Sciatica is a common condition characterized by pain that radiates along the path of the sciatic nerve, starting in the lower back and extending down the leg. This pain, which can manifest as a sharp, shooting, or burning sensation, is typically caused by the compression or irritation of the nerve roots in the lumbar spine. While a primary care provider is the first stop, an orthopedic doctor is often necessary, especially when the underlying cause is structural or when initial conservative treatments fail. The need for this specialist depends on the specific diagnosis and the severity of the nerve compression.
Initial Evaluation and Diagnosis of Sciatica
The process of confirming sciatica and pinpointing its source begins with a thorough physical examination and medical history review. A physician will assess your muscle strength, reflexes, and sensation, often utilizing the straight leg raise test, where lifting the leg causes pain to shoot below the knee if the sciatic nerve is irritated. Common structural causes of sciatica include a herniated disc, spinal stenosis (narrowing of the spinal canal), spondylolisthesis, or piriformis syndrome.
While a clinical examination can often diagnose sciatica, imaging tests are frequently used to visualize the specific structural problem. X-rays can reveal bone spurs or alignment issues, while a magnetic resonance imaging (MRI) or computed tomography (CT) scan provides detailed images of the soft tissues, such as the intervertebral discs. These scans are useful if a structural issue is suspected, or if symptoms are severe, persistent, or accompanied by neurological deficits. Identifying the exact location and nature of the nerve impingement determines the most appropriate treatment path.
The Specific Role of an Orthopedic Doctor
An orthopedic doctor, or orthopedist, specializes in the diagnosis and treatment of conditions affecting the musculoskeletal system, including the bones, joints, ligaments, tendons, and the spine. Because most sciatica originates from a structural problem within the lower back, these specialists possess the deep anatomical knowledge to manage the underlying cause. Their expertise makes them the appropriate destination for patients whose pain is caused by issues like disc herniation, spinal stenosis, or bone spurs.
The orthopedist develops a comprehensive treatment plan that can involve both non-surgical and surgical interventions. A referral becomes important when conservative treatments have not relieved pain after several weeks, or if the patient experiences significant neurological deterioration. Symptoms like foot drop (difficulty lifting the front part of the foot) or loss of bowel or bladder control are considered medical emergencies that require immediate orthopedic or neurosurgical consultation.
Orthopedic Treatment Pathways
Orthopedic care for sciatica typically begins with non-surgical management, which often includes prescription medications and targeted injections. Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants are commonly prescribed to control initial pain and reduce inflammation around the irritated nerve. For more intense or persistent pain, an orthopedic specialist may administer an epidural steroid injection (ESI).
An ESI involves injecting a corticosteroid medication directly into the epidural space near the affected nerve root to deliver a powerful anti-inflammatory effect. This targeted injection can provide substantial temporary relief, which is often used to create a therapeutic window for the patient to engage effectively in physical therapy. If these conservative measures fail to provide adequate relief after six to twelve weeks, or if the patient’s neurological symptoms worsen, surgical intervention may be considered.
The two most common surgical procedures for sciatica are microdiscectomy and laminectomy, performed by orthopedic spine surgeons or neurosurgeons. A microdiscectomy is a minimally invasive procedure used to remove the portion of a herniated disc that is compressing the nerve root. A laminectomy involves removing a small part of the bone (lamina) or enlarging the bony opening to relieve pressure on the spinal cord or nerves, often necessary for spinal stenosis. Surgery is generally reserved as a last resort but can provide rapid and lasting relief.
Complementary and Alternative Specialists
Sciatica management is often a multidisciplinary effort, and an orthopedic doctor frequently coordinates care with other specialists. Physical therapists (PTs) are integral, focusing on rehabilitation through exercises designed to strengthen the core muscles, improve flexibility, and reduce pressure on the sciatic nerve. The customized regimen helps restore proper movement patterns.
Pain management specialists, who may be physiatrists or anesthesiologists, work closely with orthopedists to offer advanced, non-surgical pain relief options like specialized nerve blocks or radiofrequency ablation. These professionals focus on maximizing pain control to improve a patient’s quality of life and allow them to participate in rehabilitation. Neurosurgeons also treat sciatica, and their role often overlaps with orthopedic spine surgeons in performing complex spinal procedures.