Sciatica

Your sciatic nerve begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg.

The sciatic nerve is your body’s longest nerve and one of the most important ones. It has a direct effect on your ability to control and feel your legs. When this nerve is irritated, you’ll experience sciatica.

Sciatica is a sensation that can manifest itself as a moderate to severe pain in your back, buttocks, and legs. You may also feel weakness or numbness in these areas.

Sciatica is a symptom caused by an underlying injury to your sciatic nerve or an area that affects the nerve, such as your vertebrae, which are the bones in your neck and back.

As many as 40 percent of people will get it at some point during their lives. It becomes more frequent as you age.

Signs of sciatica

Sciatica is a very distinct type of symptom. If you’re experiencing pain that flows from your lower back through your buttock area and into your lower limbs, it’s typically sciatica.

Sciatica is the result of damage or injury to your sciatic nerve, so other symptoms of nerve damage are usually present with the pain. Other symptoms may include the following:

  • You may have pain that gets worse with movement.
  • You may have numbness or weakness in your legs or feet, which is usually felt along your sciatic nerve pathway. In severe cases, you may experience a loss of feeling or movement.
  • You may feel the sensation of pins and needles, which involves a painful tingling in your toes or feet.
  • You may experience incontinence, which is the inability to control your bladder or bowels. This is a rare symptom of cauda equina syndrome (CES), which is described below, and it calls for immediate emergency attention.

What causes sciatica?

Sciatica can be caused by several conditions that involve your spine and can affect the nerves running along your back. It can also be caused by an injury, for example from falling, or spinal or sciatic nerve tumors.

Common conditions that can cause sciatica are described below.

Herniated disks

Your vertebrae, or spinal bones, are separated by pieces of cartilage. Cartilage is filled with a thick, clear material to ensure flexibility and cushioning while you move around. Herniated disks occur when the first layer of the cartilage rips.

The substance inside can compress your sciatic nerve, resulting in lower limb pain and numbness. It’s estimated that 1 to 5 percent of all people will have back pain caused by a slipped disk at some point in their lives.

Spinal stenosis

Spinal stenosis is also called lumbar spinal stenosis. It’s characterized by the abnormal narrowing of your lower spinal canal. This narrowing puts pressure on your spinal cord and your sciatic nerve roots.

Spondylolisthesis

Spondylolisthesis is one of the associated conditions of degenerative disk disorder. When one spinal bone, or vertebra, extends forward over another, the extended spinal bone can pinch nerves that make up your sciatic nerve.

Piriformis syndrome

Piriformis syndrome is a rare neuromuscular disorder in which your piriformis muscle involuntarily contracts or tightens, causing sciatica. Your piriformis muscle is the muscle that connects the lower portion of your spine to your thighbones.

When it tightens, it can put pressure on your sciatic nerve, leading to sciatica. Piriformis syndrome can worsen if you sit for long periods, fall, or experience a car crash.

Risk factors for developing sciatica

Certain behaviors or factors can raise your risk of developing sciatica. The most common factors for developing sciatica include the following:

  • As your body ages, it becomes more likely that parts will wear out or break down.
  • Certain careers place a lot of strain on your back, especially those that involve lifting heavy objects, sitting for extended periods, or twisting movements.
  • Having diabetes can increase your risk of nerve damage.
  • Smoking can cause the outer layer of your spinal disks to break down.

When to seek medical attention

Seek immediate medical attention if you experience the following symptoms:

  • Your pain comes after a severe injury or accident.
  • You have sudden, excruciating pain in your lower back or leg that’s coupled with numbness or muscle weakness in that same leg.
  • You’re unable to control your bladder or bowels, which are the symptoms of cauda equina syndrome.

Cauda equina syndrome

In rare cases, a herniated disc can press on nerves that cause you to lose control of your bowel or bladder. This condition is known as cauda equina syndrome.

