Sciatica

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is sciatica?

The spine is divided into five regions: cervical (uppermost), thoracic, lumbar, sciatic and coccyx (at the base of the spinal cord). Sciatica refers to a group of symptoms that occur when a sciatic nerve is compressed, injured or inflamed. The sciatic nerves are the longest nerves in the body. They branch out from either side of the spinal cord in the lower back (the sciatic region) and run through the buttocks and down the legs. The sciatic nerves and their branches are responsible for both movement and sensation in the legs and feet.

Compression, injury or inflammation of the sciatic nerve results in symptoms that typically include pain anywhere along the nerve path through the buttock, leg and foot on the affected side. Weakness and numbness can also occur.

There can be wide variability in the specific combination of motor and sensory symptoms. A common cause of sciatic nerve compression and inflammation is a herniated, or bulging, disk in the lower spine. Sciatic nerve compression can also be due to general wear and tear on the spine and the disks that cushion the vertebrae of the spine.

Sciatica nerve symptoms are treatable. Sciatica treatment varies depending on the severity of your symptoms, the presence of complications, your age and medical history, and the type of work and activities you perform.

Seek prompt medical care if you experience symptoms of sciatica, such as pain that runs down the leg. Early diagnosis and treatment can reduce or eliminate symptoms and complications, such as loss of leg movement and disability. Seek immediate medical care (call 911) for symptoms involving loss of leg movement or sensation, or loss of bowel or bladder control.

What are the symptoms of sciatica?

The type and severity of symptoms of sciatica vary from person to person. Certain activities can make sciatica nerve pain and other symptoms worse. Examples include coughing, sneezing, movement of the back, or sudden movements.

Symptoms of sciatica may include:

  • Burning, numbness or tingling in the back, buttock, leg or foot

  • Pain in the back, buttock, leg or foot. Pain may shoot down from the lower back through the buttock and leg and into the foot. Pain may also occur in only one area of the lower extremity, such as above the knee or below the knee.

  • Weakness in the back, buttock, leg or foot

Symptoms that might indicate a serious condition

In some cases, the underlying cause of sciatica can be serious. Seek immediate medical care (call 911) for the inability to feel or move the lower extremity, or loss of bowel or bladder control.

What causes sciatica?

Sciatica frequently occurs due to a bulging or herniated disk in the lower spine. This can pinch or put pressure on the sciatic nerve, which is responsible for movement and sensation in the legs and feet.

Other causes of sciatica include:

  • Degenerative disk disease (caused by wear and tear and effects of aging on the spine)

  • Osteoarthritis

  • Pregnancy

  • Spinal tumor (rare)

  • Trauma to the spine or back

What are the risk factors for sciatica?

A number of factors increase the risk of developing sciatica. Risk factors include:

  • Age older than 40 years

  • Back injury

  • Contact sports

  • Degenerative spine disease

  • Obesity and being overweight

  • Occupation that includes heavy lifting, bending, or twisting and using improper lifting techniques

  • Sedentary lifestyle or occupation, which can weaken the muscles that support the spine

  • Smoking

Reducing your risk of sciatica

You can lower your risk of developing sciatica by:

  • Maintaining a healthy weight

  • Not smoking

  • Participating in a regular, but moderate, exercise program that includes stretching and core exercises, which strengthen the muscles that support your abdomen and back

  • Taking exercise breaks when sedentary, such as walking and stretching every two hours when working all day at a computer

  • Using proper techniques and body mechanics when lifting heavy objects, such as lifting with the legs and not the back

How do doctors diagnose sciatica?

To diagnose sciatica and its underlying cause, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor may ask about sciatica include:

  • What symptoms are you experiencing, including pain, numbness or weakness?

  • When and how did the pain and other symptoms begin?

  • Does the pain radiate or travel?

  • How would you describe the pain, such as shooting, burning or stabbing?

  • What, if anything, seems to make your symptoms better or worse?

  • How are your pain and other symptoms affecting your ability to complete daily activities or work?

  • How often do you exercise or get physical activity?

  • What treatments have you tried so far?

During the exam, your doctor will focus on your muscles and nerves. This includes checking your muscle strength and reflexes. Your doctor may ask you to squat and rise, walk on your toes or heels, and do a straight leg test. This involves your doctor slowly raising your leg while you lie on your back. You will need to let your doctor know when you feel pain.

Depending on the results, your doctor may order testing including:

  • Imaging exams, which may include X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) 

  • Nerve conduction studies, such as electromyography (EMG), to measure how well your nerves send signals and how your muscles respond to them

How do you treat sciatica?

With early diagnosis and treatment, it is possible to reverse the symptoms of sciatica in many cases. Doctors base treatment plans on the underlying cause, the severity of your symptoms, your medical history and general health, and other factors.

Medications doctors use to treat sciatica include:

  • Antidepressants, which can help reduce sciatic nerve pain

  • Corticosteroid injection into the spine, which reduces inflammation and pain

  • Muscle relaxants, which ease muscle tension and pain

  • Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which help to control inflammation and pain

  • Non-opioid pain drugs, such as tramadol (Ultram), for treatment of chronic sciatic pain

  • Short-term opioids for acute sciatic pain relief

Depending on the underlying cause of sciatica, doctors may recommend a variety of other treatments and therapies including:

  • Chiropractic therapies, such as spinal manipulation, electrical stimulation, and trigger-point therapy

  • Complementary therapies, such as yoga, acupuncture, massage and biofeedback

  • Physical therapy and prescribed exercise to improve muscle strength in the back and abdomen, increase flexibility and movement, and reduce pain

Surgery may be necessary in some cases. Doctors may recommend it to relieve severe pain or to address leg weakness or bowel or bladder incontinence. Options include laminectomy or discectomy, both of which relieve pressure on the sciatic nerve.

What are the potential complications of sciatica?

Complications of sciatica can have a profound effect on the ability to function in everyday life. In some cases, it can be permanently disabling.

You can reduce the risk of serious complications of sciatica by following the treatment plan you and your doctor design specifically for you. Complications of sciatica include:

  • Abuse and misuse of medications used to treat sciatica

  • Adverse effects of treatment

  • Bladder incontinence

  • Bowel incontinence

  • Loss of leg movement

  • Permanent disability

  • Poor quality of life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Oct 8
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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