Sciatica Treatment in Castle Rock
What is Sciatica?
Sciatica is pain that radiates along the path of the sciatic nerve, which runs from the lower back through the buttock and down the back of the leg. It is not a condition on its own but a symptom of an underlying problem - most commonly a herniated disc or spinal stenosis compressing one of the nerve roots that form the sciatic nerve.
Sciatica is a specific type of radiculopathy - the broader term for any pinched nerve in the spine. When the pinched nerve is in the lower back and the pain goes down the leg, it is called sciatica.
What Does Sciatica Feel Like?
Sharp, burning, or shooting pain from the lower back or buttock down the back of the leg
Pain that may extend to the foot or toes
Numbness or tingling in the leg, foot, or toes
Weakness in the leg or foot - difficulty lifting the foot or pushing off while walking
Pain that is worse with sitting, bending forward, coughing, or sneezing
Symptoms usually affect one leg, though bilateral sciatica can occur with central stenosis
What Causes Sciatica?
Lumbar disc herniation: The most common cause, especially in patients under 50. Disc material pushes out and presses on a nerve root. More on the disc herniation page.
Lumbar spinal stenosis: Narrowing of the spinal canal compresses the nerve roots. More common in patients over 60. More on the spinal stenosis page.
Spondylolisthesis: A vertebra slipping forward can compress the nerve roots. More on the spondylolisthesis page.
Foraminal stenosis: Narrowing of the bony opening where the nerve exits the spine.
Piriformis syndrome: The piriformis muscle in the buttock can irritate the sciatic nerve, mimicking sciatica from a spine problem.
When Should I Seek Immediate Medical Attention?
Seek urgent evaluation if you experience new or worsening loss of bowel or bladder control, rapidly progressive weakness in the leg or foot, or severe numbness in the groin or saddle area. These may indicate cauda equina syndrome, which requires emergency treatment.
How is Sciatica Diagnosed?
Dr. Carrera's team evaluates sciatica with a detailed history, neurological examination (testing strength, sensation, and reflexes), and imaging. An MRI shows the discs, nerves, and spinal canal and helps identify the specific cause and location of nerve compression. The clinical exam and imaging together determine which nerve root is involved and guide treatment.
How is Sciatica Treated?
Conservative care: Many cases of sciatica improve within 6 to 12 weeks with activity modification, anti-inflammatory medications (meloxicam, naproxen), nerve-calming medications (gabapentin, pregabalin), and a short course of oral steroids for severe flares. Physical therapy is started once the acute pain settles.
Dr. Carrera's rapid relief approach: For patients in severe pain, the team often recommends a combination of treatments working together: a nerve-calming medication like gabapentin, an anti-inflammatory medication like meloxicam, and an epidural steroid injection to deliver targeted relief to the inflamed nerve root. This combination addresses the pain from multiple angles simultaneously.
Transforaminal epidural steroid injection (TFESI): The most targeted treatment for sciatica from a disc herniation or foraminal stenosis. A transforaminal epidural delivers medication directly alongside the compressed nerve. It can also confirm which nerve is the source.
Interlaminar or caudal epidural: For bilateral sciatica, stenosis affecting multiple levels, or post-surgical patients. More on the interlaminar and caudal epidural pages.
Spinal cord stimulation (SCS): For chronic sciatica that persists despite injections and conservative treatment - especially after spine surgery - spinal cord stimulation is one of the most effective options available.
Surgery: Considered when there is significant or progressive weakness, cauda equina syndrome, or symptoms that do not improve after an adequate trial of non-surgical treatment. Dr. Carrera's team coordinates surgical referrals when appropriate.
Schedule an Evaluation
If sciatica is limiting your ability to walk, sit, work, or sleep, Dr. Carrera's team can identify the cause and start targeted treatment. Patients with severe acute symptoms can be seen quickly, and procedures are typically scheduled within one week of the initial consultation.