What Is Sciatica?
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Medically reviewed by Amy Kwan, PT
Sciatica is an impairing and often painful condition caused by damage, compression, or inflammation in the sciatic nerve. The sciatic nerve is the largest nerve in the body. It originates in the low back and travels down each leg to the heels of your feet.
The sciatic nerve helps with both motor and sensory function, allowing you to move your muscles and feel sensation in your legs. When the nerve is damaged or otherwise disturbed, it can cause pain, a burning sensation, or paresthesias, sometimes referred to as "pins and needles" that can start in the buttocks and radiate down the leg. Rarely, some people may experience weakness in the affected leg or legs, too.
Although painful, sciatica usually resolves on its own after four to six weeks. In cases where the condition lingers, there are a variety of medical, surgical, and complementary therapies that are effective at providing relief.
Sciatica Symptoms
The term sciatica is sometimes incorrectly used to describe any low back pain or pain radiating down the leg. However, sciatica is the condition referring to pain or other symptoms caused as a result of the sciatic nerve becoming compressed or irritated.
The symptom many people associate with sciatica is one-sided low back pain with pain radiating down the leg of the affected side. Some people will have a pain or burning sensation in their buttock on the affected side, too. Actions like sneezing, coughing, or moving may increase the discomfort.
Many people also experience changes in sensation in the leg, including the foot at times. Sometimes these feelings in the leg can be unusual and difficult to describe. These changes include:
Pins and needles
Numbness and tingling
Feeling usually cold or hot, or a burning sensation
Having a shooting pain or discomfort down the leg
Rarely, people may experience one-sided leg weakness as well, or a feeling that their leg is "heavy."
Related: What Causes Tingling in Feet—And When to See a Doctor
What Causes Sciatica?
Sciatica occurs when something irritates the sciatic nerve at the spine, where the nerve starts. In older adults, two common causes of sciatica are bone spurs (bumps of extra bone that grow on the end of the bones) and arthritis (a condition characterized by inflammation of the joints) in the spine. Herniated disks, also known as slipped or ruptured discs, are a leading cause of sciatica in adults younger than 40. They occur when the gel-like material inside the spinal discs protrudes due to damage or weakness.
Other conditions that can cause sciatica symptoms include:
Bulging disks: When a herniated disk bulges or protrudes from the back
Lumbar spinal stenosis: A narrowing of the space that holds the spine
Spondylolisthesis: A condition that causes vertebrae to slip away from the vertebra below it
Lumbar epidural hematoma: A condition where blood builds up between the layers of tissue that protects the spinal cord and compresses it
A benign or malignant tumor: A tumor, or a mass of cells that can be cancerous or noncancerous, can put pressure on the sciatic nerve
Injuries: Misalignment of the vertebrae (the back bones), muscle spasms in the lumbar (low back) or pelvic region, and other traumatic injuries can cause sciatica
Sciatica is a fairly common condition, with 10-40% of people getting it at some point in their lifetime. Some people are more likely to get it than others. Some factors that increase your risk of developing sciatica include:
Being in your 40's
Occupations that require having to hold unusual positions for an extended period, such as having a job as a truck driver or machine operator
If you have had sciatica before, physical activity may increase the likelihood it comes back
If you have never had sciatica before, physical activity may decrease the likelihood you will get it.
Related: What Causes Back Pain?
Diagnosis
Your healthcare provider will likely begin by asking about your symptoms and past medical history to help them form a diagnosis. They may also ask you to perform some exercises to assess your mobility and pain level, such as squatting and walking on your heels and toes, among others.
Your provider may perform a straight-leg test. To do this, they slowly raise your leg while you lay on your back, and you tell them when you start to experience pain. Tracking how high your leg is when you begin feeling pain may help your provider locate the origin of the pain. This exam is usually enough to make a diagnosis
Imaging such as X-ray and magnetic resonance imaging (MRI) are usually not recommended initially, as it does not generally change the course of treatment. Many people develop changes in their spine over time that do not have sciatica, so it could be unclear if any results from an X-ray are even related to their pain. Imaging may be utilized with people whose sciatica symptoms are persisting to identify if an underlying cause exists that needs more aggressive intervention.
Treatments for Sciatica
The majority of sciatica cases will go away on their own in four to six months without any medical treatment. Some people may need treatment to manage pain until symptoms resolve or if the pain does not go away on its own. Providers will usually begin with "conservative management", such as light exercise, and work their way up to more invasive treatments such as prescription medicine and/or surgery.
Use of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Tylenol (acetaminophen) are not recommended for treating sciatica. Alternatively, using hot and cold packs on areas where you're experiencing pain and staying moderately active may help improve symptoms.
If this is not enough to manage symptoms, pain medication like corticosteroid shots (used to treat inflammation), anticonvulsants (often used to treat nerve pain), muscle relaxants, and opioid pain medications may be prescribed. However, there is conflicting evidence about how effective some of the medications used for sciatica are.
A 2015 meta-analysis of 12 studies found that acupuncture can help relieve the pain associated with sciatica. Other complementary therapies such as spinal manipulation and deep tissue massage may also help some people reduce pain, depending on what's causing your sciatica. If you are interested in trying these methods, discuss your case with your healthcare provider and they can help advise you.
Surgery may be considered in some cases; although, some studies have shown that people with sciatica who underwent surgery saw similar improvement in symptoms after two years compared to people who did non-surgical treatment.
Prevention
Some studies suggest that some people are more likely to develop sciatica than others due to genetic makeup. However, there are also lifestyle changes you can make to reduce your chances of getting sciatica. These include:
Stay active: Increasing activities such as walking and cycling may help protect you against sciatica.
Avoid smoking: Quitting smoking has been shown to reduce your likelihood of developing sciatica
Maintain a healthy weight: You are more likely to have sciatica if you have obesity. Weight can put additional pressure on the nerve, so weight management may prevent the onset of sciatica for some people.
Complications
If your sciatica does not improve on its own in several weeks, it is important to seek out medical attention to prevent complications.
It is possible to develop nerve damage if the sciatic nerve is compressed too much for too long. Nerve damage could cause cauda equina syndrome (CAS) if it occurs at the bottom of the spine. CAS is a medical emergency where the nerves that control your ability to go to the bathroom and feel sexual sensations are damaged. Sensation in the legs and feet can also be altered. This can result in permanent loss of function in these areas.
The sooner cauda equina syndrome is identified and treated, the greater your chance of recovering sensation in those areas.
Living with Sciatica
The prognosis for sciatica is generally a good one. Many cases of sciatica go away on their own within four to six weeks. Some people may have persistent or recurring pain. In these cases, individuals will want to discuss with their healthcare providers what treatment options may be best for them as well as implementing lifestyle changes to reduce the chances of sciatica coming back in the future.
Frequently Asked Questions
Does walking help sciatica?
Yes, walking has been shown to help those with sciatica. It has also been shown to help prevent sciatica.
How long does a sciatica flare-up last?
Many cases of sciatica go away in four to six weeks. However, for some it may last much longer and become a chronic condition.
What should you not do with sciatica?
You should not sit or lay in one position for a long time with sciatica. Also, if you are experiencing numbness you should avoid hot packs or hot water bottles to reduce the chance of burning yourself.
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