Sciatica, although commonly thought of as disease or condition, is actually a symptom. In other words, sciatica is not an independent condition (like arthritis or diabetes) but rather a symptom of an underlying problem. Sciatica is pain that stems from the sciatic nerve. The sciatic nerve is the largest nerve in our body, branching out from the lower back, down the buttocks, and down the back of the legs. Part of the sciatic nerve runs down the thigh, calf, foot and toes. The nerve runs through most of your lower body.
Sciatica can be thought of as a “flare up” of the sciatic nerve when it becomes compressed, irritated or is under pressure.
What Causes Sciatica?
The most common cause for sciatica is when a herniated disc in the spine (ruptured or bulging disc) presses against the nerve. If you think about the sciatic nerve as a live wire and a disc as a foreign object pressed against that live wire, there will be an electric reaction (pain). Sciatica can also be the result of spinal canal narrowing (spinal stenosis), a pinched nerve, tumors, pregnancy or even an infection that affects the nerve. What all of these causes have in common is that the large sciatic nerve somehow becomes disturbed.
Sciatica is most common in patients over 40 years old. It’s also more likely to affect those with an unhealthy BMI and smokers.
Causes of Sciatica Cheatsheet:
- Spinal stenosis/ Lumbar spinal stenosis (narrowing of the spine canal)
- Ruptured/ slipped disc
- Isthmic spondylolisthesis
- Degenerative disc disease (like Lumbar degenerative disc disease)
- Bone Spurs (Osteophytes)
- Piriformis syndrome
- Sacroiliac joint dysfunction
- Torn/ strained muscles
- Pinched nerve
Pregnancy can increase pressure on your disc and cause herniation. However, it would not technically be a “cause” of sciatica.
Symptoms of Sciatica
Although you may not experience every one of these symptoms, most patients with sciatica will experience the following:
- Back pain or pain in the buttocks
- Pain that travels or shoots down your leg and foot.
- Pain on one side of your body
- Pain is relieved when lying down or walking (worsened by sitting or standing) if it is a herniated disc issue.
- Pain is relieved with sitting or leaning forward (worsened by standing upright or walking) if it is a stenosis issue.
- Pain is described as “sharp, shooting, severe”.
- Leg or back pain is the primary symptom (in some cases, back pain takes a “backseat” to the leg pain experienced).
- Numbness or tingling (“pins and needles”) in your leg.
- Irritation with prolonged standing or sitting.
- Flare-ups after exercising or sudden movement.
If you are experiencing any of the following due to sciatica, seek medical attention ASAP:
- Neurological symptoms that are progressing (e.g. leg weakness).
- Bowel or bladder dysfunction.
- Unintentional weight loss (could be a sign of cancer)
- Fever, chills (could be a sign of infection)
How to Treat Sciatica
Sciatic symptoms don’t always need surgery to be fixed. In fact, surgery to resolve sciatica is quite rare. Majority of patients will treat their sciatica with non-invasive surgical methods and some good ol’ fashion time. What you must be mindful of when seeking a solution for your sciatic pain, is what the root cause of your sciatic pain is. Treatment will be very different for those that have a fracture that is triggering a flare-up versus someone who is diagnosed with lumbar spinal stenosis.
It’s been estimated that sciatica will affect up to 43% of the population at some point.
Here are the most common ways to treat sciatic pain:
1. Physical Therapy
Engaging in regular physical therapy that has been tailored to treat the root cause of your sciatica is very important. If your sciatica is caused by a herniated disc versus stenosis, the exercises will be different.
Doing the wrong exercises for your diagnosis can be painful and damaging. It’s important that you work with a professional physical therapist (or physiotherapist) before exercising. If your sciatica has been triggered by a fracture or a slipped disc, aggressive physical therapy may not be the answer. Your physician will be able to guide you toward the best treatment solution for your individual case.
In saying this, physical therapy and targeted exercises usually help most patients get their pain under control after a flare-up. Commonly, exercises that target the lower back and hips are used to alleviate pain and strengthen and condition. Exercises can fix the underlying issues that are causing sciatic pain and help build up strength and flexibility to avoid future preventable injuries and flare-ups.
Common exercises to relieve sciatic pain are:
- Standing hamstring stretch
- Sitting spinal stretch
- Knee to opposite shoulder
- Pigeon pose stretching
- Four point stretch
- Knee to chest stretch
2. Take Medications
Although medication won’t fix the problem, it can offer pain-relief which will let you be more mobile and engage in important physical therapy. Medication will help with inflammation and can help to treat the pain you’re in. A long-term solution must be uncovered to prevent a future injury.
Here are the types of medication you may be recommended:
- Over-the-counter Pain Relievers. At first, you will likely try to treat your pain and inflammation with medication you can purchase at your local pharmacy. Common pain relievers are: Acetaminophen (Tylenol), Aspirin or Nonsteroidal anti-inflammatory drugs (NSAIDs, like Advil, Motrin), Naproxen (Aleve).
- Muscle Relaxants. Muscle relaxants act as a sedative that can temporarily alleviate muscle pain, spasms and stiffness. Commonly prescribed muscle relaxants are: Baclofen, Chlorzoxazone (Lorzone, Parafon Forte DSC), Carisoprodol (Soma), Cyclobenzaprine (Amrix, FlexePax), Dantrolene (Dantrium), Diazepam (Valium), (Methocarbamol (Robaxin). Read more about muscle relaxants.
- Prescription Medication. Prescribed by your doctor, prescription pain narcotics can come with a laundry list of side-effects (including addiction). However, for severe pain, opioids or non-opioid pain medication may be recommended. Prescription NSAIDs may also be an option for you.
- Antidepressants. Although it may seem controversial, antidepressants have been used for several years to treat lower back pain. Talk to your doctor about antidepressants as an option. Like all prescription medication, antidepressants can have serious side-effects. Common antidepressants for sciatica: amitriptyline (Elavil), doxepin (Sinequan), and amoxapine (Asendin). Read more about antidepressants.
3. Corticosteroid Injections
Cortisone injections are sometimes called “corticosteroids” or just “steroid injections”. The injections are made up of the medication “cortisone”. The injection of cortisone treats inflammation. Reducing inflammation in the sciatic nerve will relieve pain. Cortisone cuts down the inflammation that is flaring up your sciatic nerve.
Most likely, you will receive your cortisone injection as an epidural. This is injected right into the spine. Learn more about the different types of cortisone/ steroid injections here.
As always, surgery is the “end of the line” treatment. In other words, surgery is reserved for people who:
- Have uncontrolled pain.
- Have symptoms that are worsening.
- Are not improving with less-invasive treatments.
- Have “red flags” that require immediate intervention like neurological symptoms (leg weakness) or bowel/ bladder dysfunction.
Always talk to your primary physician or specialist about the next steps for you. If your quality of life has taken a hit, it’s time to get proactive. If you have back pain, Sign-up for PeerWell. We have a free daily smartphone programs that can improve your symptoms.