It can also cause numbness or tingling in your groin area, decreased sexual sensation, and paralysis if left untreated.

This disorder often develops slowly. It’s important to go to your doctor or an emergency room immediately if the symptoms appear.

The symptoms of this disorder can include:

  • an inability to control your bladder or bowels, which can result in incontinence or retention of waste
  • pain in one or both of your legs
  • numbness in one or both of your legs
  • weakness in one or both of your legs, making it hard to get up after sitting
  • stumbling when you try to get up
  • a noticeable progression or sudden severe loss of feeling in your lower body, which includes the area between your legs, buttocks, inner thighs, heels, and entire foot

Diagnosing sciatica

Sciatica is a symptom that varies from one person to another and depends on the condition that’s causing it. To diagnose sciatica, your doctor will first want to get your full medical history.

This includes whether you have had any recent injuries, where you feel the pain, and how the pain feels. They’ll want to know what makes it better, what makes it worse, and how and when it started.

The next step is a physical exam that’ll include testing your muscle strength and reflexes. Your doctor might also ask you to do some stretching and moving exercises to determine which activities cause more pain.

The next round of diagnosis is for people who have dealt with sciatica for longer than a month or have a major illness, such as cancer.

Nerve tests will allow your doctor to examine how nerve impulses are being conducted by your sciatic nerve and learn if there are any abnormalities. These tests may help locate the area involved and the degree to which the impulse is being slowed.

Imaging tests will allow your doctor to get a look at your spine, which will help them determine the cause of your sciatica.

The most common imaging tests used to diagnose sciatica and find its cause are spinal X-rays, MRIs, and CT scans. Normal X-rays will not be able to provide a view of sciatic nerve damage.

An MRI uses magnets and radio waves to create detailed images of your back. A CT scan uses radiation to create detailed images of your body.

Your doctor may order a CT myelogram. For this test, they’ll inject a special dye into your spine to help produce clearer pictures of your spinal cord and nerves.

Treatment options for sciatica

Upon first diagnosis of sciatica, your doctor will likely give you tips for treating your sciatica pain. You should continue your daily activities as much as possible. Lying in bed or avoiding activity can worsen your condition.

Some commonly suggested at-home treatments are described below.

Cold

You can purchase ice packs or even use a package of frozen vegetables.

Wrap the ice pack or frozen vegetables in a towel and apply it to the affected area for 20 minutes per day, several times per day, during the first few days of pain. This will help to reduce swelling and ease pain.

Hot

You can also purchase hot packs or a heating pad.

It’s recommended that you use ice during the first couple of days to reduce swelling. After two or three days, switch to heat. If you continue to have pain, try alternating between ice and heat therapy.

Stretching

Gently stretching your lower back can also be helpful. To learn how to stretch properly, get personal, one-on-one physical therapy or even yoga instruction from a physical therapist or instructor trained to deal with your injury.

Over-the-counter medication

Over-the-counter medications, such as aspirin and ibuprofen, can also help with pain, inflammation, and swelling. Be careful about using aspirin excessively, since it can cause complications, such as stomach bleeding and ulcers.

Regular exercise

The more you stay active, the more endorphins your body releases. Endorphins are pain relievers made by your body. Stick to low-impact activities at first, such as swimming and stationary bicycling.

As your pain decreases and your endurance improves, create an exercise regimen that includes aerobics, core stability, and strength training. A regimen with these components can decrease your risk of future back problems.

Physical therapy

Exercises in physical therapy can help to improve your posture and strengthen your back muscles.

Prescription medication

Your doctor might prescribe muscle relaxers, narcotic pain relief, or antidepressants. Antidepressants can increase your body’s endorphin production.

Epidural steroid medication

Corticosteroid medications are injected into an area called the epidural space, which is the canal that surrounds your spinal cord. Because of side effects, these injections are given on a limited basis.

Surgery

Surgery may be needed for severe pain or situations in which you have lost control of your bowel and bladder or have developed weakness in certain muscle groups of the lower extremity.

