Sciatica

sciatic man hands on lower back pain

What you need to know about sciatica and back pain

What is sciatica?

The sciatic nerve is a major nerve that begins deep in the lower back, runs through the hip and deep into each buttock before traveling down each leg.

Sciatica occurs when there is significant pressure on one or more of the lumbar nerve roots, causing pain. Sciatica is not a diagnosis as much as it is a description of symptoms.

Pressure on the sciatic nerve can be caused by a variety of conditions including; herniated disc spinal stenosis, degenerative disc disease, spondylolisthesis, or other abnormalities of vertebrae.

Medical professionals may also refer to sciatica as radiculopathy - a medical term used to describe pain, numbness, tingling, and weakness in the arms or legs caused by a nerve root problem.

 
 

woman black cropped yoga pants holds back of thigh sciatica pain

Back pain vs. sciatica

Depending on where the sciatic nerve is being compressed, the pain can originate either deep inside the buttock, or even close to the spine. This can make it difficult to differentiate sciatica from other types of lower back pain. Additionally, sciatica can be a complication of other underlying lower back and pelvis conditions – and these may also cause pain in the upper and middle back.

So often, the strongest indicators that you are specifically experiencing sciatica is tingling or pain traveling down one or both legs.


young man at desk lower back pain

What are the symptoms of sciatica?

Sciatica symptoms can vary widely and include tingling, numbness, or pain that radiates to the buttocks, legs, and feet. Sciatica sensations can vary from a mild tingling, dull ache, to a deep burning pain. In some cases, the pain is severe enough to cause mobility issues.

Common symptoms of sciatica include:

  • Constant pain in only one side of the buttock or leg (rarely in both legs)
  • Lower back pain
  • Hip pain
  • Pain in the buttocks that gets worse when sitting
  • Tingling or burning sensation running down a leg
  • Weakness or numbness in the leg
  • Pain that shoots through the hip and leg when standing up

In most cases, sciatic pain originates deep inside one of the buttocks and then radiates down the legs and feet. Some people experience a sharp pain in one part of the leg or hip and numbness in other parts. The affected leg may also feel weak or cold.

Pain from sciatica often starts slowly, but can worsen depending where the pressure sits on the nerve and if there is increasing inflammation. Sciatic pain may be exacerbated at night, after standing/sitting for long periods, when sneezing, coughing or laughing or from other exertions on the hips.

Sciatic pain typically lasts less than six weeks, unless there are more serious underlying conditions. Pain that lasts longer than four weeks, or worsens from sitting, coughing, sneezing, or straining may require a longer recovery.


skeleton spine pen points to herniated or lumbar bulging disc

Four common causes of sciatica

There are several low back disorders that can cause or contribute to sciatica.

1. Piriformis syndrome

The piriformis muscle, which attaches the lower part of the spine to the hipbone and sits right on top of the sciatic nerve, is one of the most common causes of sciatica. Piriformis syndrome develops when the piriformis muscle spasms, or is inflamed and compresses the sciatic nerve.

2. Trauma

Traumatic sciatica results from direct nerve compression caused by external forces to the lumbar or sacral spinal nerve roots. Falls, motor vehicle accidents and sports injuries can all be possible causes of sciatica. Traumatic impact can injure the nerves, or broken bone fragments can compress the nerves. 

3. Herniated or lumbar bulging disc

A bulging or herniated disc is when the gel-like material within the spinal disc either expands like a balloon, or bursts. As a result, there is the possibility that the disc material will press against an adjacent nerve root and compress delicate nerve tissue, causing sciatic pain.

In the case of a herniated disc,  there is compression of the nerve root and the disc material contains hyaluronic acid that causes further nerve inflammation.

4. Spondylolisthesis

Spondylolisthesis is when one vertebra slips forward over an adjacent vertebra, causing a spinal nerve root compression that produces sciatic leg pain. Spondylolisthesis is usually developmental (from birth or developing during childhood) but can result from spinal degeneration, trauma or physical stress.


massage lower back for sciatica pain

What are the treatments for sciatica

Sciatica most often develops over time but can be caused by a single traumatic event. The vast majority of sciatica symptoms improve after a few weeks or months without surgical intervention. For some however, the leg pain can be severe and debilitating.

If you believe you are experiencing sciatica, it is recommended to see a healthcare professional, both to determine an appropriate pain management/reduction plan – but also to ensure it’s not a more serious medical issue.

Because there are many potential causes of sciatic nerve compression, treatment options vary and can be very different for individual patients.

A combination of the following treatments is often the most effective for patients experiencing sciatica:

  • Physiotherapy is the most common treatment for sciatica
  • Alternating ice massage and heat therapy can relieve acute sciatica pain
  • Anti-inflammatory medications such as non-steroidal anti-inflammatory drugs (NSAIDs, i.e. ibuprofen, naproxen or COX-2 inhibitors) or oral steroids can be used, but only under doctor supervision
  • Epidural (lower back) steroid injections can reduce inflammation around the nerve root and the associated low back pain
  • Surgery may also be considered, typically (but not always) following a course of more conservative treatments

Although it is always recommended to seek the support of a medical professional, you may find that exercise, nutrition and general activity are great ways to keep sciatica at bay or help reduce its impact on your life.