- Understanding Sciatica
- Leg pain, sciatica
- What are the symptoms?
- What are the causes?
- How is a diagnosis made?
- What treatments are available?
- Recovery and prevention
- Sources & links
- Low Back Pain
- 8 red flags your back pain could be something more serious
- You’re experiencing pain that also affects your legs, hips, and glutes
- Your back pain won’t go away with any types of treatments
- You have pain in your kidneys
- You’re experiencing heartburn with back pain
- You’re experiencing numbness, tingling, and a burning sensation
- Your back pain is localized
- You’re not getting better
- You’re experiencing chest pain
Sciatica is a particular type of lower back pain, or leg and back pain that comes from injury or pressure on your sciatic nerve. Your sciatic nerve is a large nerve formed by roots coming out of your spinal cord in the lower part of your back. These roots come together to form two large nerves that run down the back of each of your legs.
The reason sciatica can cause lower back pain as well as leg pain and weakness is that your sciatic nerves control the muscles in the backs of your knees and lower legs. These two nerves also supply feeling to the backs of your thighs, parts of your lower legs, and the soles of your feet.
“Because sciatica is caused by pressure on the nerve roots that make up the sciatic nerve, and there are multiple nerve roots, different people feel sciatic pain in different places,” says S. Christine Kovacs, MD, a rheumatologist at the Lahey Clinic in Burlington, Massachusetts.
Sciatica Symptoms and Causes
Sciatica most often strikes people in their 40s and 50s, according to a study published in March 2015 in the New England Journal of Medicine.
Situated between the bones of the spine, intervertebral disks act as cushions and shock absorbers. If they become damaged and start to bulge out between the bones of your lower back (a condition known as a slipped or herniated disk), they can press on your sciatic nerve roots and cause sciatica. Herniated disks are the most common cause of sciatica, according to the American Academy of Orthopaedic Surgeons.
About 1 to 2 percent of the population will have back pain caused by a slipped disk at some time in their lives, according to U.S. National Library of Medicine. Herniated disks are most often the result of wear and tear, but can also develop from a sudden injury.
Symptoms of sciatica may include:
- Lower back pain
- Shooting pain down the back of the leg
- Burning leg and back pain
- Tingling and numbness of the back or leg
- Weakness of the back or leg
Not everyone has experiences back pain with sciatica, notes Dr. Kovacs. You may only experience tingling and numbness. It all depends on which roots of the nerve are affected. “Although sciatica can occur on both sides, it is usually one-sided,” she adds. Sciatic pain may get worse with sitting, walking, bending, sneezing, or coughing.
Diagnosing and Treating Sciatica
A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. During the physical exam, you may be asked to lift your leg while lying on your back — shooting pain down the back of your leg while in this position is a common sign of sciatica. Your doctor will also check the strength and reflexes in your leg.
An X-ray of your back and an MRI are common tests sometimes used to help diagnose sciatica. Not all cases will require these tests. “Sciatica symptoms such as numbness and weakness may need to be evaluated with an MRI,” says Kovacs.
Treatment of sciatica usually starts with rest and pain control. “During the first 72 hours an ice pack may be applied to the lower back to reduce swelling. After that, heat works best to relax muscle spasms and reduce pain,” explains Kovacs.
Typical treatments may include:
- A few days of bed rest
- Over-the-counter pain relievers
- Cold and hot compresses
- Resuming activity after a few days with mild stretching exercises or other physical therapy
- Muscle relaxants (may be needed for muscle spasms)
Some people may need steroid injections into the spine. In rare cases, surgery may also be considered.
Though it can be a very painful condition, sciatica usually responds to a short period of rest and non-surgical treatment. Up to 90 percent of people with sciatica get better over time without surgery.
Leg pain, sciatica
What are the symptoms?
Classic sciatic pain starts in the low back and buttocks. It affects one leg traveling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling (pins-and-needles) can occur in your leg and foot. This usually is not a concern unless you have weakness in your leg muscles or foot drop.
Sitting usually causes the most pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may actually feel better than sitting or standing for too long.
Seek medical help immediately if you have extreme leg weakness, numbness in the genital area, or loss of bladder or bowel function. These are signs of a condition called cauda equina syndrome.
What are the causes?
Sciatica can be caused by a number of conditions that irritate or compress the sciatic nerve:
- Piriformis syndrome: Tightening or spasm of the piriformis muscle can compress the nerve.
