Is Your Back Pain Sciatica?

Illustration of sciatica.

What Is Sciatica?

Sciatica is a pain that radiates from the low back down a lower extremity; it is caused by irritation of the sciatic nerve. The sciatic nerve transmits sensation from the lower extremities and lumbar area of the low back. It is common for people to recover from sciatica without a surgical operation.

Photo of a person with lower back pain due to sciatica.

Sciatica Symptoms

Low back pain that radiates to the hip, buttock, and down a lower extremity is the most common symptom of sciatica. Sometimes sciatica pain worsens with bending at the waist, coughing, sitting, or sneezing. Sciatica can also cause tingling, numbness, or weakness of the leg. Sciatica symptoms can occur rapidly and persist for weeks.

Photo of a man lifting a box.

Sciatica or Other Back Pain?

Back pain is extremely common. There are many causes of lower back pain that are not sciatica. Frequently, low back pain is caused by back strain of muscles and ligaments. The characteristic feature of sciatica is pain that radiates down the leg from the low back, often reaching the foot.

Photo of pregnant woman holding her back.

Who Is Likely to Get Sciatica?

Sciatica is common as we reach middle age. Pregnancy can lead to sciatica as a result of direct pressure on the sciatic nerve by the enlarging uterus. Other causes of sciatica are degenerative spinal arthritis and lumbar disk herniation.

Cut away photo of a slipped disc.

Cause: Herniated Disk

Disk herniation is a common cause of sciatica. The disk cushions between the spinal vertebrae weaken and are more vulnerable to injury as we age. The weakened disk can herniate its gel-like center to cause direct pressure on the nerves in the spinal canal that form the sciatic nerve.

A CT scan of the spine shows spinal stenosis.

Cause: Spinal Stenosis

Degeneration of the vertebrae of the spine can lead to narrowing of the spinal canal; this is called spinal stenosis. This can lead to pressure on the spinal nerve roots that form the sciatic nerve. Sciatica can be a symptom of spinal stenosis.

MRI of a spinal tumor.

Cause: Spinal Tumors

Tumors are rare causes of sciatica when they put direct pressure on the sciatic nerve or its nerve roots.

Illustration of piriformis muscle.

Cause: Piriformis Syndrome

The piriformis muscle in the buttock can sometimes lead to irritation of the sciatic nerve. This is referred to as piriformis syndrome.

Photo of a man removing his wallet from his back pants pocket.

A Fat Wallet Can Trigger Piriformis

A wallet or object that is in the back pocket during prolonged sitting can lead to piriformis syndrome and irritation of the sciatic nerve, causing sciatica. Placing the wallet in the front pocket instead can avoid the problem.

A pelvis x-ray.

Cause: Infection or Injury

Rarely, sciatica can be caused by injury, fracture, infection, or inflammation. Any condition that leads to direct pressure or irritation of the sciatic nerve can cause sciatica. Sometimes, no specific cause of sciatica can be detected.

Photo of doctor examining a sciatica patient.

Diagnosing Sciatica: Exam

To detect the cause of sciatica, the doctor will ask about all the symptoms the patient is experiencing as well as their location and aggravating or relieving features. During the examination, the patient may be asked to do various maneuvers with the lower extremities.

Photo of a person getting an MRI.

Diagnosing Sciatica: Imaging

Various tests, such as MRI scans, CT scans, and others, may be used to help detect the cause of sciatica. With a precise diagnosis, the treatment program can be optimized.

Photo of a person using a smart phone.

Complications Related to Sciatica

When sciatica is complicated by uncontrolled loss of bowel or bladder control, it is considered an emergency. These symptoms are evaluated rapidly to consider whether or not an immediate surgical operation is necessary.

Photo of hot and cold compress for pain relief.

Sciatica Relief: Use Ice and Heat

Home remedies for new sciatica include heat-pad or ice-pack applications. Each can be applied for approximately 20 minutes every couple of hours. Some benefit from alternating heat and ice applications.

Photo of a person taking pain medication for sciatica.

Sciatica Relief: Medication

Medications that are over the counter and are used for sciatica include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Cortisone injections into the spinal canal can be helpful for selected patients.

Photo of woman stretching her legs and lower back.

Sciatica Relief: Stretching

Strict bed rest is recommended less often than in the past. Physical therapists are experts at designing optimal exercise programs for sciatica. Brief walking can be helpful for certain people with sciatica.

Photo of syringe.

Sciatica Relief: Injections

Spinal injection of cortisone medication (steroids) can be beneficial for severe sciatica. This medication rapidly reduces the inflammation around the nerves.

Photo of a surgeon during an operation.

Sciatica Relief: Surgery

For persisting sciatica that does not respond to medical management, surgical operation can sometimes be required. Various operations differ depending on the exact condition causing the sciatica. Sometimes disk material and bone is actually removed to free up the adjacent irritated nerves.

Photo of a woman performing physical therapy after sciatica surgery.

Sciatica Rehab

After spinal surgery, there are often activity restrictions, as tissues must heal. Physical therapy is often prescribed to strengthen the back and promote healing by avoiding injury. The goal is eventual return to one's usual activities.

Photo of acupuncture needles.

Complementary Therapies

Adjunctive therapies, such as massage, yoga, osteopathic & chiropractic care, and acupuncture, can sometimes be helpful for back pain.

Photo of a man lifting a box from the floor.

Preventing Sciatica

Sciatica can recur. To minimize the chances of recurrence, people should exercise regularly, maintain proper posture, and protect the back by bending at the knees to lift heavier objects.

Sources:

IMAGES PROVIDED BY:

  1. Image Source: Primal Pictures, 3D4Medical/Photo Researchers Inc. Sciatica Pictures Slideshow
  2. BrandX, 3D4Medical/Photo Researchers
  3. Corbis
  4. Zia Soleil/Iconica
  5. Simon Fraser / Photo Researchers, Inc
  6. Scott Camazine / Photo Researchers, Inc.
  7. Living Art Enterprises / Photo Researchers, Inc
  8. Joseph Bloch / Phototake
  9. Stockbyte
  10. ISM/Phototake
  11. Michele Constantini
  12. Rubberball
  13. Enamul Hoque/Photographer's Choice
  14. Steve Pomberg/WebMD
  15. Digital Vision
  16. Fridhelm Volk/Doc-Stock
  17. Lori Greig/Flickr
  18. ERproductions/Blend Images
  19. Michele Constantini/PhotoAlto
  20. iStockfoto
  21. Ian Hooton/SPL

REFERENCES:

  • Klippel, J.H.: "The Primer On The Rheumatic Diseases"
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