Sciatica

Sciatica comes from a problem with the sciatic nerve, which branches from your lower back and hips and runs down each leg. Sciatica causes pain, weakness, numbness, or tingling. Many cases of sciatica can be successfully treated non-surgically.

Sciatic pain can be severe

Sciatica is marked by pain, or a pins and needles tingling that radiates from your lower (lumbar) spine to your buttock and down the back of your leg. Typically sciatica happens on just one side of your body.

Sciatic pain ranges from mild discomfort anywhere along the nerve pathway, to severe pain radiating down the back of your thigh and calf. Severe symptoms may cause loss of bowel and bladder control.

A bulging or herniated disc is the most common cause

A bulging or herniated disc is the most common cause of sciatica.

Discs are spongy material found in between each vertebra in your spine. When a disc bulges or herniates, the disc can compress and irritate the sciatic nerve.

Causes of sciatica

A bulging or herniated disc is the most common cause of sciatica, but it can arise from many other causes.

  • An autoimmune inflammatory arthritis that affects the vertebrae in the spine, called ankylosing spondylitis or AS, causes the vertebrae to begin to fuse, eventually placing pressure on the sciatic nerve.
  • High activity levels and daily actions such as heavy lifting, repeated twisting at the waist, or extensive driving can lead to sciatica. Also, doing the opposite and living sedentary lifestyles like spending most of the day sitting can also cause sciatic nerve damage.
  • Paget’s disease, a rare chronic bone disorder typically occurring in older adults. This disease causes bones to grow larger than they should, which then puts pressure on the sciatic nerve.
  • Pregnancy, especially the third trimester, when the body’s posture is off center and the extra weight from the baby, expanding uterus, or extra fluid press on the sciatic nerve.

  • Physical risk factors like obesity or people with diabetes can cause nerve damage-related sciatica.
  • Piriformis syndrome, a rare neuromuscular condition that comes from trauma to the hip or buttocks, genetics, or sedentary lifestyle. The piriformis muscle in the buttocks becomes irritated and compresses or irritates the sciatic nerve.
  • Spinal stenosis is a narrowing in the spinal canal from osteoarthritis. Thickened ligaments compress the sciatic nerve, resulting in sciatica.
  • Spinal trauma, any accident or injury that may have occurred to the spine (automobile accidents or falls) that can leave broken bone fragments or bone overgrowth that press on the sciatic nerve.
  • Spinal tumors, while uncommon, can place pressure on the sciatic nerve and cause sciatica. Only CT scans or MRIs reveal them.

How is sciatica diagnosed?

Woman checking in for clinic visit

Muscle and reflex tests

Your provider will need to identify your pain pattern by conducting a series of muscle and reflex tests to determine whether or not your pain is sciatica. These strength tests can be to lift your legs one at a time, while on your back, or walk on your toes or heels, or rise from a squatting position. If the sciatic nerve has been affected, the pain will usually worsen during these strength tests.

If pain is present and located through the physical, a treatment plan for managing sciatica will be  implemented.

Occasionally, when the pain is severe but there are no other symptoms, medical imaging tests (x rays, MRIs, CT scans, or EMGs) and diagnostic nerve blocks may be necessary to reveal the underlying cause of sciatica, which is most commonly herniated disks or bone spurs.

Treatments for sciatica

Self-care measures

Treatment for sciatica begins with self-care measures that can include:

  • Alternating cold and warm packs placed on the painful area for 20 minutes, several times a day.
  • Magnesium supplementation may help decrease inflammation and improve sciatic nerve pain.
  • Massage.
  • Over the counter pain relief such as ibuprofen and naproxen sodium.
  • Rest (although too much inactivity could make symptoms worse).
  • Specific stretching exercises; avoiding bouncing, sudden twisting motions.

If self care measures do not resolve the sciatica over a period of time, your provider may suggest more involved treatment such as physical therapy, prescription medication, steroid injections, or as a very last resort, surgery for those with debilitating nerve damage.

man stretching on basketball court

Physical therapy

As acute pain from the sciatica subsides, your doctor or physical therapist will create a rehabilitation program to avoid future injuries. Physical therapy for sciatica is all about improving your current condition and preventing another injury. The therapy usually includes correcting posture, stretching, and strengthening muscles in your core and back to regain flexibility.

Prescription medication

Medication may be prescribed to ease sciatic pain. The kinds of medication that are typically suggested for sciatica:

  • Anti-inflammatories.
  • Anti-seizure medications.
  • Muscle relaxants.
  • Narcotics.
  • Tricyclic antidepressants.

Steroid injections

When sciatic pain is not being remedied, doctors may recommend a corticosteroid medication to be injected at the site of the affected nerve root. Corticosteroid shots are helpful in reducing inflammation in the sciatic nerve, and therefore temporarily reducing pain. The effects of the steroid injection wear off after a few months, though, and the number of injections are limited due to the risk of serious steroid side effects if too many injections are given too often.

Surgery

As a last resort, surgery is offered to assist patients whose sciatica has not improved with other therapies. Surgery is an option to help bring relief to those with continued numbness or weakness of the affected area, or loss of bowel or bladder control. The end goal is to remove the bone spur or herniated disk that is pressing against the sciatic nerve.

Frequently asked questions (FAQs) about sciatica

Depending on the cause of sciatica, people describe their pain differently. Most often the pain is described as moderate to severe sharp and shooting, electric-like jolts of pain that come and go as the sciatic nerve is compressed. The pain extends from the lower back to the feet, causing weakness or tingling. The pain can be aggravated by inactivity or too much movement.

Prolonged sitting, or a sudden cough or sneeze, can actually aggravate symptoms.

Sciatica can be very common in pregnancy and will often come and go throughout the pregnancy. It is most common in the third trimester as the body loosens ligaments (to prepare the body for birth) and stretches as it takes on additional weight.

Causes of sciatica in pregnancy can be from an expanding uterus, fluid retention, weight gain of mom and baby, and/or the baby’s head as it settles into the proper birth position. All of these changes can put pressure on and compress the sciatic nerve.

Sciatica isn’t just a condition for older adults. In fact, it occurs most frequently in those between age 30 and 50. Learn more about causes and treatments for sciatica.