Answer:

Consider the spine. It is basically a stack of vertebral bones one on top of another, much like a stack of coins. It not only acts to support the body and allow upright posture, but it also forms a canal through which the spinal cord (nerve tissue) descends. At each level, between every vertebra, nerves exit the spine and pass out to all areas of the body. These nerve roots sometimes coalesce outside the spine into a large cord, traveling together for a distance before they separate and go their own way. The largest nerve in the body, the diameter of a large finger, is the sciatic nerve. Nerves that exit the lower lumbar vertebra form the sciatic nerve. The sciatic nerve travels through the buttock and down the back of the thigh, the calf, and into the foot. Hank knows this because this is the exact distribution of his pain.

"Sciatica" occurs when something irritates or damages the sciatic nerve or the nerve roots that feed into it. The pain can be exquisitely intense. If there is actual damage to the sciatic nerve, you may experience more than pain -- for example, loss of sensation somewhere in the leg, buttocks or genital area, or loss of strength in the leg. If loss of sensation is confirmed, or if weakness is found, there is an urgent need to determine the cause of the sciatica and do something about it so that the damage doesn't become permanent. If it is just pain, it should always be treated conservatively at first. That means don't rush off to a back surgeon, and don't panic about getting an MRI or CT scan right away.

Although many things can cause sciatica, trauma is the most common. Hank probably has a "pinched nerve," although a herniated disc is possible. He should apply ice to the lower back and rest on a hard mattress for the next couple of days. After that he should move around as well as he can. He should avoid sitting, which is the hardest thing on the back -- better to be lying down or standing upright. Anti-inflammatory medications such as ibuprofen are a good idea but he may also need some stronger pain pills. Steroids can be very effective, and might be tried if he does not feel better within a few days. Physical therapy, or a well-trained chiropractor, can relieve some of the pain quite well, especially if there are secondary muscle spasms.