Sciatica

Pain, weakness, or tingling that originates in the lower back or the buttocks and travels down one leg may be caused by what’s called sciatica—a descriptive term used to classify discomfort caused by bodily changes that put pressure on the sciatic nerve.

The sciatic nerve is the longest in the body, originating in the lower back and running down the back of each leg. If this nerve becomes compressed, it can cause discomfort anywhere along the nerve or where it provides sensation, from the lower back to the foot.

About 10% of people with lower back pain have sciatica. The condition is more common among people 40 and older.

People may find relief through physical activity, heat application to the affected area, or physical therapy. Symptoms of sciatica sometimes improve relatively quickly. In some people, sciatica resolves without any intervention. The condition sometimes recurs, especially among older adults and those with back problems.

What is sciatica?

Sciatica is the term used to describe pain that radiates from the lower back through the buttocks down one leg. It usually only affects only one side of the body.

The sciatic nerve originates in the spinal cord within the lower back. It provides sensation throughout both legs, all the way down to the toes. Pain, weakness, and other discomfort arise when the nerve becomes compressed.

The most common way that the sciatic nerve becomes compressed is from a herniated disk. In the spinal column, the bones of the spine (vertebrae) are separated by cartilage cushions (disks). These disks act as shock absorbers, so the vertebrae don’t rub together.

Sometimes a compressed disk causes inflammation, which puts pressure on the sciatic nerve. Other times, however, compression causes a disk to rupture, typically due to age-related changes, heavy lifting, or gradual “wear and tear.” The cartilage may bulge outward, coming into contact with the sciatic nerve.

What causes sciatica?

Anything that puts pressure on the sciatic nerve may lead to sciatica.

Possible causes include:

• A slipped or herniated disk
• Age-related disk changes
• Complications of osteoarthritis
• Spinal stenosis
• Spondylolisthesis
• Diabetic neuropathy
• Sports injuries
• Blunt force trauma, such as a car accident
• A fractured pelvis
• Pregnancy
• Paget’s disease
• A spinal tumor

What are the symptoms of sciatica?

People with sciatica typically experience discomfort on one side of the body, from the lower back to the foot. Symptoms are more likely to affect the leg or buttock rather than the back—and often are felt below the knee. They may include:

• Pain
• Weakness
• Tingling
• Numbness
• Aching
• Burning
• Muscle spasms
• Inability to move the affected leg

Some people experience more discomfort when they:

• Sneeze
• Cough
• Bend at the waist
• Twist at the waist
• Walk or run
• Climb stairs

What are the risk factors for sciatica?

People are more likely to experience sciatica if they:

• Are 40 or older
• Are tall
• Are overweight or obese
• Smoke
• Experience high levels of stress
• Do a lot of heavy lifting, sitting, or driving
• Play contact sports
• Have had back surgery
• Have chronic lower back pain

How is sciatica diagnosed?

You may be diagnosed with sciatica after sharing your medical history with your doctor and getting a physical exam. For most people, diagnostic tests aren’t necessary.

Tell your doctor about any symptoms you’ve experienced, including leg pain, muscle weakness, numbness, or tingling. Let the doctor know how long you’ve been experiencing discomfort and if anything may have triggered symptoms, such as lifting something heavy or playing sports. Sharing details about your work tasks will help your doctor understand whether your daily activities contribute to your discomfort. Be sure to mention if you have a history of lower back pain or a previous back surgery. Your doctor may ask if you have arthritis or diabetes, which could increase your risk for sciatica.

During a physical exam, your doctor may observe your posture and gait to see if your movements are impacted by pain or discomfort. The doctor may examine your lower back or leg to see if certain areas are tender to the touch. The doctor may ask you to bend or lift your leg in certain ways, looking for characteristic sensations that help diagnose the condition. If you experience pain during certain maneuvers (below), it could indicate sciatica:

• Straight leg raise. While lying flat on your back, your doctor lifts the affected leg without bending it. If you experience pain during this maneuver, you may have a herniated disk.
• Crossed straight leg raise. While lying flat on your back, your doctor lifts the unaffected leg, keeping it straight. If you have a herniated disk, this maneuver will cause pain to shoot through your affected leg.
• Femoral stretch. While lying on your stomach, your doctor bends the knee of your affected leg 90 degrees. They then place a hand beneath your knee to lift the leg off the table. Thigh pain may suggest a herniated disk.

Doctors often diagnose sciatica without diagnostic tests. In some cases, however, testing may be necessary to confirm a diagnosis or rule out other conditions. If you’ve experienced sciatica-like symptoms for three months without relief, your doctor may perform the following tests:

• Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT). These scans may reveal spinal cord abnormalities that may or may not be sciatica.
• Electromyography and nerve conduction studies, which can determine whether nerve damage has occurred.

How is sciatica treated?

Sciatica discomfort typically improves within 4 to 6 weeks. Sometimes, it improves on its own, without treatment or intervention. The condition sometimes recurs, especially if the cause isn’t addressed.

Below are treatment options for sciatica.

• Lifestyle changes. Some or all of the below at-home treatments can help symptoms resolve more quickly:
  • Limit bed rest. If your symptoms are intense, 24 to 48 hours of bed rest can help.
  • Get physical activity. Keeping active is the best way to improve sciatica symptoms. Go for short walks daily, and do any exercises your doctor recommends.
  • Apply ice and heat. Put ice packs on the tender areas during the first two days you’re experiencing sciatica pain. After two or three days have passed, use a heating pad to provide relief.
  • Change your sleep position. If you sleep on your side, place a pillow between your bent knees while in bed. If you sleep on your back, place several pillows beneath your bent knees.
  • Physical therapy. A physical therapist can help you recover from this painful condition by stretching you, helping you improve your posture, and teaching you to strengthen your core, which helps to support your back.
  • Seek alternative therapies. Some people may benefit from deep tissue massage or acupuncture. These therapies may ease discomfort.

  What is the outlook for people with sciatica?

  Sciatica discomfort typically improves within 4 to 6 weeks. Sometimes, it improves on its own, without treatment or intervention. The condition sometimes recurs, especially if the cause isn’t addressed.

  In rare cases, compression of the sciatic nerve causes complications, including loss of bladder or bowel control or permanent nerve damage. Seeking treatment early should help to address discomfort and relieve pressure on the sciatic nerve before complications like these occur.

  What makes Yale unique in its treatment of sciatica?

  “The Yale New Haven Spine Center utilizes a team-based, multidisciplinary approach in the treatment of patients with sciatica,” says Yale Medicine orthopaedic surgeon Arya Varthi, MD. “Non-operative management is emphasized, and patients are offered physical therapy, medications, and lumbar injections, depending on the severity and duration of their symptoms. Patients who do not improve with non-surgical management are offered consultation with fellowship-trained spine surgeons who offer state-of-the-art surgical interventions.”