The scoop on sciatica pain
Fun fact: The sciatic nerve is the largest nerve in the human body. It runs from the lower back down each side of your body, along the back of the hips, butt cheeks, and knees, down the back of the calf, and into the foot. It provides both sensory and motor nerve function to the legs and feet.
Not-so-fun fact: Sometimes this nerve can get compressed in the spine at one of the roots—where it branches off the spinal cord—and cause pain that radiates down the length of the nerve. This is a dreaded condition known as sciatica. It is estimated that between 10 and 40 percent of people will experience sciatica in their lifetime.
"Sciatica is the body telling you the sciatic nerve is unhappy," says E. Quinn Regan, MD, a board-certified orthopaedic surgeon at the Illinois Bone & Joint Institute. "When the nerve is compressed at the root, it becomes inflamed, causing symptoms," Dr. Regan says. These symptoms can range from mild to debilitating.
While sciatica can often resolve on its own, easing symptoms and feeling better usually requires some attention and careful behaviour modifications. Rarely, you may need more medical intervention to recover fully.
Here's everything you need to know about sciatica, including symptoms, how it's diagnosed, how it's treated, and what you can do to prevent it from recurring.
Symptoms of sciatica
Sciatica is quite literally a pain in the butt. The tell-tale symptom of sciatica is pain that radiates along the nerve, usually on the outside of the butt cheek and down the back of the leg. It usually only happens on one side of the body at a time. Sciatica doesn't necessarily cause lower back pain, though it can.
Dr. Regan says that people with sciatica describe the pain as electric, burning, or stabbing, and in more severe cases, it can also be associated with numbness or weakness in the leg. If sciatica causes significant muscle weakness, to the point of losing function, and/or the pain is so bad you can't function, it's time to get immediate help, Dr. Regan says.
Another symptom that warrants a trip to the ER and immediate medical intervention: bowel or bladder incontinence. "That means there's a massive compression, and the pressure is so severe it's harming the nerves that go to the bowel and bladder," says Brian A. Cole, MD, a board-certified orthopaedic surgeon and owner of Englewood Spine Associates in New Jersey. This is rare, but when it happens, it's imperative to decompress the nerve immediately, he says.
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The main causes of sciatica
The most common cause of sciatica is a herniated or slipped disc. A herniated or slipped disc happens when pressure forces one of the discs that cushion each vertebra in the spine to move out of place or rupture. Usually it's caused when you lift something heavy and hurt your back, or after repetitive bending or twisting of the lower back from a sport or a physically demanding job.
Sciatica also can be caused by:
- a bone spur (osteophyte), which can form as a result of osteoarthritis
- narrowing of the spinal canal (spinal stenosis), which happens with normal wear-and-tear of the spine and is more common in people over 60
- spondylolisthesis, a condition where one of your vertebrae slips out of place
- a lower back or pelvic muscle spasm or any sort of inflammation that presses on the nerve root
Some people are born with back problems that lead to spinal stenosis at an earlier age. Other potential, yet rare, causes of sciatic nerve compression include tumours and abscesses.
Something known as piriformis syndrome can also cause sciatica-like symptoms, though it is not considered true sciatica. The piriformis is a muscle that runs along the outside of the hip and butt and plays an important role in hip extension and leg rotation.
Piriformis syndrome is an overuse injury that's common in runners, who repetitively strain this muscle, leading to inflammation and irritation. Because the muscle is so close to the sciatic nerve, piriformis syndrome can compress the nerve and cause a similar tingling, radiating pain as sciatica. The difference is that this pain is not caused by compression at the nerve root, but rather, irritation or pressure at some point along the length of the nerve.
Sciatica risk factors
Anyone can end up with a herniated disc and ultimately sciatica, but some people are more at risk than others. The biggest risk factor is age. "The discs begin to age at about age 30, and when this happens they can develop defects," Dr. Regan says. These defects slowly increase the risk of a disc slipping or rupturing.
Men are three times more likely than women to have a herniated disc, Dr. Regan says. Being overweight or obese also increases your chance of injuring a disc. A physically demanding job, regular strenuous exercise, osteoarthritis in the spine, and a history of back injury can also increase your risk. Sitting all day doesn't help either, Dr. Cole says. "You put more stress on your back biomechanically sitting than anything else you do."
