Sciatica

What is sciatica?

Sciatica refers to pain that originates along the sciatic nerve, the longest and thickest nerve in the body. It starts where five nerve roots in the lower back and buttocks area join into one. It then separates into right and left sciatic nerves. Each runs down from the lower back through the hips, buttocks, and leg to end just below the knee. At that point, it branches into smaller nerves which continue down into your leg, foot, and toes.

Sciatica symptoms

Sciatic nerve pain can be mild to severe. You might experience sciatic pain anywhere from your lower back down to your legs, although it’s usually more severe in the legs. The pain is described as burning, stabbing, sharp, shooting, or electric. It may be constant, or it may come and go.

Symptoms can include:

• Pain anywhere along the nerve
• Muscle weakness in the leg or foot
• Pain that gets worse with movement
• Loss of movement
• Numbness in the leg
• Tingling, pins-and-needles feeling in the leg, foot, and toes
• Loss of bladder and bowel control (with the rare condition cauda equina)

The pain tends to get worse when sitting or standing for long periods or by sudden, forceful movements like a cough or sneeze. It can come on suddenly or gradually, depending on the cause.

Sciatica Causes

Sciatica is caused by irritation, inflammation, pinching, or compression of the nerve. It is commonly caused by a herniated disc or a bone spur. It could also be the result of an injury or other medical conditions like:

• Slipped or herniated disc
• Degenerative disc disease
• Osteoarthritis
• Spinal stenosis
• Bone spurs
• Spondylolisthesis
• Injury to the spine or sciatic nerve
• Tumors in the spinal canal
• Piriformis syndrome
• Cauda equina syndrome (rare)
• Aging

Your risk of developing sciatica is greater if you:

• Have a previous injury
• Are overweight
• Have weak core muscles
• Have a very physical job
• Sit for extended periods
• Live a sedentary lifestyle
• Smoke
• Don’t use proper posture when lifting weights
• Have diabetes
• Have osteoarthritis
• Are pregnant

Sciatica Diagnosis

The first step in a diagnosis is a physical exam. Your doctor may check your reflexes and muscle strength and ask you to perform movements known to aggravate sciatic pain.

If your pain is severe or doesn’t improve, you may need further testing, including:

• X-ray of your spine to look for a bone spur
• MRI of your back look for a herniated disc
• CT scan of your spine for a view of the spinal cord and nerves
• Electromyography (EMG) to measure electrical impulses in your nerves and how your muscles respond

Sciatica Treatment

Sciatic pain usually improves with self-care, including:

• Cold packs (initially)
• Hot packs (after 2-3 days)
• Stretching your lower back
• Over-the-counter pain relievers

If the pain doesn’t improve after six weeks of self-care, you should call your doctor. Medical treatments may include:

• Medications to treat the inflammation and pain
• Physical therapy to strengthen your back muscles and improve flexibility
• Steroid injections to treat inflammation
• Surgery to remove the bone spur or piece of herniated disc irritating the nerve, along with lumbar fusion to stabilize the spine if needed

Most people recover without complications within about six weeks. Although rare, complications can include:

• Chronic pain
• Long-term muscle weakness
• Loss of feeling in the leg

Does sciatica affect one or both legs?

Sciatica can occur in both legs at once, depending on where the nerve is pinched, but it usually only affects one leg.

Does sciatic pain mean I have nerve damage?
Actual damage to the sciatic nerve is rare, and the discomfort typically clears up without medical intervention.

Does bed rest help sciatica?
Resting for the first day or so is fine if needed, but activity will actually help heal the inflammation. Gentle stretching or short walks can help.

Shane Mangrum, MD

Christopher Tomaras, MD

David Tran, MD

Raymond Walkup, MD