Sciatica, a very common ailment, is often first encountered during pregnancy. While many people mention “sciatica” anytime they have back pain, sciatica refers to a specific nerve that is pinched. The sciatic nerve is one of the thickest and longest nerves in the body. It originates from the lowest area of the spinal cord and travels down the buttocks and back of the thigh before splitting into two separate nerves behind the knee. These two nerves then subsequently support all of the muscles below the knee. When the sciatic nerve is entrapped, it causes lightening-like pain down the buttocks, back of the thigh, back of the calf and parts of the foot.
The most common causes of this nerve to be entrapped are a bulging disc or a bone spur. Given that bone spurs tend to increase with age, disc problems are a more common cause of this ailment in pregnant women. Low back pain that doesn’t radiate is more likely to be musculoskeletal (for a discussion of low back pain, click here).
Discs are fluid-filled sacks that in some ways resemble water balloons. They provide a cushion between bones of the spinal column. Like water balloons, if one side is squeezed, the other side pooches-out. It is for this reason that certain positions trigger the pain of sciatica. When an MRI of the low back is taken, the patient is lying flat, giving the disc an opportunity to fall back into place. It is for this reason, that sometimes, an MRI is negative even with a classic case of sciatica.
While oral medication and surgery are common therapies for sciatica, there are several other therapies to consider:
1) Rest: Several days of bed rest, lying on a firm surface, knees bent, with a pillow under the knees. This provides some slack in the nerve. The goal is to give the nerve enough rest to allow swelling around the nerve to subside.
2) Physical therapy: Back strengthening exercises will build muscle. This added backsupport will reduce strain on the disc.
3) Epidural steroid injections: This is a procedure that looks and feels similar to the epidurals given just prior to childbirth. However, it does not cause leg numbness, and in the end, you will not be handed a baby!
4) Lidoderm patches: This is topical anesthetic (not yet approved for pregnancy) that can give pain relief with very few side effects.