Sciatica pain is caused by an irritation, inflammation, pinching or compression of a nerve in the lower back. The most common cause is a herniated or slipped disk that causes pressure on the nerve root. Most people with sciatica get better on their own with time and self-care treatments.
What is sciatica?
Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. The sciatic nerve is the longest and thickest (almost finger-width) nerve in the body. It’s actually made up of five nerve roots: two from the lower back region called the lumbar spine and three from the final section of the spine called the sacrum. The five nerve roots come together to form a right and left sciatic nerve. On each side of your body, one sciatic nerve runs through your hips, buttocks and down a leg, ending just below the knee. The sciatic nerve then branches into other nerves, which continue down your leg and into your foot and toes.
True injury to the sciatic nerve “sciatica” is actually rare, but the term “sciatica” is commonly used to describe any pain that originates in the lower back and radiates down the leg. What this pain shares in common is an injury to a nerve -- an irritation, inflammation, pinching or compression of a nerve in your lower back.
If you have “sciatica," you experience mild to severe pain anywhere along the path of the sciatic nerve – that is, anywhere from the lower back, through the hips, buttocks and/or down your legs. It can also cause muscle weakness in your leg and foot, numbness in your leg, and an unpleasant tingling pins-and-needles sensation in your leg, foot and toes.
People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as “burning,” "electric” or “stabbing.”
The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. A forced and sudden body movement, like a cough or sneeze, can also make the pain worse.
Sciatica can come on suddenly or gradually. It depends on the cause. A disk herniation can cause sudden pain. Arthritis in the spine develops slowly over time.
Sciatica is a very common complaint. About 40% of people in the U.S. experience sciatica sometime during their life. Back pain is the third most common reason people visit their healthcare provider.
You are at greater risk of sciatica if you:
Have an injury/previous injury: An injury to your lower back or spine puts you at greater risk for sciatica.
Live life: With normal aging comes a natural wearing down of bone tissue and disks in your spine. Normal aging can put your nerves at risk of being injured or pinched by the changes and shifts in bone, disks and ligaments.
Are overweight: Your spine is like a vertical crane. Your muscles are the counterweights. The weight you carry in the front of your body is what your spine (crane) has to lift. The more weight you have, the more your back muscles (counterweights) have to work. This can lead to back strains, pains and other back issues.
Lack a strong core: Your “core” are the muscles of your back and abdomen. The stronger your core, the more support you’ll have for your lower back. Unlike your chest area, where your rib cage provides support, the only support for your lower back is your muscles.
Have an active, physical job: Jobs that require heavy lifting may increase your risk of low back problems and use of your back, or jobs with prolonged sitting may increase your risk of low back problems.
Lack proper posture in the weight room: Even if you are physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting or other strength training exercises.
Have diabetes: Diabetes increases your chance of nerve damage, which increases your chance of sciatica.
Have osteoarthritis: Osteoarthritis can cause damage to your spine and put nerves at risk of injury.
Lead an inactive lifestyle: Sitting for long period of time and not exercising and keeping your muscles moving, flexible and toned can increase your risk of sciatica.
Smoke: The nicotine in tobacco can damage spinal tissue, weaken bones, and speed the wearing down of vertebral disks.
First, your healthcare provider will review your medical history. Next, they’ll ask about your symptoms.
During your physical exam, you will be asked to walk so your healthcare provider can see how your spine carries your weight. You may be asked to walk on your toes and heels to check the strength of your calf muscles. Your provider may also do a straight leg raise test. For this test, you’ll lie on your back with your legs straight. Your provider will slowly raise each leg and note the point at which your pain begins. This test helps pinpoint the affected nerves and determines if there is a problem with one of your disks. You will also be asked to do other stretches and motions to pinpoint pain and check muscle flexibility and strength.
Depending on what your healthcare provider discovers during your physical exam, imaging and other tests might be done. These may include:
Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.
Magnetic resonance imaging (MRI) or computed tomography (CT) scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.
Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.
Myelogram to determine if a vertebrae or disk is causing the pain.
The good news about sciatic pain is that it usually goes away on its own with time and some self-care treatments. Most people (80% to 90%) with sciatica get better without surgery, and about half of these recover from an episode fully within six weeks.
Be sure to contact your healthcare provider if your sciatica pain is not improving and you have concerns that you aren’t recovering as quickly as hoped.
Get immediate medical attention if you experience:
Severe leg pain lasting more than a few hours that is unbearable.
Numbness or muscle weakness in the same leg.
Bowel or bladder control loss. This could be due to a condition called cauda equina syndrome, which affects bundles of nerves at the end of the spinal cord.
Sudden and severe pain from a traffic accident or some other trauma.
Even if your visit doesn’t turn out to be an emergency situation, it’s best to get it checked out.
No, the sciatic nerve is not the only source of what is generally called “sciatica” or sciatica pain. Sometimes the source of pain is higher up in the lumbar spine and causes pain in front of the thigh or in the hip area. This pain is still called sciatica.
Hip problems, such as arthritis in the hip, usually cause groin pain, pain when you put weight on your leg, or when the leg is moved around.
If your pain starts in the back and moves or radiates towards the hip or down the leg and you have numbness, tingling or weakness in the leg, sciatica is the most likely cause.
Radiculopathy is a broader term that describes the symptoms caused by a pinched nerve in the spinal column. Sciatica is a specific type, and the most common type, of radiculopathy.
Some rest and change in your activities and activity level may be needed. However, too much rest, bed rest, and physical inactivity can make your pain worse and slow the healing process. It’s important to maintain as much activity as possible to keep muscles flexible and strong.
Before beginning your own exercise program, see your healthcare provider or spine specialist first to get a proper diagnosis. This healthcare professional will refer you to the proper physical therapist or other trained exercise or body mechanics specialist to devise an exercise and muscle strengthening program that’s best for you.
Sciatica that is caused by a herniated disk, spinal stenosis, or bone spur that compresses the sciatic nerve can cause inflammation – or swelling – in the affected leg. Complications of piriformis syndrome can also cause swelling in the leg.
While all these conditions affect either the spinal cord, nerves, muscles, ligaments or joints and all can cause pain, none are directly related to sciatica. The main causes of these conditions are different. Sciatica only involves the sciatic nerve. That being said, the most similar condition would be carpal tunnel syndrome, which also involves a compression of a nerve.
A final word about sciatica. . . .
Most cases of sciatica do not require surgery. Time and self-care treatment are usually all that’s needed. However, if simple self-care treatments do not relieve your pain, see your healthcare provider. Your healthcare provider can confirm the cause of your pain, suggest other treatment options and/or refer you to other spine health specialists if needed.