Lower back pain. Lumbar radiculopathy. Sciatic nerve dysfunction. Lumbago. No matter what you call it, sciatica is a painful, recurring nuisance that impacts your quality of life. Sciatica refers to pain, weakness, tingling, or numbness along the sciatic nerve, the main nerve in your leg and largest nerve in your body. The sciatic nerve controls the muscles of the hamstrings, back of the knee and lower leg. It also provides sensation to the back of the thigh and lower leg, and the sole of the foot.
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If you suffer from sciatica, the first thing you should understand is that it's a symptom of a medical problem and not a disease in itself. Most cases of sciatica are symptoms of an inflammatory condition irritating the sciatic nerve.
Symptoms of Sciatica
Sciatica pain varies widely from one person to another. It can range from a dull ache or a little tingling to pain so severe that a person may be unable to move. The pain most often occurs on one side. The most common symptoms of sciatica are:
- Lower back pain that radiates or spreads down your buttock and the back of one thigh
- Pain that extends from your buttock down to your foot – this can feel like sharp pain, a bad leg cramp, or a strong electrical sensation
- Numbness (in severe cases), which may be felt in the leg, back of the calf, or even the sole of the foot
- Weakness (in severe cases) – some people find that their foot drags and is hard to lift when walking
Discomfort and pain may start and progress slowly. Some people feel more pain after standing or sitting for a long time. Depending on the cause of the sciatica, pain may increase while sneezing, coughing, laughing, or straining during a bowel movement or when bending over backwards or walking more than a few yards.
Call your healthcare provider right away if:
- Your pain worsens, makes it impossible to get comfortable, intensifies when you lie down, or wakes you up at night
- You lose feeling or notice weakness in your affected leg
- You develop bowel or bladder issues, such as incontinence
- You notice redness or swelling on your back or spine
Causes of Sciatica
Sciatic symptoms occur when the root of the sciatic nerve root in the lumbar spine is compressed or damaged. Diagnosis involves finding the cause of the compression. The most common cause is a bulging or herniated disk in the lower spine. Sciatica may also be the result of a bone spur or bony growth on the spine due to progressive narrowing of the spinal canal known as spinal stenosis. Herniated disk is the most common cause of sciatica in people under 40, whereas sciatica in older people is more likely due to age-related issues such as bone spurs or arthritis. Other causes of sciatic pain could be:
- A spinal cyst or tumor
- Piriformis syndrome, a disorder in which the piriformis muscle in the buttocks irritates the sciatic nerve
- A pelvic injury or fracture
- Spondylolisthesis, a spinal disorder in which a bone (vertebra) slips forward onto the bone below it
- Obesity
- Poor posture or seated position
- An abscess
- A blood clot
- Nerve disorders
Diagnosing Sciatica
In order to understand what's causing your sciatica, your healthcare provider will start by asking you questions about the type, location, and severity of your pain. They will also perform a physical exam, testing your reflexes, checking for numbness or loss of sensation, and asking you to do things like squat and rise, raise and lower your leg, or walk on your heels and toes.
If pain is severe and/or long lasting, additional tests may be ordered such as an X-ray, MRI, or discogram. In some cases, an electromyography (EMG) and nerve conduction study (NCS) may be needed. These procedures are performed together to identify the specific site of the injury causing your sciatica.
Non-invasive Treatment of Sciatica
In most cases, sciatica goes away by itself with rest and time. Your doctor will start by recommending non-invasive measures to reduce inflammation and calm symptoms. These include:
- Over-the-counter nonsteroidal anti-inflammatory (NSAIDS) medicines such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol)
- Applying heat or ice to the painful area – try ice for the first 48 to 72 hours and then switch to heat
- Movement. While this is no time to train for a triathlon, bedrest is NOT recommended – staying relatively active helps minimize inflammation
- Osteopathic manipulation
- Back exercises and/or physical therapy to strengthen your back
- Spinal injection with cortisone or a similar drug
Be careful not to do any heavy lifting or twist your back while you are being treated for sciatica. You can start exercising again after two to three weeks of treatment, focusing on strengthening your abdominal core and improving spinal flexibility.
Surgical Treatment of Sciatica
If, after three or more months of nonsurgical treatment, you still have disabling pain, your doctor may recommend surgery. This involves the surgical removal of the herniated disk or bone spurs that are irritating your sciatic nerve. Surgery may be performed under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.
Surgery is a big decision. If your primary care physician has been treating you, you may want to consult a physiatrist (pain specialist) and make sure you have exhausted all treatment possibilities before you see an orthopedic surgeon.
If you opt for surgery, be sure to discuss any other conditions you might have with your doctor. Smoking, high blood pressure, diabetes, how long you've had the sciatica pain, and even depression can affect the outcome of the procedure.
Learn more about spine care and treatments available at El Camino Health.
To find a doctor who can help diagnose and treat your back pain, click here.
This article first appeared in the September 2023 edition of the HealthPerks newsletter.