- Trauma: A sports injury or fall can fracture the spine or tear a muscle and damage nerves.
- Herniated disc: The gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress nerves.
- Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord and nerves.
- Osteoarthritis: As discs naturally age they dry out and shrink. Small tears in the disc wall can be painful. Bone spurs can form. The facet joints enlarge and ligaments thicken.
- Spondylolisthesis: A weakness or stress fracture in the facet joints can allow a vertebra to slip out of position and pinch the nerves.
Leg pain can also be caused by a joint problem in the hip or sacroiliac joint. This type of referred pain is quite common, but is not sciatica.
How is a diagnosis made?
A careful medical exam will attempt to determine the type and cause of your spine problem and the treatment options. A diagnostic evaluation includes a medical history and physical exam. Sometimes imaging scans (e.g., x-ray, CT, MRI) and tests to check muscle strength and reflexes are used.
What treatments are available?
Healing begins with self-care and nonsurgical strategies (Fig. 2). The goal is to correct the problem, restore function, and prevent re-injury.
Figure 2. Exercise, strengthening, stretching and ideal weight loss are key elements to your treatment. Make these a part of your life-long daily routine.
Self care: Sciatica often resolves with rest, ice or heat, massage, pain relievers, and gentle stretches. Reduce muscle inflammation and pain using an ice pack for 20 minutes several times a day during the first 48 to 72 hours. Thereafter, a warm shower or heating pad on low setting may be added to relax the muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If self-care treatments aren’t working within the first couple of days, see your doctor. (See Self Care for Neck and Back Pain).
Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen, can bring relief. A muscle relaxant may be prescribed for spasms. If pain is severe, an analgesic may be prescribed that can be taken with the NSAID or muscle relaxant.
Steroids can reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) tapered over a five-day period or by injection directly into the painful area (see epidural steroid injections and facet injections). Steroids may provide immediate pain relief within 24 hours.
Physical therapy: For most leg pain, we recommend a nearly normal schedule from the onset. Physical therapy can help you return to full activity as soon as possible and prevent re-injury. Physical therapists will show proper lifting and walking techniques, and exercises to strengthen and stretch your lower back, leg, and stomach muscles. Massage, ultrasound, diathermy, heat, and traction may also be recommended for short periods. Patients may also benefit from yoga, chiropractic manipulation and acupuncture.
Surgery: Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or severe pain that has not resolved after a reasonable course of nonsurgical treatment. Surgery for a herniated disc, called a discectomy, removes the portion of the disc compressing the spinal nerve. People with stenosis may benefit from a decompression of the nerves.
Recovery and prevention
A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time.
Prevention is key to avoiding recurrence:
- Proper lifting; avoid sitting for long periods
- Good posture during sitting, standing, moving, and sleeping
- Regular exercise with stretching and strengthening
- An ergonomic work area
- Good nutrition, healthy weight and lean body mass
- Stress management and relaxation
- No smoking
If you have questions, please contact the Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.
acute: a condition of quick onset lasting a short time, opposite of chronic.
cauda equina syndrome: compression of the end of the spinal cord (cauda equina) causing low back pain, numbness in the saddle area (groin), extreme leg weakness, difficulty controlling bladder or bowel function; an emergency condition if left untreated can cause paralysis.
chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.
sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg.
updated > 9.2018
reviewed by > Banita Bailey, RN, Mayfield Clinic, Cincinnati, Ohio
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.
ANATOMY RELATED TO SCIATICA
The sciatic nerve is the longest and largest nerve in your body. Five sets of paired nerve roots combine to create it, and it’s about the diameter of a pencil. The sciatic nerve starts in your low back, and travels through your pelvic region.
In most people, the sciatic nerve runs under the piriformis muscle, which moves your thigh side to side. From there, the sciatic nerve descends through the buttocks and the back of the thighs. Behind your knee, smaller nerves branch out from the sciatic nerve and travel down to your feet.
Causes OF SCIATICA
There are many potential causes for sciatica including a bulging or a herniated disc, degenerative disc disease, piriformis syndrome, pregnancy, spinal stenosis, a spinal tumor or spinal infection, spondylolisthesis, or trauma. Any one of these conditions can put pressure on the sciatic nerve or related nerve roots in your low back to cause pain and other symptoms.
