sciatica
Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the lower back through the hips and buttocks and down each leg. Sciatica most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve.
Sciatica happens when irritation, inflammation, pinching or compression affect one or more nerves that run down your lower back and into your legs. It’s usually not a serious or dangerous condition, and most people with sciatica get better on their own with time and self-care treatments. But severe cases may need surgery.
What is sciatica?
Sciatica is nerve pain from an injury or irritation to your sciatic nerve. In addition to pain, it can involve tingling or numbness in your back or butt that may also radiate down your leg. More severe symptoms are also possible.
Your sciatic nerve is the longest and thickest nerve in your body. It’s up to 2 centimeters wide . Despite its name, it’s not just one nerve. It’s actually a bundle of nerves that come from five nerve roots branching off from your spinal cord.
You have two sciatic nerves, one on each side of your body. Each sciatic nerve runs through your hip and buttock on one side. They each go down the leg on their side of your body until they reach just below your knee. Once there, they split into other nerves that connect to parts farther down, including your lower leg, foot and toes.
Having sciatica means you can experience mild to severe pain anywhere with nerves that connect to the sciatic nerve. The symptoms can affect your lower back, hips, buttocks or legs. Some symptoms may extend as far down as your feet and toes, depending on the specific nerve(s) affected.
Types of sciatica
There are two types of sciatica. Regardless of what type you have, the effects are the same. The types are:
- True sciatica. This is any condition or injury that directly affects your sciatic nerve.
- Sciatica-like conditions. These are conditions that feel like sciatica, but happen for other reasons related to the sciatic nerve or the nerves that bundle together to form it.
Healthcare providers tend to refer to both types as just “sciatica.” The differences between them usually only matter when your healthcare provider determines how to treat it.
SYMPTOMS AND CAUSES
symptoms of sciatica?
Sciatica symptoms can include:
- Pain. Sciatica pain happens because of pressure on the affected nerve(s). Most people describe sciatica pain as burning or like an electric shock. This pain also often shoots or radiates down the leg on the affected side. Pain commonly happens with coughing, sneezing, bending or lifting your legs upward when lying on your back.
- Tingling or “pins and needles” (paresthesia). This is similar to the feeling you have when a leg falls asleep because you sat cross-legged.
- Numbness. This is when you can’t feel sensations on the skin in the affected areas of your back or leg. It happens because signals from your back or leg are having trouble reaching your brain.
- Muscle weakness. This is a more severe symptom. It means that muscle command signals are having trouble reaching their destinations in your back or legs.
- Urinary incontinence or fecal incontinence. This is a very severe symptom. It means signals that control your bladder and bowels aren’t reaching their destinations.
What causes sciatica?
Sciatica can happen because of any condition that affects the sciatic nerve. It can also happen because of conditions affecting any of the five spinal nerves that bundle to form the sciatic nerve.
Conditions that can cause sciatica include:
- Herniated disks.
- Degenerative disk disease.
- Spinal stenosis.
- Foraminal stenosis.
- Spondylolisthesis.
- Osteoarthritis.
- Injuries.
- Pregnancy.
- Tumors, cysts or other growths.
- Conus medullas syndrome.
- Cauda equina syndrome.
DIAGNOSIS AND TESTS
How is sciatica diagnosed?
A healthcare provider can diagnose sciatica using a combination of methods. They’ll review your medical history and ask about your symptoms. They’ll also do a physical examination. That exam will include:
- Walking. Sciatica often causes visible changes in how you walk. Your provider will watch for those changes as part of diagnosing sciatica.
- Straight leg raise test. This involves having you lie on an exam table with your legs straight out. They’ll slowly raise your legs one at a time toward the ceiling and ask when you start to feel pain or other symptoms. These can help pinpoint the cause of sciatica and how to manage it.
- Other flexibility and strength checks. These can help your provider determine if any other factors are causing or contributing to your sciatica.
Treating sciatica usually involves trying to decrease pain and increase mobility. Many treatments are things you can do yourself.
There are several treatment options if you have sciatica that won’t go away or is more severe. Surgery might be an option if your case is severe or other treatments don’t help.
Self-treatment
Depending on the cause, milder cases of sciatica usually get better with self-treatment.
NOTE: Pain that’s moderate to severe, with numbness and tingling or muscle weakness are all symptoms that need professional medical care. You shouldn’t try to self-treat them.
Self-treatments can include:
- Ice. Cold or ice packs can help reduce pain and swelling during the first few days after sciatica pain starts. You can use an ice pack or a bag of frozen vegetables for this (but always wrap them in a towel to prevent cold-related injuries to your skin). Apply cold for 20 minutes at a time, several times a day.
- Heat. After the first several days of using cold or ice, switch to a heating pad or warm compress. Apply heat for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs — whichever best relieves your discomfort.
- Over-the-counter medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first choice. They reduce pain, swelling and inflammation.
- Stretching and activity. Learning how to stretch properly from an instructor with experience with low back pain can be a major help. They may also be able to help you work your way up to other general strengthening, core muscle strengthening and aerobic exercises.
If the self-care treatment approach doesn’t help after a few weeks, you should talk to a healthcare provider.
Conservative treatments
Conservative treatments are a step up from self-treatment. Your healthcare provider can offer these as options if self-care wasn’t helpful or if your symptoms are severe enough to need more involved care.
Conservative treatments can involve similar treatments to self-care, but with your healthcare provider guiding you. They can also involve the following:
- Prescription medications. Painkillers, muscle relaxers and other medications may help with sciatica symptoms. Other medications, like tricyclic antidepressants and anti-seizure medications, may also help if you have chronic or nerve-based pain.
- Physical therapy. The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. Options include stretching exercises or low-impact activities like walking, swimming or water aerobics.
- Spinal injections. Injections like corticosteroids may provide short-term relief (typically up to three months). These usually involve local anesthesia, so there’s less discomfort. Your healthcare provider can tell you more about this process.
- Alternative therapies. These treatments are increasingly popular and offer options other than standard medical therapies or medications. They include seeing a chiropractor for spine adjustments, yoga, acupuncture and more. Massage therapy might also help muscle spasms that occur with sciatica. Biofeedback can also help you manage pain and relieve stress.
Surgery options for sciatica
Surgery may be the best option when sciatica is more severe. Usually, healthcare providers don’t recommend surgery unless you have symptoms that indicate nerve damage is happening or imminent. They may also recommend surgery if you have severe pain that prevents you from working or going about your usual routine, or if your symptoms don’t improve after six to eight weeks of conservative treatment.
Surgery options to relieve sciatica include:
- Diskectomy. This is a surgery that removes fragments or small sections of a herniated disk that are pressing on a nerve.
- Laminectomy. Each vertebra has a rear section called the lamina (it’s on the side of the vertebra just underneath the skin of your back). A laminectomy involves removing a section of the lamina that’s pressing on spinal nerves.
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