The two most common types of surgery are discectomy, in which part of the disk that’s pressing on nerves that make up the sciatic nerve is removed, and microdiscectomy, in which the disk removal is done through a small cut while your doctor uses a microscope.

Alternative treatments

Alternative medicine is growing in popularity. There are a number of alternative remedies for sciatica. These include the following:

  • An acupuncturist can insert sterilized needles at key points to affect the flow of energy in your body. This procedure is virtually painless.
  • chiropractor can manipulate your spine to achieve maximum spinal mobility.
  • A trained professional can induce hypnosis, which is intended to put you in a very relaxed, focused state of mind, allowing you to best receive healthy suggestions and instructions. In the case of sciatic pain, the messages might involve pain relief.
  • massage therapist can apply motion, pressure, tension, or vibration to your body to relieve pressure and pain.

How to prevent sciatica

The following steps can help you prevent sciatica or keep it from occurring again:

  • Exercise often. Strengthening your back muscles and your stomach or core muscles is the key to maintaining a healthy back.
  • Mind your posture. Make sure your chairs offer proper support for your back, place your feet on the floor while sitting, and use your armrests.
  • Mind how you move. Lift heavy objects in the proper way, by bending at your knees and keeping your back straight.

How long does acute and chronic sciatica last?

Sciatica is a pain that starts in the lower back. It travels through the hips and buttocks and down the legs. It occurs when nerve roots that make up the sciatic nerve become pinched or compressed. Sciatica usually affects only one side of the body.

Sciatica can be acute or chronic. An acute episode may last between one and two weeks and usually resolves itself in a few weeks. It’s fairly common to experience some numbness for a while after the pain has subsided. You may also have sciatic episodes a handful of times a year.

Acute sciatica may eventually turn into chronic sciatica. This means the pain exists pretty regularly. Chronic sciatica is a life-long condition. It doesn’t currently respond well to treatment, but the pain from chronic sciatica is often less severe than the acute form.

How to manage sciatic pain

For many people, sciatica responds well to self-care. Rest for a couple of days after a flare-up begins, but don’t wait too long before resuming activity. Long periods of inactivity will actually make your symptoms worse.

Applying hot or cold packs to your lower back may provide temporary relief. You can also try these six stretches to help relieve sciatic pain.

Over-the-counter medication, like aspirin or ibuprofen (Advil), may help reduce inflammation, swelling, and alleviate some of your pain.

If your symptoms are severe and home remedies aren’t reducing your pain, or if your pain is getting worse, see your doctor. They might prescribe medications to relieve your symptoms, such as:

Your doctor may also suggest that you attend physical therapy after your symptoms improve. Physical therapy can help prevent future flare-ups by strengthening your core and back muscles.

You doctor might also suggest steroid injections. When injected into the area surrounding the affected nerve, steroids can reduce inflammation and pressure on the nerve. You can only receive a limited number of steroid injections, though, since there’s a risk of severe side effects.

Surgery may be recommended as a last resort if your pain hasn’t responded to other treatments. It may also be an option if your sciatica is causing loss of bowel or bladder control.

Lifestyle changes

There are some things you can do to prevent future sciatica flare-ups:

  • Exercise regularly to maintain strength in your back.
  • When sitting, maintain a good posture.
  • Avoid bending over to lift heavy objects. Instead, squat down to pick things up.
  • Practice good posture when standing for long periods of time, and wear supportive shoes.
  • Maintain a healthy diet. Obesity and diabetes are risk factors for sciatica.

When to see your doctor

Call your doctor if:

  • your symptoms aren’t improving with self-care
  • the flare-up has lasted longer than a week
  • the pain is more severe than it has been with previous flare-ups or is gradually worsening

Seek emergency medical help if the pain has occurred immediately following a traumatic injury, such as a car accident, or if you’re having trouble controlling your bladder or bowels.

