MedStar Harbor Hospital’s Orthopaedic Surgeon John Carbone, MD, Discusses Diagnosing and Treating Sciatica

Sciatica episodes generally pass and over-the counter drugs and at-home exercises can help, according to Dr. John J. Carbone, an orthopedic surgeon who specializes in spine surgery and spine reconstruction at MedStar Harbor Hospital.

May 21, 2015

Baltimore—(May 21, 2015)—Anyone suffering from sciatica can say that the pain can be intense, from the back all the way down the leg. Those who are overweight, smoke, don't exercise or even wear high heels can make the pain worse. And while exercising can keep you fit, it can also lead to nerve pain. But episodes generally pass and over-the counter drugs and at-home exercises can help, according to Dr. John J. Carbone, an orthopedic surgeon who specializes in spine surgery and spine reconstruction at MedStar Harbor Hospital.

What is sciatica and what causes it?

Sciatic pain is pain in the distribution of the sciatic nerve into the leg, generally, past the knee and into the foot. It often is a compression or irritation of the nerve root from spinal stenosis or disc herniation. Although the most common cause originates in the spine, there can be other musculoskeletal causes for sciatic pain. Some other causes may include piriformis syndrome (compression of the nerve by a muscle in the pelvis) or tarsal tunnel syndrome (nerve compression in the ankle).

Why do so many athletes seem to have it? Isn't inactivity is a risk factor?

Athletes can irritate nerve roots due to the extreme stresses they place on their bodies and the twisting motions they place on their spine. These strains can occur with compression because of the twisting motion or impact loading due to contact sports. Of course, de-conditioning or decreased activity may diminish core strength and make any athlete more vulnerable to injury.

What over-the-counter medications, therapies or specific exercises can alleviate pain?

In general, anti-inflammatories such as ibuprofen or naproxen sodium medications are most effective for common nerve root irritation. Although the pain can be intense, the vast majority of these episodes will spontaneously resolve. Maintaining core strength and flexibility should minimize nerve root exposure to injury.

Are there good preventive measures to keep pain from returning?


Core strength and flexibility management are good preventive measures. Abdominal muscles carry up to 40 percent of the spinal load; therefore, good core and abdominal strengthening minimizes the pressure put on the spine. Your physician, or a therapist under the supervision of a doctor, can recommend which exercises would be helpful and safe for you. Also, people who smoke have a higher risk of back pain and disc disease. Tobacco cessation can frequently resolve back pain symptoms. Smoking has been shown to be an independent risk factor for back and degenerative disc disease.

When is it time to see the doctor and what can one offer?

Emergency treatment should be pursued in the event of cauda equine syndrome. These are changes in bowel or bladder function. These changes would be if you cannot empty your bladder or bowel or if you have numbness in the groin area, called "saddle anesthesia." You should seek evaluation through an emergency department as soon as possible. In the event of weakness in both legs or a single leg, it is important to be evaluated by a primary care physician as soon as possible. Occasionally, surgical decompression of the spinal canal or nerve roots gives the best clinical outcome. Sciatic pain without a functional deficit can be treated in a slow, deliberate manner non-urgently, which may include anti-inflammatory and physical therapy treatment.

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