Is it back pain or sciatica? Here’s what to look for

From clickondetroit.com

A sharp jolt of pain that shoots from your lower back down your leg. A burning or tingling sensation that makes it uncomfortable to sit, stand or sleep. For many people, it’s not ordinary back pain; it could be sciatica.

According to Dr. Mahmoud Sabbagh, a pain management physician at DMC Rehabilitation Institute of Michigan (RIM), sciatica happens when the sciatic nerve becomes irritated or inflamed.

“Something pressing on the nerve can cause pain in the lower back going down the leg,” he explained.

Some people may also experience numbness, tingling, burning, spasms or cramping that feels like a Charlie horse. Symptoms can look different from person to person and don’t always appear all at once.

What causes sciatica?

One of the most common causes Sabbagh sees is a bulging or herniated disc that puts pressure on the sciatic nerve. Arthritis and spinal stenosis -- when the space around the nerve narrows -- can also irritate the sciatic nerve over time. 

Lifestyle and work routines may increase your risk, as well. Sitting for long periods, especially in jobs like trucking, puts pressure on the spine. Lifting heavy objects without proper form, weaker core muscles and carrying extra body weight can also strain the lower back.

As many as 40% of people in the U.S. will have sciatica during their life, and it becomes more frequent as we age.

When to pay attention

Mild cases may improve with rest, stretching or over-the-counter medication.

However, Sabbagh recommended seeing a provider if the pain:

• Lasts more than a few days.
• Doesn’t improve with basic at-home care.
• Starts to affect sleep, mobility or daily routines.

“Waiting too long can make treatment harder and limit options,” he said.

As many as 40% of people in the U.S. will have sciatica during their life, and it becomes more frequent as we age. (Detroit Medical Center)

Treatment options

Care usually begins with the least invasive steps.

“We always begin with the simplest approach,” Sabbagh said.

Treatment may include:

• Avoiding movements that add pressure to the nerve.
• Guided home exercises or physical therapy.
• Over-the-counter anti-inflammatory medication.

If pain makes walking, sitting or standing difficult, a steroid injection may be considered to help reduce inflammation.

One misconception Sabbagh hears often is that injections are something patients will need repeatedly.

“Our goal is always one,” he said.

If symptoms return, the treatment plan is re-evaluated.

Surgery is rare and only explored when other options have not helped.

Why early care matters

Sciatica doesn’t have to become a long-term issue. Recognizing symptoms early and getting evaluated when the pain lingers can make a meaningful difference in comfort, mobility and overall quality of life.

https://www.clickondetroit.com/sponsored/2025/10/21/is-it-back-pain-or-sciatica-heres-what-to-look-for/

Understanding the Last Stages of Sciatica: Symptoms, Treatment Options, and Recovery

From emergeortho.com

Sciatica back pain is a type of pain that begins in the back and often radiates down the leg as it worsens. The last stages of sciatica can be very painful and have a debilitating impact on mobility. Getting expert medical care for sciatica is essential for managing pain, getting relief, and being able to function normally and comfortably.

What Is Sciatica?

Sciatica refers to pain that begins in the lower back and radiates down the leg and even as far as the foot. This is caused by the compression of nerves in the spine that make up the sciatic nerve. These nerves form a bundle in the lower back. Pain from sciatica often begins in the buttocks or hips and then later travels down the leg.

A common cause of classic sciatica is a ruptured, or herniated, disc in the spine. The ruptured part of the disc presses on nerves causing inflammation and pain. The pain is constant, no matter how you move or position yourself.

Thickened bone or bone spurs can also press on the nerves and cause sciatica pain, also known as positional sciatica. This causes pain mostly when standing and walking. You should feel relief when you sit or bend at the waist.

What Are the 4 Stages of Sciatica?

Sciatica does not necessarily progress the same way in all patients. While there are no firmly defined stages of sciatica, it may get worse over time or get better and then recur. Patients may experience:

• Early or Acute Sciatica. In the earliest stage, sciatica pain may be acute, meaning it comes on suddenly. Many people experience only back pain in the earliest stages of sciatica and do not seek treatment.
• Worsening Pain. Early sciatica left untreated can advance to more severe pain and pain that radiates past the lower back, into the hips or buttocks, down the leg, or as far as into the foot.
• Chronic Pain. For some patients, sciatica pain and discomfort becomes chronic. The pain may fluctuate from better to worse and back.
• Recurring Sciatica. Even after treatment or using conservative pain management and recovering from sciatica, it can recur later.

