Sciatica: What You Need to Know

Sciatica is nerve pain caused by injury, irritation or compression of the bundle of nerves that together form the sciatic nerve. The sciatic nerve is the longest and thickest nerve in the body — about 2 centimeters wide at its largest. The condition often causes pain in the lower back, buttock and one leg, and sometimes extends into the foot or toes.

Types of sciatica

There are two types of sciatica. Regardless of what type you have, the effects are the same. The types are:

• True sciatica. This is any condition or injury that directly affects your sciatic nerve.
• Sciatica-like conditions. These are conditions that feel like sciatica, but happen for other reasons related to the sciatic nerve or the nerves that bundle together to form it.

Healthcare providers tend to refer to both types as just “sciatica.” The differences between them usually only matter when your healthcare provider determines how to treat it.

What are the symptoms of sciatica?

Sciatica symptoms can include:

• Pain. Sciatica pain happens because of pressure on the affected nerve(s). Most people describe sciatica pain as burning or like an electric shock. This pain also often shoots or radiates down the leg on the affected side. Pain commonly happens with coughing, sneezing, bending or lifting your legs upward when lying on your back.
• Tingling or “pins and needles” (paresthesia). This is similar to the feeling you have when a leg falls asleep because you sat cross-legged.
• Numbness. This is when you can’t feel sensations on the skin in the affected areas of your back or leg. It happens because signals from your back or leg are having trouble reaching your brain.
• Muscle weakness. This is a more severe symptom. It means that muscle command signals are having trouble reaching their destinations in your back or legs.
• Urinary incontinence or fecal incontinence. This is a very severe symptom. It means signals that control your bladder and bowels aren’t reaching their destinations.

What causes sciatica?

Sciatica can happen because of any condition that affects the sciatic nerve. It can also happen because of conditions affecting any of the five spinal nerves that bundle to form the sciatic nerve.

Conditions that can cause sciatica include:

• Herniated disks.
• Degenerative disk disease.
• Spinal stenosis.
• Foraminal stenosis.
• Spondylolisthesis.
• Osteoarthritis.
• Injuries.
• Pregnancy.
• Tumors, cysts or other growths.
• Conus medullas syndrome.
• Cauda equina syndrome.

What are the risk factors for sciatica?

Because sciatica can happen for so many reasons, there are many potential risk factors, which include, but aren’t limited to:

• Having a current or previous injury. An injury to your spine or lower back increases your risk of developing sciatica.
• Normal wear-and-tear. As you get older, normal wear-and-tear on your spine can lead to pinched nerves, herniated disks and other conditions that can cause sciatica. Age-related conditions like osteoarthritis can also play a role.
• Having excess weight or obesity. Your spine is like a construction crane when you stand upright. The weight you carry in the front of your body is what your spine (crane) has to hoist. Muscles in your back are like the winch and cable, pulling to keep you vertical. The more weight you have, the more your back muscles have to work. That can lead to back strains, pain and other issues.
• Having insufficient core strength. Your “core” is the term for the muscles of your back and abdomen (stomach area). Like in the crane analogy, having a stronger core is like upgrading the crane’s components to handle a heavier load. The muscles of your abdomen are important because they help anchor your back muscles.
• Your job. Jobs that require heavy lifting, a lot of bending, or working in awkward or unusual positions may increase your risk of low back problems. However, jobs with prolonged sitting — especially without proper back support — may also increase your risk of low back problems.
• Not using good posture and form when lifting. Even if you’re physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting, strength training or similar activities.
• Having diabetes. Type 2 diabetes increases your risk of diabetes-related peripheral neuropathy. That damages your nerves, including any of the nerves that can cause or contribute to sciatica.
• Physical inactivity. Sitting for long periods and a lack of physical activity can contribute to an increased risk of sciatica.
• Unknown causes. Many cases of sciatica don’t have a cause that healthcare providers can find.

Diagnosis and Tests

The straight-leg test helps healthcare providers diagnose sciatica and other causes of back pain.

How is sciatica diagnosed?

