What is sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. The pain often begins in the low back and travels down the buttocks and leg. Sometimes it feels like a bad leg cramp, but generally it is more sharp and shooting. Anything that causes irritation or compression of the sciatic nerve can cause sciatica. Common causes include a herniated disc, degenerative disc disease, spinal stenosis, piriformis syndrome, and pregnancy.
What are the symptoms of sciatica?
The most common symptoms of sciatica include:
- Pain in the rear or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the rear
- A shooting pain that makes it difficult to stand up
Sciatica usually affects only one side of the lower body. The pain often radiates from the lower back all the way through the back of the thigh and down the leg. It may feel like a bad leg cramp or sore muscle. Some people describe it as a jolt or shock of pain that shoots down the leg. Others come to know the pain gradually over time.
When should I see a doctor for sciatica?
You should see a doctor if you have signs or symptoms of sciatica, such as:
- Persistent pain that lasts more than a week or gets worse
- Numbness or muscle weakness in your leg or foot
- Loss of bladder or bowel control, indicating possible nerve damage (cauda equina syndrome)
See your doctor immediately if you experience:
- Sudden, severe pain in your low back or leg
- Numbness in your inner thighs or groin area
- Progressive leg or foot weakness
These symptoms could indicate a serious medical condition that requires emergency care. Seek prompt medical attention if your sciatica progressively worsens or is not improving.
What tests are done for sciatica?
Your doctor will begin by reviewing your medical history and performing a physical exam. Be prepared to describe your symptoms in detail, including when they started and what makes the pain better or worse.
Tests that can help pinpoint the cause of sciatica include:
- Reflex, sensation, and motor tests – These assess nerve function and muscle strength.
- Straight leg raise test – This checks for lumbar radiculopathy. Pain when lifting your straight leg up off the examining table can indicate nerve root irritation.
- Imaging studies – X-rays, CT scans or MRIs provide pictures of your spine to check for problems with your vertebrae, discs, spinal cord or nerves.
- Electromyography – Needles and electrodes are inserted into the muscles to measure how your nerves respond. This can detect nerve dysfunction.
Your doctor may order blood tests to check for underlying health conditions. Diagnostic injections may also be used to find the irritated nerve.
What are the treatment options for sciatica?
The main treatments for sciatica are:
Medications
Over-the-counter pain relievers like ibuprofen (Advil, Motrin IB) or naproxen (Aleve) can provide short-term relief. Your doctor may prescribe muscle relaxants or anti-inflammatory drugs. Antidepressants and anticonvulsants used for nerve pain can also be effective.
Cold and heat
Ice packs or a heating pad may relieve discomfort. Try alternating hot and cold. Avoid applying ice directly to your skin.
Exercise and physical therapy
Specific exercises and stretches can help strengthen your back and leg muscles, improving mobility and reducing pressure on your sciatic nerve. A physical therapist can provide an individualized exercise program.
Spinal injections
Epidural steroid injections deliver anti-inflammatory medicine directly into your spinal canal. They can temporarily relieve inflammation and pain.
Acupuncture
Fine needles are inserted into specific points along the body. This is thought to relieve pain and improve overall well-being. More research is needed on acupuncture for sciatica.
Surgery
If your symptoms are severe or other treatments do not help, your doctor may recommend surgery to alleviate pressure on your sciatic nerve. Common procedures include:
- Microdiscectomy – Removing a herniated portion of a disc
- Laminectomy – Removing a small section of bone to enlarge the spinal canal
- Discectomy – Removing an entire herniated disc
When is surgery needed for sciatica?
Most people improve with nonsurgical sciatica treatments, but surgery may be an option if you have:
- Unbearable or progressively worsening nerve pain
- Persistent weakness or numbness in your leg
- Bladder or bowel dysfunction
- No improvement with other therapies
Surgery for sciatica involves removing whatever is compressing or irritating the sciatic nerve roots. The most common causes of nerve compression that require surgery are:
Herniated discs
Discs act as cushions between your vertebrae. A herniated disc occurs when its jelly-like center pushes against the nerve. Symptoms result when the herniation compresses a nerve root.
Bone spurs
Extra bone growths (spurs) can form along the spine. Bone spurs that develop on the vertebrae can press against the nerves.
Spinal tumors
Noncancerous (benign) or cancerous (malignant) tumors that develop inside the spinal cord, or tumors extending into the spine, may irritate spinal nerves.
Spinal stenosis
This condition causes narrowing of your spinal canal, compressing the nerves. Surgery can enlarge the passageway to relieve pressure.
Conclusion
Sciatica often goes away within a few weeks using nonsurgical treatments like anti-inflammatory medications, exercise, physical therapy or spinal injections. See your doctor promptly if pain persists or you have any numbness, tingling or weakness in your leg. Surgery may be needed for an identifiable cause of nerve compression, like a herniated disc or bone spur, that does not improve with conservative treatment. Always talk to your doctor about the risks and benefits of any procedures.