Symptoms OF SCIATICA
The symptoms for sciatica can be wide ranging. Pain can travel from the low back, through the buttocks, downward into the leg, and sometimes into the foot. It can feel like shooting pain, burning, tingling numbness or weakness. You can feel symptoms down your entire leg, only part of your leg, or on only one side of your lower body. Pain can range from mild to severe and can cause sitting, standing, and walking to be painful and/or difficult.
Treatment FOR SCIATICA
The treatment for sciatica may differ depending on the underlying cause of the symptoms. Medications may be used to calm down inflammation and make you more comfortable. Spine-specialized physical therapy is typically recommended to help relieve nerve tension and inflammation.
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Commented January 24, 2020
Heidi, I appreciate you sharing your thoughts. I share in your frustration and certainly agree we need to think creatively and be pro-active when evaluating the administrative side of things and our commitment to high level documentation. I also agree that patient advocacy is the primary driver of change for an organization like CMS. My greatest frustration is that this seems fairly obvious, however the APTA has done nothing to communicate these changes to the patients directly other than social media. Drug companies long ago realized that they needed to cut out the middle man and make the case for their products directly to the consumer. As a result, every other commercial these days is from a drug manufacturer, so now patients go into the doctor’s office asking about these drugs instead of waiting for the doctor’s suggestion that they might help. We wouldn’t still be bombarded by drug ads if they weren’t effective. I can’t understand why the APTA has not used some of it’s marketing budget to speak directly to consumers about our services so patients were educated about the benefits of physical therapy, so they were aware how CMS policies will affect their care and can get directly involved, so when they went in to see the doctor because of neck pain or balance issues that they are the ones asking to go to PT. You point out that we must think proactively and advocate, but when productivity requirements continue to go up and more personal time is spent on documentation we need to rely on our professional association. I feel it is time that they consider some forward thinking and radical changes to the way they do business. I refer to the old adage that doing what you have always done and expecting a different result is the definition of insanity. The APTA needs to change their methods and communicate directly with our current and future patients if we are to stop this steady decline in reimbursement and spread the word about the benefits of physical therapy care.
Low Back Pain
Pain and fatigue
Acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs may be used for relief from pain due to lumbar radiculitis, but narcotics should usually be avoided. Higher levels of pain can be alleviated by steroid injections, but the number of injections per year is limited.
A TENS (Transcutaneous Electrical Nerve Stimulator) unit or biofeedback may be tried. A TENS unit is a small, battery-operated device which relieves pain by blocking nerve impulses. Biofeedback is a technique which can help control pain, blood flow, and skin temperature.
Meditation, hypnosis, and others may be learned from a psychologist who specialized in pain management.
Radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) typically does not correlate with a patient’s diet. Being overweight, however, can contribute to back pain; for instance, being overweight could create pain in a person’s knees, and a resulting change in gait could adversely affect the spine. In such instances, or if excess weight causes back pain, a change in diet, in conjunction with exercise, could benefit the patient.
Exercise and therapy
A physician’s exam and laboratory tests will help a doctor determine the appropriate time for a patient to start an exercise program.
Physical therapy can help improve patients’ biomechanics and strengthen core muscles that better support the spine and a person’s upper-body control. Building a program of range-of-motion stretches and strengthening exercises into one’s daily routine can be very helpful to reduce painful events; such programs are most effective if the patient is diligent at home, apart from visits to the physical therapist.
Patients can adjust daily work activities and/or reduce participation in activities that cause or exacerbate pain. If specific postures are more painful, explore other postures that could provide relief.
Acupuncture and other complimentary therapies may be considered, as well.
If back pain is not relieved using other forms of treatment, medication may be prescribed. The medication chosen depends on the back pain. For example, medications called analgesics can help relieve pain. If back pain is caused by arthritis, medication to reduce inflammation as well as relieve back pain may be prescribed. The most common medications prescribed are called nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.
People taking medication for back pain should ask their doctor or pharmacist questions such as those listed below:
- What will the medication do?
- How long will it take before I notice results?
- What is the name of the medication? Is there a generic brand?
- Are there side effects I should know about?
- How should I take the medication (i.e. before or after meals, with or without food, etc.)?
- How often should I take the medication?
- What should I do if I forget to take a dose at the specified time?
