isn’t enough room in the pathway for the nerves to stay healthy.

In addition, sciatica can be caused by piriformis syndrome, when the piriformis muscle compresses the sciatic nerve in the buttock. This can be caused by abusing the nerve, such as sitting all day or running too much. Trauma, such as falling off a horse, or an anatomical problem, such as being overweight, can trigger the condition as well.

When people are affected by any of these causes, they can feel pain, numbness, weakness and strange feelings, such as “pins and needles” and “hot and cold” sensations, usually in the outside of the calf and the top of the foot, Dr. Fishman says.

Most patients are diagnosed by having an MRI, or magnetic resonance imaging, or an EMG, electromyography. Those people with piriformis syndrome must have an EMG to detect changes in the muscles and nerves.

The severity of the sciatica will determine whether the sufferer needs surgery. Persons with spinal stenosis usually will need surgery eventually to widen the tunnel from the head to the lower back where it is narrow so the nerve fibers fit with ease.

Taking short-term steroids and doing physical therapy sometimes can ease sciatica. At least 75 percent of the people with problems caused by a herniated disc can get better with conservative means, such as physical therapy.

About 95 percent of patients with piriformis syndrome recover without surgery. In fact, Botox injections often relax the muscles around the sciatic nerve. In rare instances, surgery is performed to thin the piriformis muscle. In a few cases, the muscle compressing the sciatic nerve is removed. There is about a 10 percent recurrence of all causes of sciatica.

“The danger signs are weakness or when the numbness starts to ascend,” Dr. Fishman says. “You have numb feet and then ankles, and calves. If the bowel or bladder movements change, and you’re wetting your pants, go to the ER immediately. Otherwise, you can permanently lose control and become paralyzed.”

About 12 years ago, Bernard Rosner, 58, of Lexington, Mass., injured his piriformis muscle because of bad posture and a strained bowel movement. At his worst, he could walk, but not without a lot of pain. With stretching and routine exercise, he has mostly recovered. A specific stretch has helped him significantly with the tightness of his muscles.

“You sit on the floor, and you take the left leg and extend it out straight,” he says. “The right leg is flexed up toward your chin [with the foot flat on the floor]. You take your left arm and push on the right side of the right leg. You repeat it on the other side.”