Symptoms in the Last Stages of Sciatica

Back pain is a typical early sign of sciatica. As it progresses to the last stages, the pain often radiates down the leg and into the foot. This can become severe and interfere with normal functioning. Additional symptoms may include numbness, tingling, or weakness in the leg or foot. In most people, sciatica affects one side of the body only.

How To Manage Advanced Sciatica Pain

Sciatica pain can become severe and even debilitating, interfering with normal mobility and activities. Before opting for surgical treatment, your orthopaedist might recommend some conservative pain management strategies to keep you comfortable while waiting for the injury to heal:

• Over-the-counter anti-inflammatory medications, such as Tylenol
• Prescription anti-inflammatories and oral steroids
• Steroid injections
• Physical therapy

Physical therapy is especially useful in helping manage pain with sciatica before resorting to surgery. Targeted exercises help train the body to function better with pinched nerves. Physical therapy can also support healing and relieve pressure on the compressed nerve.

Surgical Treatment Options for Sciatica

Orthopaedists generally prefer to begin treatment for sciatica with conservative treatments to allow the body to heal. Patients with advanced sciatica and severe pain that they cannot tolerate or function with are often good candidates for surgical procedures:

• Laminotomy. This procedure involves removing a small amount of the lamina. The lamina is the bony arch over the spinal cord to relieve pressure on a nerve.
• Laminectomy. In a laminectomy, the surgeon moves all of the lamina. This is more extensive than a laminotomy and usually requires more recovery time.
• Discectomy. This is a procedure used to treat a herniated disc by removing the part of the disc causing nerve compression. A microdiscectomy is less invasive, uses a smaller incision, and requires less recovery time.

If surgery is appropriate for you, your surgeon will discuss the procedure best for your situation. They may combine a laminotomy or laminectomy with a discectomy for better results. Recovery from any of these procedures can be a couple of months but most often leads to less pain and improved mobility.

Early intervention for sciatica is best because it allows you to get relief from pain and supports your body’s natural healing. Getting treated before you have advanced, severe sciatica does not mean you have to have surgery. Your orthopaedist will discuss the best option with you.

https://emergeortho.com/news/last-stages-of-sciatica-treatment/ 

What should you do when sciatica flares?

From health.harvard.edu

By Heidi Godman

These options can help calm the searing pain of an irritated sciatic nerve

People with diagnosed sciatica have no trouble recognizing a flare-up. It strikes as numbness, tingling, or pain in the buttock and down the leg, caused by irritation to the sciatic nerve, which begins in the spine and travels downward into the leg.

While it's easy to identify a flare-up, it's trickier to tamp it down. It may take a combination of approaches to ease discomfort.

What is sciatica?

Sciatica is the term for discomfort caused by irritation of the sciatic nerve. This nerve starts at each side of the low back and extends down through the buttocks, back of the thigh, and lower leg.

Irritation usually occurs in the spine, with one of the nerve roots that eventually form the sciatic nerve. Anything pressing against a nerve root — such as a bony growth from arthritis in the spine or a bulging disc in between the spinal bones — can inflame the nerve root and send pain, numbness, or tingling all the way down one of the sciatic nerves.

"If you've never had it before, it's common to worry that you may have damaged your sciatic nerve. It's usually more of an irritation, however, as opposed to an outright injury," says Dr. Max Epstein, a physiatrist at Spaulding Rehabilitation Hospital. "But if you also experience muscle weakness or significant changes to your bowel or bladder habits, that could be a sign of nerve damage. In either case, you should speak to a health care provider as soon as possible."

Pill-free approaches

Coping with sciatica discomfort starts with pill-free strategies that you can try immediately.

Stay active. One of the most important things you can do when sciatica flares is to avoid bed rest. "Part of low back pain is muscle-related, possibly because muscles surrounding the irritated nerve roots tighten and try to protect the area. Movement keeps the muscles loose and working correctly. If you don't move, they can get tight and increase pain," says Dr. Max Epstein, a physiatrist at Harvard-affiliated Spaulding Rehabilitation Hospital.

