Sciatica

Medically Reviewed by Dany Paul Baby, MD on February 15, 2023

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from your lower back down the back of each leg.

The telltale sign of sciatica is pain that starts in your lower back and shoots down one leg, sometimes all the way into your foot. It can happen with an injury or just with the wear and tear of aging. Certain conditions can make it worse.  There are treatments for it.


 

Common symptoms of sciatica include:

  • Lower back pain
  • Pain in the rear or leg that is worse when sitting
  • Hip pain
  • Burning or tingling down the leg
  • Weakness, numbness, or a hard time moving the leg or foot
  • A constant pain on one side of the rear
  • A shooting pain that makes it hard to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of your thigh and down through your leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. The pain may worsen when you cough or sneeze.

For some people, the pain from sciatica can be severe and disabling. For others, the sciatica pain might be infrequent and irritating but has the potential to get worse.

Seek medical attention right away if you have:

  • Fever and back pain
  • Swelling or redness in your back or spine
  • Pain that moves down your legs
  • Numbness or weakness in the upper thighs, legs, pelvis, or bottom
  • Burning when you pee or blood in your pee
  • Serious pain
  • Loss of bladder or bowel control (leaking or not being able to make it to the toilet in time)

 

Sciatica results from irritation of the root(s) of your lower lumbar and lumbosacral spine.

A herniated disk causes most cases of sciatic pain.

Other common causes of sciatica include:

  • Lumbar spinal stenosis (narrowing of the spinal canal in your lower back)
  • Degenerative disk disease (breakdown of disks, which act as cushions between the vertebrae)
  • Spondylolisthesis (a condition in which one vertebra slips forward over another one)
  • Pregnancy
  • Muscle spasm in the back or buttocks

Risk factors, or things that may make you more likely to develop sciatica, include

  • Aging (which can cause changes in the spine, like bone spurs or herniated disks)
  • Diabetes
  • Being overweight
  • Not exercising regularly and not having strong muscles in your core (your glutes, abs, and back)
  • Wearing high heels
  • Sleeping on a mattress that is too hard or too soft
  • Smoking
  • Your job,  if it involves sitting or driving for long periods of time, twisting your back, or carrying heavy things

If you've had an injured lower back or spine, that can also make sciatica more likely.

The first thing your doctor probably will do is ask questions about your back pain: Do you have numbness or weakness in your legs? Do certain positions help your discomfort? Has the pain kept you from doing any activities? Have any home remedies eased your pain at all?

They will also want to know about your lifestyle: Do you do a lot of physical work, like heavy lifting? Do you sit for long periods of time? How often do you exercise?

You'll also get a physical exam so they can check your reflexes and see how strong your muscles are. They might have you do certain activities, like walking on your heels or toes, to see what’s causing your pain.

If your pain is severe, the doctor might order imaging tests to check for bone spurs and herniated disks. You could get tests like:

  • X-ray, which makes pictures of the inside of your body, to check for bone spurs (growths of normal bone)
  • CT scan, which combines a series of X-rays to get a better look at your spinal cord and spinal nerves
  • MRI, which uses radio waves and magnets to create pictures of your insides to get a detailed look at your back and spine
  • Electromyography (EMG), which measures how fast nerve signals travel through your muscles. This is to see if a herniated disk is compressing nerves that control muscles.  (A herniated disk is a torn or leaky disk between vertebrae in your spine. You may also hear it called a "slipped," "ruptured," or "bulging" disk.)

If those tests are inconclusive, you may need additional imaging.

Most people with sciatica feel better after self-care activities or at-home remedies like:

  • Using cold or hot packs
  • Stretching
  • Taking over-the-counter pain medication

If your pain isn’t getting better, your doctor might suggest other options.

Medication

Your doctor might recommend medication, such as:

  • Anti-inflammatory medications
  • Anti-seizure medications
  • Muscle relaxants
  • Opioids
  • Antidepressants

Physical therapy

A physical therapist can show you how to do exercises that will improve your posture and make you more flexible. They’ll also make the muscles that support your back stronger.

Steroid injections

Your doctor might recommend you get steroid injections, like a cortisone shot. They’ll give you a shot that has medicine to help with inflammation around the nerve, which can help reduce your pain. The effects usually last a few months, but they’ll wear off over time.

Acupuncture and treatment by a chiropractor are other treatments that also may be helpful. 

Surgery

If you have extreme pain that doesn’t get better, weakness, or a loss of bladder or bowel control, your doctor might recommend surgery. They’ll take out the bone spur or herniated disk that’s pressing on your nerves and causing your pain. The conversation about surgery will start only after you’ve tried nonsurgical treatments.
 

Show Sources

Photo Credit:

EyeEm/Getty Images

 

SOURCES: 

Cleveland Clinic.

Penn Medicine: “Sciatica.”

Mayo Clinic: “CT scan,” “Electromyography (EMG),” ”MRI,” “Sciatica,” “X-ray," "Sciatica."

The American Journal of Medicine: “The Effect of Smoking on the Risk of Sciatica: A Meta-analysis.”

Cedars-Sinai: "Bone Spurs."

Cleveland Clinic: "Herniated Disk (Slipped, Ruptured or Bulging Disk)."

Mayo Clinic: "Sciatica."

 

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