Certain muscle weaknesses and imbalances can also make you more prone to disc injury and, consequently, sciatica. "People with weak core muscles and instability around the spine might be more prone to this since the muscles need to stabilize the joints of the vertebrae in which the nerves exit," says Theresa Marko, a board-certified orthopaedic physical therapist in private practice in New York City.
How sciatica is diagnosed
If your symptoms suggest sciatica, your doctor will do a physical exam to check your strength, reflexes, and sensation. A test called a straight leg raise can also test for sciatica, Dr. Regan says. How it's done: Patients lie face up on the floor, legs extended, and the clinician slowly lifts one leg up. At a certain point, it may trigger sciatica symptoms. (The test can also be done sitting down.)
Depending on how severe the pain is and how long you've had symptoms, doctors may also do some scans (MRI or CT) on your spine to figure out what's causing the sciatica and how many nerve roots are impacted.
Scans can also confirm there isn't something else mimicking the symptoms of sciatica. Muscle spasms, abscesses, hematomas (a collection of blood outside a blood vessel), tumours, and Potts disease (spinal tuberculosis) can all cause similar symptoms.
Managing mild to moderate sciatica
Resting, avoiding anything that strains your back, icing the area that hurts, and taking nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen, are the first-line treatment options for sciatica, Dr. Regan says. If you have a physically demanding job that requires you to lift heavy things, taking some time off, if at all possible, will help.
While it's important to avoid activities that might make things worse, you do want to keep moving, says Marko. "Research now advises against bed rest. You want to move without overdoing it."
A physical therapist can help you figure out what movements are safe and beneficial to do. For example, certain motions—squatting, performing a deadlift, or doing anything that involves bending forward at the waist—can be really aggravating. Light spine and hamstring stretching, low-impact activities like biking and swimming, and core work can help. "In general, we need the nerve to calm down a bit and to strengthen the muscles of your spine, pelvis, and hips," Marko says.
"Within a week to 10 days, about 80 percent of patients with mild to moderate sciatica are going to be doing much better," Dr. Regan says. Within four to six weeks, you should be able to return to your regular activities—with the caveat that you'll need to be careful about straining your back to avoid triggering sciatica again.
Treating severe sciatica
If you're trying the treatment options for mild to moderate sciatica and your symptoms worsen or just don't get better, you may need a higher level of treatment.
If OTC pain relievers aren't cutting it, your doctor may prescribe a muscle relaxant like cyclobenzaprine (Flexeril).
An epidural steroid injection near the nerve root can reduce inflammation and provide a huge relief for some people with sciatica. The results are varied, and some people may need more than one injection to really feel relief.
Surgery is usually a last resort, only considered once all of the conservative and minimally invasive options have been exhausted. Dr. Regan notes that a small percentage of people with sciatica end up needing surgery—these are usually patients who have severe enough sciatica that their primary care doctors have referred them to spinal specialists. And only about a third of patients who see spinal specialists may end up having surgery, he says.
Surgeries to relieve disc compression are typically quick and done on an outpatient basis, according to Dr. Cole.
Preventing sciatica in the future
"Once you have a back issue, you have a higher chance of having a back issue in the future," Dr. Regan says. Which means that your first bout of sciatica isn't likely to be your last. It's important to adopt a healthy lifestyle to reduce the risk of sciatica striking again.
Building core strength is key. "Think of your midsection as a box, and you need to target all sides," Marko says. "By this, I mean abdominals, obliques, diaphragm, pelvic floor, glutes, and lateral hip muscles." These muscles all support the spine, so the stronger they are, the better the spine can handle whatever is thrown its way.
If there's an activity you enjoy that aggravates your back, ditch it for an alternative. For example, running can trigger back pain and sciatica in some people, Dr. Regan says. If you're prone to it, try a new form of cardio that's gentler on your back, like swimming, biking, or using the elliptical. Even just logging fewer miles per week can help reduce your risk.
Dr. Regan also recommends making sure you learn how to weight train properly. Lifting with the best form possible, learning your limits, and reducing weight when you need to will help keep your back safe from disc injuries.
Making small changes to your daily life and workouts can help keep your back healthy and minimize the time you have to waste dealing with sciatica in the future.
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