What is Sciatica?

Sciatica is the pain that begins in the lower back, radiating into the buttocks and down the back of one leg. Pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs or muscle strain. Sciatica pain typically improves with exercise, rest, and other self-care measures. Chronic pain that continues despite treatment may be helped with surgery to relieve the underlying cause.

Leg pain ranges from mild to severe, and can be acute or chronic:

• Acute sciatic pain – occurs suddenly and usually heals within several days to weeks. The severity relates directly to the amount of tissue injury. The source of pain may be in the spinal joints, discs, nerves, or muscles and ligaments.
• Chronic sciatic pain – persists for more than 3 months and its source may be hard to determine. Chronic pain may be felt all the time or worsen with certain activities. Contributing factors may include nerve damage, tissue scarring, arthritis, or mental effects of pain. People with chronic symptoms may be referred to a pain specialist.

Causes of Sciatica

Sciatica can be caused by a number of conditions that irritate or compress the sciatic nerve:

• Piriformis syndrome – tightening or spasm of the piriformis muscle can compress the nerve.
• Trauma – a sports injury or fall can fracture the spine or tear a muscle and damage nerves.
• Herniated disc – the gel-like center of a spinal disk can bulge or rupture through a weak area in the disc wall and compress nerves.
• Stenosis – narrowing of the bony canals in the spine can compress the spinal cord and nerves.
• Osteoarthritis – as discs naturally age, they dry out and shrink. Small tears in the disc wall can be painful, bone spurs can form, and the facet joints enlarge, and ligaments thicken.
• Spondylolisthesis – a weakness of stress fracture in the facet joints can allow a vertebra to slip out of position and pinch the nerves.

Symptoms of Sciatica

Classic sciatic pain starts in the low back and buttocks. It affects one leg traveling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling can occur in your leg and foot. This is usually not a concern unless you have weakness in your leg muscles or foot drop.

Sitting is the most common cause of pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may feel better than sitting or standing for too long.

Diagnosis and Treatment of Sciatica

A careful medical exam will determine the type and the cause of your spine problem and the treatment options. A diagnostic evaluation includes a medical history and physical exam. Your provider may need imaging scans, like X-ray or MRI to check muscle strength and reflexes.

Your provider may explore noninvasive treatments before considering surgery. These can include:

• Self-care – including rest, ice, heat, massage, or pain relievers.
• Medication – such as anti-inflammatories, antidepressants, corticosteroids or opioids.
• Steroid injection – injected into the area around the nerve root to help reduce pain. 
• Physical therapy – includes exercises to correct posture, strengthen core, and improve range of motion.

Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or a severe pain that has not resolved after a reasonable course of nonsurgical treatment. Surgery for a herniated disc, called a discectomy, removes a portion of the disc that is compressing the spinal nerve. People with stenosis may benefit from a decompression of the nerves.

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