A healthcare provider can diagnose sciatica using a combination of methods. They’ll review your medical history and ask about your symptoms. They’ll also do a physical examination. That exam will include:

• Walking. Sciatica often causes visible changes in how you walk. Your provider will watch for those changes as part of diagnosing sciatica.
• Straight leg raise test. This involves having you lie on an exam table with your legs straight out. They’ll slowly raise your legs one at a time toward the ceiling and ask when you start to feel pain or other symptoms. These can help pinpoint the cause of sciatica and how to manage it.
• Other flexibility and strength checks. These can help your provider determine if any other factors are causing or contributing to your sciatica.

Management and Treatment

How is sciatica treated, and is there a cure?

Treating sciatica usually involves trying to decrease pain and increase mobility. Many treatments are things you can do yourself.

There are several treatment options if you have sciatica that won’t go away or is more severe. Surgery might be an option if your case is severe or other treatments don’t help.

Self-treatment

Depending on the cause, milder cases of sciatica usually get better with self-treatment.

NOTE: Pain that’s moderate to severe, with numbness and tingling or muscle weakness are all symptoms that need professional medical care. You shouldn’t try to self-treat them.

Self-treatments can include:

• Ice. Cold or ice packs can help reduce pain and swelling during the first few days after sciatica pain starts. You can use an ice pack or a bag of frozen vegetables for this (but always wrap them in a towel to prevent cold-related injuries to your skin). Apply cold for 20 minutes at a time, several times a day.
• Heat. After the first several days of using cold or ice, switch to a heating pad or warm compress. Apply heat for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs — whichever best relieves your discomfort.
• Stretching and activity. Learning how to stretch properly from an instructor with experience with low back pain can be a major help. They may also be able to help you work your way up to other general strengthening, core muscle strengthening and aerobic exercises.

If the self-care treatment approach doesn’t help after a few weeks, you should talk to a healthcare provider.

Conservative treatments

Conservative treatments are a step up from self-treatment. Your healthcare provider can offer these as options if self-care wasn’t helpful or if your symptoms are severe enough to need more involved care.

Conservative treatments can involve similar treatments to self-care, but with your healthcare provider guiding you. They can also involve the following:

• Prescription medications. Painkillers, muscle relaxers and other medications may help with sciatica symptoms. Other medications, like tricyclic antidepressants and anti-seizure medications, may also help if you have chronic or nerve-based pain.
• Physical therapy. The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. Options include stretching exercises or low-impact activities like walking, swimming or water aerobics.
• Spinal injections. Injections like corticosteroids may provide short-term relief (typically up to three months). These usually involve local anesthesia, so there’s less discomfort. Your healthcare provider can tell you more about this process.
• Alternative therapies. These treatments are increasingly popular and offer options other than standard medical therapies or medications. They include seeing a chiropractor for spine adjustments, yoga, acupuncture and more. Massage therapy might also help muscle spasms that occur with sciatica. Biofeedback can also help you manage pain and relieve stress.

Surgery options for sciatica

Surgery may be the best option when sciatica is more severe. Usually, healthcare providers don’t recommend surgery unless you have symptoms that indicate nerve damage is happening or imminent. They may also recommend surgery if you have severe pain that prevents you from working or going about your usual routine, or if your symptoms don’t improve after six to eight weeks of conservative treatment.

Surgery options to relieve sciatica include:

• Diskectomy. This is a surgery that removes fragments or small sections of a herniated disk that are pressing on a nerve.
• Laminectomy. Each vertebra has a rear section called the lamina (it’s on the side of the vertebra just underneath the skin of your back). A laminectomy involves removing a section of the lamina that’s pressing on spinal nerves.

What are the possible complications or side effects of treatment?

The possible complications and side effects depend on many factors, especially the specific treatments used, the severity of your symptoms, what caused your sciatica and more. Your healthcare provider is the best person to tell you about the possible side effects and complications that are most likely. They can also advise you on managing, minimizing or avoiding them.

How soon after treatment will I feel better?

Recovery time from sciatica depends on the specific treatment, the severity of your symptoms, their cause and more. Many cases of sciatica go away within four to six weeks without needing professional medical treatment.

More severe cases may also take weeks or months to get better, especially if you have more severe symptoms. Waiting too long to get treatment for sciatica — generally more than six months — also makes a good outcome less likely, so it’s important not to wait too long to talk to a healthcare provider.

Data source：

• https://my.clevelandclinic.org/health/diseases/12792-sciatica
• https://health.clevelandclinic.org/how-to-get-better-sleep-with-sciatica-pain?
• https://en.wikipedia.org/wiki/Sciatica?