How is sciatica different from back pain?

In sciatica, the pain radiates from the lower back into the leg. In back pain, discomfort remains in the lower back.

There are many other conditions with symptoms similar to sciatica. These include:

This is why it’s important to see your doctor for a full diagnosis. Your doctor can then work with you to create an appropriate treatment plan.

How long does sciatica in pregnancy last?

A 2008 review estimates between 50 and 80 percent of women experience lower back pain in pregnancy, but it’s highly unlikely to actually be sciatica.

Occasionally the position of your baby can add pressure to the sciatic nerve, leading to sciatica. Depending on whether your baby’s position changes, the pain may last for the remainder of your pregnancy, come and go, or disappear. It should fully resolve after your baby is born.

Sciatica in pregnancy doesn’t indicate any problems other than pain and discomfort for the mother. Prenatal massage or prenatal yoga may help relieve some of your discomfort. You can also try one of these other drug-free treatments for sciatica during pregnancy.

Bottom Line:
Sciatica is a painful condition. It can make it more difficult to perform daily tasks. You might have severe pain but relatively infrequent attacks, or you may have less severe but constant sciatic pain.

There are many ways to relieve the symptoms of sciatica. In most cases, the pain is completely alleviated within a couple of weeks.

Talk to your doctor if your symptoms don’t improve with home treatment, last a long time, or you’re having difficulty completing your daily tasks. Your doctor can help come up with a treatment plan that will work for you.

How to ease sciatica without surgery

Sciatica describes pain that radiates down the back of the thigh and into the lower leg. It may be caused by irritation of one or more of the lower spinal nerves. The pain can be mild or severe, and often develops as a result of wear and tear on the lower spine. The good news is that sciatica is most often relieved through conservative methods within a matter of weeks and without requiring surgery. Working to improve your back and core strength while increasing flexibility throughout your hips and lower body will significantly reduce your chances of experiencing lower back pain and other symptoms of sciatica.

Symptoms

The symptoms of sciatica can vary from a mild ache to excruciating pain that radiates along the pathway of your sciatic nerve, which runs from your lower back down past your hips and into each leg. These symptoms can include numbness, tingling sensations, or muscle weakness that travels down the back of your thigh and into your calf or foot. It’s often worse with coughing or sneezing. Typically, people affected with sciatica will experience symptoms on only one side of the body. Although the pain may be severe, sciatica can most often be relieved through physical therapy, chiropractic and massage treatments, improvements in strength and flexibility, and the application of heat and ice packs.

Risk factors

There are many factors that can leave you susceptible to sciatica, which affects both athletes and those who are less active. People who lead a sedentary lifestyle are more likely to develop sciatica than active people. However, endurance athletes are also prone to experiencing sciatica from overworked and stiff muscles.

Age is also a significant factor, as those between the ages of 30 and 60 often experience age-related degeneration in their spine, including herniated disksbone spurs, and joint dysfunction in the hips. Obesity and diabetes are other common contributors, according to the Mayo Clinic.

The good news

A physical therapist can help you to determine whether sciatica can be relieved through conservative methods such as chiropractic adjustments, static stretching, and cold therapy. Most people respond well to simple techniques and are pain-free within a matter of weeks. Chiropractic adjustments and massage therapy may help improve the alignment of your spine and address other underlying conditions while also improving blood circulation and muscle relaxation. Minor pain can also be treated with the application of heat and cold.

While some doctors may recommend surgery as a treatment for sciatica after noninvasive measures have failed, experts say it’s not always the right choice for everyone. In fact, according to the Cleveland Clinic, nearly 50 percent of people with sciatica report their symptoms improving within 1.5 months of their diagnosis. Nonsurgical treatments may include a longer period of recovery. However, surgery comes with its own risks, which include infection and blood clots. It’s important to talk with your doctor about your sciatica to determine which treatment is best for you.

