Sciatica

What is Sciatica?
You know what it feels like: shooting pain down your leg. You might also have tingling or numbness. Your doctor says it's sciatica, but confusingly enough, sciatica isn't actually a condition. It's a medical term used to describe symptoms—the shooting pain, tingling, and numbness—caused by a low back condition.

That means that your sciatica could be caused by a bulging disc or a herniated disc, degenerative disc disease, piriformis syndrome, pregnancy, spinal stenosis, a spinal tumor or spinal infection, spondylolisthesis, or trauma.

Any one of those conditions can put pressure on the sciatic nerve or related nerve roots in your low back. And that pressure is what causes your pain and other symptoms.

Your doctor may also call sciatica a radiculopathy, which is a medical term used to describe pain, numbness, tingling, and weakness in the arms or legs. Since sciatica originates in your low back—the lumbar spine—it is called a lumbar radiculopathy.

Symptoms of Sciatica
To get the best treatment for sciatica, it's important to recognize and understand the symptoms.

You can feel sciatica in different ways, including:

Pain that travels from the low back, through the buttocks, downward into the leg, and sometimes into the foot.
Shooting pain down your leg — sometimes described as like electricity.
Burning and tingling sensations in your leg.
Partial leg numbness or weakness.
Pain, burning, tingling, numbness, or weakness on only one side of your lower body.
Pain and other symptoms may be constant and vary from mild to severe.
Sitting, trying to stand up, and walking may be painful and difficult.
Coughing, sneezing, and other sudden movements can intensify pain.

You must treat your back pain properly. Seek medical attention if your pain persists — and seek immediate attention if you have any of the following emergency signs:

Pain is getting worse.
Pain affects your every day activities.
Leg weakness or numbness.
Loss of bowel or bladder control.

You can experience sciatica in different ways and in different parts of your leg — it all depends on where your sciatic nerve is affected in your low back. When you're describing your symptoms to your doctor, it's helpful to be as exact as possible. This will help him or her more accurately diagnose the cause.

So when you feel pain, is it…
especially intense above your knee? Instead of originating in your low back (lumbar spine), your pain possibly starts in your buttocks. With these symptoms, it's likely that your sciatic nerve is being pinched by the piriformis muscle, which moves your thigh side to side.

below your knee and into your foot? You may also not react as quickly when the doctor tests your knee-jerk reflex (that's when he or she taps your knee with a tiny mallet). You may have trouble bringing your foot up. With these symptoms, it's likely that your sciatic nerve is being pinched at the L3-L4 level of your low back (lumbar spine).

on the side of your foot? Your ankle reflexes may not be very quick, either. It could be difficult for you to lift your heel off the ground or walk on your tiptoes (should you ever need to do that). With these symptoms, it's likely that your sciatic nerve is being pinched at the L5-S1 level of your low back (lumbar spine) and pelvic region (sacrum).

in your big toe and maybe in your ankle, too? This is also known as foot drop. You may have numbness and/or pain on the top of your foot, but you really feel it in your big toe. With these symptoms, it's likely that your sciatic nerve is being pinched at the L4-L5 level of your low back (lumbar spine)

Causes of Sciatica
It's important to understand what conditions cause sciatica because remember, sciatica is not a condition — it's a medical term used to describe symptoms caused by other low back conditions.

Several low back conditions can cause sciatica, including:

Bulging disc or herniated disc: This is the most common cause of sciatica. When a disc bulges, the gel-like center (nucleus pulposus) pushes against the outer wall of the disc (annulus fibrosus). A herniated disc means that the nucleus pulposus breaks through the annulus fibrosus. With both bulging and herniated discs, the disc material can press on nerve roots, causing sciatica. The consequences of a herniated disc are worse than those of a bulging disc. The disc material that leaks out contains an acidic, chemical irritant (hyaluronic acid) that causes nerve inflammation.

Degenerative disc disease (DDD): Sciatica is a common result of the aging process that affects discs called degenerative disc disease. DDD is a change in the disc shape and function, and it can result in a bulging disc or a herniated disc and pain.

Piriformis syndrome: The piriformis muscle, located in the lower part of the spine, connects to the thighbone, and helps you rotate your hip. The sciatic nerve runs under the piriformis muscle, so muscle spasms can compress the sciatic nerve. It may be difficult to diagnose and treat as it is not easily identified by x-ray or MRI.

Pregnancy: The extra weight and pressure on your spine caused by pregnancy can cause compression of the sciatic nerve. The symptoms will usually go away after childbirth.
Spinal stenosis: Your nerves travel through passageways in your spine, and when this space narrows (stenosis), it can put pressure on the nerves in your low back.
Spinal tumors and spinal infections: Although very rare, tumors and infections can compress the sciatic nerve.

Spondylolisthesis: If a vertebra slips forward over the vertebra below it, it's called spondylolisthesis. This slip can pinch the nerve root and cause sciatica.

Trauma: You can develop sciatica because of direct nerve compression from an outside force. For example, you could be injured in a car accident, resulting in a pinched nerve in your low back.

Exams and Tests for Sciatica
Call your spine specialist if you suspect you have sciatica. (If you don't already have a spine specialist, you can find one using our Find a Back and Spine Specialist feature.)

During your visit, your spine specialist will ask you questions and perform some basic exams. This is to try to identify the cause of your sciatica and develop a treatment plan for you—a way to manage your pain and other symptoms and to help you recover.

First, your spine specialist will ask about your current symptoms and remedies you have already tried. He or she will ask some typical questions, such as:

When did the pain start?
Where do you feel pain?
On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain.
What activities did you recently do?
Does walking uphill or downhill increase pain?
What have you done for your pain?
Does anything reduce the pain or make it worse?