Modify activities. If activity is painful, do only what you can tolerate. "Think of a green, yellow, or red zone of pain. The green zone is a mild amount of pain while doing an activity. That's okay. But if you get into the yellow zone, it's time to pull back and modify an activity," Dr. Epstein says. "For example, if it hurts to carry a full laundry basket, take out a few things. Or if it's painful to stand at the sink and do dishes, open the cabinet below the sink and rest your foot on the bottom of the cabinet. That will take tension off the nerve."

Stretch. Keep the muscles loose and limber with gentle stretching, but only within the green zone of pain. For example, you might stand and try to touch your toes to stretch your back and leg muscles. Or try some yoga poses. Dr. Epstein recommends the cat-cow: Get down on all fours, with your hands directly beneath your shoulders and your knees beneath your hips. Inhale and lift your head and tailbone toward the ceiling, while curving your lower spine toward the floor. As you exhale, round your back, bringing your chin toward your chest and tucking your tailbone under. Repeat the exercise 10 times.

Use hot or cold therapy. Hot or cold therapy for sciatica can take many forms. For example, you might soak in a warm bath or apply a hot pack or a cold pack to your leg or back. "What works for one person might not work for another, so you may have to experiment to see what's best for you," Dr. Epstein says. How does it help sciatica? "Heat may loosen muscles, and cold may tamp down inflammation, but we don't know for sure," Dr. Epstein explains.

Relaxation. Staying relaxed is an important part of controlling both acute pain (the kind that's sudden and temporary) or chronic (ongoing) pain.

"All pain is processed in the mind. If you're able to calm the processing centres, the perception of pain may decrease," Dr. Epstein says. He recommends trying breathing exercises, meditation, yoga, or tai chi. Practicing mindfulness — focusing attention on the present moment — might also help ease discomfort by helping you to accept it.

Drugstore remedies

Several over-the-counter remedies can also play a part in relieving sciatica.

Oral painkillers. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) help reduce inflammation, which reduces pain. But they may cause stomach ulcers and bleeding, liver or kidney damage, or an increased risk of heart attacks. So get your doctor's okay before using them, and find out the dose and frequency that's safe for you.

Acetaminophen (Tylenol) is often less effective at relieving sciatica pain than NSAIDs, but it's also less risky — unless you take it in very high doses, which can cause liver damage. The usual limit is no more than 3,000 milligrams (mg) per day, but your doctor might set a lower limit depending on your health.

Topical painkillers. Applying painkillers to your skin as creams, gels, or patches can also bring sciatica relief. Topical NSAIDs such as diclofenac gel (Voltaren) may have fewer risks than NSAID pills, since topicals stay close to the site of application and aren't well absorbed by the rest of the body. But it's still wise to check with your doctor before using them. Other types of topicals with fewer risks than NSAIDs include creams, sprays, and patches that contain anaesthetics such as lidocaine; pain signal interrupters such as menthol or capsaicin; or arnica gel, an herbal remedy thought to have anti-inflammatory properties. 

Turmeric supplements. Turmeric (a golden-yellow spice) contains curcumin, which appears to have anti-inflammatory and antioxidant properties. "Although there have not yet been studies that prove its benefit, it's the one supplement that I would support for pain relief. There's no clear recommendation for dosage, but 1,000 mg per day might help. You can take it all at once or break it up into morning and evening doses," Dr. Epstein says.

Call your doctor

A typical flare-up lasts for a few days to a week or two. If it's not improving or responding to home remedies, it's time to make an appointment with your doctor.

Your doctor might order imaging tests and prescribe a prescription anti-inflammatory drug, such as oral or injected prednisone. "That will buy you a window of time to strengthen muscles without pain, and keep them flexible," Dr. Epstein says. "That will help keep your body strong and protected, so you'll be in a better place than where you started."

What if you don't reach out for help? "At times the nerve stays irritated for years," Dr. Epstein says. "So try not to delay treatment. Usually our interventions are able to put out the fire or at least calm the severity of the symptoms in a meaningful way."

If you'd like more information, check out the Harvard Special Health Report Finding Relief for Sciatica (/frfsc).

https://www.health.harvard.edu/pain/what-should-you-do-when-sciatica-flares