One month ago, my wife, Mary, and I left the U.S. for a two-week trip to Europe. The first week we were to spend with my daughter, Marissa (the co-author of this blog), her husband, Oriol, and their four young children. The family lives in Andorra la Vella, the capital city of the small country of Andorra, nestled in the Pyrenees Mountains between France and Spain. For the second week, Mary and I had arranged to take a guided hiking trip conducted on the Dalmatian coast of Croatia. The trip from our hometown of Indianapolis began with a 2-hour flight to New York City, then a 7-hour flight to Barcelona. Following a 3-hour wait in the airport, we loaded our heavy luggage into a bus for the 3-hour drive to Andorra la Vella. Once we arrived there, we were greeted by the entire family, unloaded our suitcases and then pulled them the half-mile or so to reach Marissa’s apartment.
Some 5 minutes after arising the following morning, I was struck by an excruciating pain which began in my left hip and shot down through my leg, ending below the knee. It felt as though I had been stabbed, and I immediately collapsed onto the bed. This action lessened the pain, but I still had a strong tingling sensation the length of my leg. I spent the next 36 hours being both unable to stand in an erect position nor able to walk more than a few steps. We summoned a local physician the following day. House calls are not uncommon in Andorra, and within 20 minutes, the physician was doing a physical exam and taking an oral history. A diagnosis of sciatica was soon reached, and prescriptions for pain medication, a muscle relaxant, and a series of 6 daily steroid injections were provided. We were also told that there would be no hiking trip to Croatia and that the duration of sciatic pain was unpredictable. Thank goodness, Mary had earlier insisted on signing up for trip insurance. We could also spend that additional week with Marissa’s family.
Within two hours, a nurse arrived at the apartment to administer the first of my injections. The next morning I discovered that by bending forward, and shuffling with my hands grasping the fronts of my knees, I could fairly effectively avoid serious pain and walk short distances. This gait strongly resembled that of an orangutan, and only occasionally did I venture out of their home to get a café con leche and sweet roll. The next 6 days passed in a similar fashion; the injections had been completed, but I was not much improved. Fortunately, Marissa is a physical therapist and provided me with a great deal of helpful and realistic information initially and thereafter. Moreover, I had a great deal of time available to read about sciatica! I discovered that sciatica is not a definitive diagnosis, but rather a set of symptoms, including pain and numbness that radiate down the leg. In the majority of cases, it is caused by a displaced or herniated disk in the lower spine, and is quite a common malady.
The diagnosis is often derived from the patient’s description of what they have been feeling, and involves taking a medical history and conducting a physical exam. If additional testing is indicated, it generally involves the use of x-rays or an MRI. The major goal of treatment is to reduce the pain and increase mobility. Generally with a reasonable amount of rest, cautious movement and lots of patience, the condition will go away without treatment within 4-6 weeks. Exactly why this happens is not well understood. Pain relievers, usually NSAIDs, are often prescribed. Physical therapy and stretching exercises can help strengthen muscles in the abdomen and around the spine, which may relieve pressure off the disks. Surgery to relieve pressure on the nerve can be an option. However, several research study results suggest that after a year or two, outcomes for surgical patients are roughly the same as those treated conservatively (physical therapy and/or pain relievers). Since roughly 80% of sciatica patients with displaced disks get better without surgery, a conservative approach is generally recommended. However, if your sciatic pain is chronic and unrelenting, surgery remains a viable option.
It is impossible to prevent every case of sciatica, but perhaps its risk may be reduced by taking certain cautionary steps. Proper lifting techniques are recommended when attempting to move heavy weights. Since cigarette smoking is associated with disk degeneration, avoiding smoking is important. As previously mentioned, regular exercise can help strengthen back and abdominal muscles. Naturally, striving to attain good posture, whether standing, sitting or sleeping, may be beneficial.
Tomorrow (July 17) is the 4-week anniversary of the onset of my sciatica symptoms. I am grateful that I have improved roughly 5% each day since the onset and up to the present time. Yesterday, my electronic step counter indicated that I had walked some 12,000 steps without any significant discomfort. I would like to add one additional side-note to this story. At the conclusion of our two-week trip, I required wheelchair assistance at the airports in Barcelona, Rome, Toronto and Indianapolis to reach home. I was amazed at how helpful and dedicated all those involved with these procedures were. It was clear that they were very caring and dedicated individuals. By the same token, this was the first time in my life that I had ever been in the position of being a physically disabled person. To perform even the simplest tasks often required outside help for me. At times, I felt inadequate, and did not enjoy all the attention and the loss of control that was involved. Fortunately, I was traveling with my wife who consistently provided me with non-stop loving attention, without being overly solicitous. But I have come out of the experience with a much greater empathy for and recognition of the difficulties that our disabled population has to face on a daily basis.
July 16, 2016