Improve core and back strength

The musculature around your spine and abdomen may be weak or overly tight, preventing it from supporting your body as needed. Poor posture and compromised muscles can impact the alignment of your spine, increasing your risk for lower back pain and sciatica. Gentle strengthening exercises that target your core and back will improve your posture and ability to respond to stress, reducing the likelihood and severity of back pain. While you’re recovering from sciatica, you may want to avoid high-impact exercises, such as running and plyometrics.

Increase hip and hamstring flexibility

Stiff hamstrings, glutes, and hips can alter your posture and increase the stress on your lower back, which may contribute to sciatica. Most types of sciatica will benefit significantly from a stretching routine that targets the hips and hamstrings and relieves an overused or inflamed piriformis muscle. The piriformis is a small muscle that attaches at the base of the spine and runs just above the sciatic nerve. Prolonged inactivity or sitting compresses the piriformis over the sciatic nerve, which can lead to aggravation and pain. Reverse the effects of tight hips and hamstrings by adopting a simple stretching routine or incorporating yoga into your overall fitness regimen.

Here are two ways to stretch your piriformis muscle and relieve pain.

Stretch 1

  1. Lie on your back with both of your knees bent and your feet on the ground.
  2. Lift one leg and cross it just above your knee.
  3. Hold the thigh of the leg with the foot on the ground and pull up to your chest until you can feel the stretch in your buttocks.
  4. Hold for 10 to 30 seconds.
  5. Repeat on the opposite side.

Stretch 2

  1. Lie on your back with both legs straight out.
  2. Hold one knee with your opposite hand and pull your knee up and over to the opposite shoulder.
  3. Hold for 10 to 30 seconds.
  4. Repeat on the opposite side.

Medications

Physical therapy is often the first line of treatment for sciatica. However, if your symptoms don’t improve, your doctor may recommend you take medications. The most common types of drugs prescribed for sciatica pain include:

Anti-inflammatory drugs can reduce inflammation and sciatica symptoms. They can include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). They also include COX-2 inhibitors, which stop pain by blocking hormones in the body.

Muscle relaxants loosen muscles tightened up by sciatica, and narcotics help to ease sciatica pain. Epidural steroidal injections can also reduce pain. With this option, a corticosteroid and anesthetic numbing drug are inserted into the space between two vertebrae.

Tricyclic antidepressants and antiseizure medications can sometimes effectively treat sciatica, although it’s not their primary purpose.

Off-label drug use is when a drug that’s been approved by the U.S. Food and Drug Administration (FDA) for one purpose is used for a different purpose that it hasn’t been approved for. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

Chiropractic, massage, and acupuncture treatments

Alternative treatments for sciatica can also provide some pain relief. A chiropractor can adjust your spine in a way that increases spinal movement, which improves spine function and decreases pain. Chiropractic treatment can also relieve lower back pain caused by sciatica, but is less effective for radiating pain.

You may have tight muscles as a result of sciatica pain. Massage can help loosen up your muscles, alleviating some pain and improving mobility and flexibility.

Some research suggests that acupuncture can help relieve sciatica. If you’re interested in acupuncture, be sure to visit a licensed practitioner.

Using cold and heat to alleviate sciatica pain

When you first start experiencing sciatica pain, applying a cold pack can provide a lot of relief. Wrap a cold pack or a bag of frozen peas in a clean towel, and apply it to the painful area a few times a day for up to 20 minutes each time.

If your sciatica is still bothering you after a few days, then it can be helpful to try heat instead. Apply a heat lamp on the lowest setting, a hot pack, or a heating pad to the painful area.

If your pain persists, try alternating between cold packs and hot packs.

Bottom Line:
Sciatica is a painful condition that can make everyday life more challenging. The good news is that there are a lot of ways to treat it, and many of them are quite effective at reducing symptoms. Talk with your doctor to determine which treatments are best for you.

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Written by Becky Young — Updated on August 25, 2020
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