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Sciatica Part 1: Symptoms, Causes, Diagnosis, Prevention, Management & Treatment

Sciatica Part 1: Symptoms, Causes, Diagnosis, Prevention, Management & Treatment

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.

What does sciatica pain feel like?

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.

Does sciatica occur suddenly or does it take time to develop?

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.

How common is sciatica?

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.

What are the risk factors for sciatica?

You are at greater risk of sciatica if you:

During a straight leg raise 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.

How is sciatica diagnosed?

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:

OUTLOOK / PROGNOSIS

What can I expect if I have been diagnosed with sciatica?

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.

LIVING WITH

When should I contact my healthcare provider?

Get immediate medical attention if you experience:

Even if your visit doesn’t turn out to be an emergency situation, it’s best to get it checked out.

Is the sciatic nerve the only source of “sciatica” pain?

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.

How can I tell if pain in my hip is a hip issue or 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.

Is radiculopathy the same as sciatica?

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.

Should I rest if I have sciatica?

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.

Can sciatica cause my leg and/or ankle to swell?

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.

Are restless leg syndrome, multiple sclerosis, carpal tunnel syndrome, plantar fasciitis, shingles or bursitis related to sciatica?

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.

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Casey Business Development Coordinator

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