Your spine specialist will also perform physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. During the neurological exam, your spine specialist will test your reflexes, muscle strength, other nerve changes, and pain spread.

To diagnose the cause of your sciatica, you may need to have some imaging tests. You may have an x-ray or a Computerized Axial Tomography scan (a CT scan or CAT scan). If it's possible you have a herniated disc or spinal stenosis that's causing your sciatica, your doctor may order a Magnetic Resonance Imaging test (an MRI).

Drugs, Medications, and Spinal Injections to Relieve Sciatica
Your doctor may prescribe drugs, medications, or spinal injections to treat your sciatica. The severity of your pain determines the prescription, which could be:

Epidural Steroid Injections: Steroids, which reduce inflammation, can help ease your sciatic pain. With an epidural steroid injection, you get a corticosteroid medicine injected near the spinal nerve roots. These injections can reduce pain for months and sometimes longer. However, epidural steroid injections aren't effective for all patients.

Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs): These will help reduce swelling while relieving your pain. If an over-the-counter NSAID is an option for you, you and your doctor have plenty to choose from. You can use acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).

Prescription Medications: If you have chronic sciatica, you may need a muscle relaxant to help ease muscle spasms. As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they may help block pain messages on their way to the brain. They can also help increase your body's production of endorphins, a natural pain killer.

As with any treatment, including medications, you must follow your doctor's advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor.

Physical Therapy to Relieve Sciatica
Your doctor may refer you to a physical therapist to help you relieve your sciatica and restore movement. Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They also prepare your body for therapeutic exercise, which is the active part of physical therapy.

Your physical therapist may give you passive treatments such as:

Deep Tissue Massage: This technique targets chronic muscle tension that could be pressing on your sciatic nerve or related nerve roots. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).

Hot and Cold Therapies: By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. For example, a heat pack placed on your piriformis muscle may help to reduce muscle spasms that could be causing your sciatica. Cold therapy slows circulation, helping to reduce inflammation, muscle spasms, and pain. Your physical therapist will alternate between hot and cold therapies.

TENS (transcutaneous electrical nerve stimulation): You could even use this at home, if your therapist thinks it's necessary. A machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body's production of endorphins, your natural pain killers. The TENS equipment your physical therapist uses is larger than the "at home" use machine. However, whether large or small, a TENS unit can be a helpful therapy.

Ultrasound: Ultrasound sends sound waves deep into your muscle tissues and creates a gentle heat that enhances circulation and helps to speed healing. Increased circulation helps to reduce muscle spasms, cramping, swelling, stiffness, and pain.

In the active part of physical therapy, your therapist will teach you various exercises. Your physical therapy program is individualized, taking into consideration your health and history. It may include aerobic conditioning, strengthening exercises, and movements to increase flexibility and range of motion.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities.

Surgery for Sciatica
Most patients with sciatica respond well to non-surgical treatments (such as medication), so spine surgery is seldom needed to treat it. However, there are situations when you may want to go ahead with spine surgery:

You have bowel or bladder dysfunction. This is rare, but it may occur with spinal cord compression.

You have spinal stenosis, and your doctor feels that surgery is the best way to treat it.
You are experiencing other neurologic dysfunctions, such as severe leg weakness.
Your symptoms become severe and/or non-surgical treatment is no longer effective.
There are many types of surgical procedures used in spine surgery, and your spine surgeon will recommend the best procedure to treat your sciatica. And remember, the final decision to have surgery is always up to you.

Two common spinal surgeries for sciatica are:

Discectomy or Microdiscectomy: In both of these procedures, the surgeon removes all or part of a herniated disc that's pushing on your sciatic nerve and causing your sciatica symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, you should recover more quickly from a microdiscectomy.

Laminectomy or Laminotomy: These procedures both involve a part of the spine called the lamina—a bony plate that protects the spinal canal and spinal cord. A laminectomy is the removal of the entire lamina; a laminotomy removes only a part of the lamina. These procedures can create more space for the nerves, reducing the likelihood of the nerves being compressed or pinched.

Recovery from Surgery to Relieve Sciatica
After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you’ll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: in general, don’t do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection—to your doctor right away.

Alternative Treatments for Sciatica:
Acupuncture, Acupressure, Biofeedback, and Yoga
Your doctor's treatment plan may include alternative therapies such as acupuncture or acupressure, biofeedback, and yoga. Many patients have reported that alternative therapies have really helped.

You may want to try:

Acupuncture or Acupressure: Practitioners believe your body has an energy force called Qi or Chi (pronounced "chee"). They think that when Chi is blocked, you can develop physical illness. Both acupuncture and acupressure work to restore a healthy, energetic flow of Chi. (These Eastern approaches to healing are different from Western scientific concepts. That doesn't make them better or worse; it just makes them different.)

In acupuncture, the practitioner inserts fine needles into your body at specific points (it doesn't hurt, honestly). Acupressure is similar to acupuncture— but there are no needles involved. The practitioner uses thumbs, fingers, and elbows instead of needles.

Biofeedback: This is more than telling your body, "Stop feeling pain." Biofeedback is a mind-body therapy teaches you how to change, or control a habitual reaction to pain or stress. For example, if it's muscle tension causing your sciatica, you could learn deep-breathing techniques and mental exercises to help you to relax.

Yoga: If piriformis syndrome is the cause of your sciatica, yoga can help. Some yoga movements can gently stretch the piriformis muscle. As a word of caution, some yoga positions can make sciatica worse. Avoid positions that involve forward folds, twisting, or stretching the back of your legs. These movements can further irritate your sciatica.