People taking medication for back pain should also let their doctors know if they are taking other medications. Sometimes certain medications cannot be taken together.
Often surgery can effectively treat severe cases of lumbar radiculitis, when pain and instability, or other symptoms such as loss of bowel or bladder control, are sustained or worsening despite non-surgical treatments.
- Related video: Specific Indications for Spine Surgery
- Related story: Surgical Management of Spinal Stenosis
Joint aspiration is the process of removing some fluid from the sore joint(s). It is not indicated to treat lumbar radiculitis. Injection of anti-inflammatory steroids can be an effective pain reliever, though it will not change physiological structures that are causing pain.
Splints or braces
Neither splints nor braces are indicated to treat lumbar radiculitis.
Acupuncture and other complimentary therapies may be considered. Relaxation techniques, such as meditation, visual imagery, progressive muscle relaxation, yoga, or biofeedback may also be helpful for people with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs).
Any chronic pain condition can have psychological impacts on patients. The frustration of untimely bouts of pain can cause patients to choose not to participate in social activities, and/or can bring anger and depression. Reduced participation in physical activities can contribute to weight gain.
However, managing chronic pain with a program of exercise, stretching and pain medication – as well as relaxation techniques – can help the patient maintain a more active role in social opportunities. Detecting this condition early on can give patients a better chance to manage their symptoms in the long term.
Many patients are able to adequately self-monitor their pain and other symptoms of radiculitis, managing with medication, physical therapy and other treatments, and visit a physician when their symptoms change markedly or degrade over a span.
Strategies for coping
Patients who report their lumbar radiculitis symptoms (pain, tingling, numbness or a burning sensation in the back and legs) early on can give themselves a better chance to manage their symptoms in the long term. A program of exercise, stretching and pain medication – as well as relaxation techniques – often can help the patient reduce pain maintain a more active role in social opportunities. Additionally, patients and their families should be informed about the condition, exploring therapies that have helped other patients. Patients may benefit from talking with a trained psychological therapist.
Asking for help
People with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) should learn as much as they can about the disease and how to manage it. Sometimes talking to a family member or friend can provide much needed emotional support. Working with a counselor, psychologist, or social worker helps some people with lumbar radiculitis develop better coping skills.
Most people with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) can continue to work. Doctors and work supervisors should be able to help people with make any needed changes that will relieve the symptoms. This could include getting an ergonomic evaluation, and adjusting the work area or reducing the amount of time spent on particular tasks; sometimes even creating a reminder to change postures (e.g., stand up and stretch, take a brief walk) every hour or so can help.
An occupational therapist also can help find ways to modify activities or suggest tool modifications to put less stress on the spine.
Medical researchers continue to learn more about nerve pain radiating from the spinal column. For instance, ongoing and recent research evaluates the efficacy of an implanted spinal-cord neuro-stimulation device, as well as epidural steroid injections and artificial disc replacement.
Research focuses on the potential promise of nonsurgical approaches, such as magnet therapy, and a neuro-protective dietary supplement in patients suffering from lumbar radiculitis.
Recent research by pharmaceutical companies and health organizations evaluated the efficacy and safety of the drugs lenalidomide and topiramate in the treatment of painful lumbar radiculopathy.
Research suggests that Vitamin D deficiency is a major cause of musculoskeletal pain and low-back pain. In one study of 299 patients with low back pain, 83 percent were vitamin D deficient, and most experienced some pain relief with vitamin D supplement doses of 5,000 IU/d or 10,000 IU/d for three months.
Research also indicates that massage can improve flexibility and reduce pain, and increase serotonin and dopamine, in patients with low back pain.
Statistically and clinically significant relief of neuropathic pain has been reported by doctors whose patients received Ziconotide via intrathecal infusion (implanted pumps). The pain relief was temporary, and subsequent infusions were required to maintain pain relief.
Cellular, genetics, or tissue research
Recent research studies the potential for replacing or re-growing spinal disc tissue that would supplant tissue removed in the wake of disc herniation.
Summary of lumbar radiculitis
Low back pain can have dozens of causes. Lumbar radiculitis stems from nerve impingement due to herniated disc(s), arthritis, or narrowing of the spinal canal. An experienced physician can discern which disorder is causing pain and discomfort, and set out an appropriate course of treatment.
Patients with lumbar radiculitis often describe a sharp and burning, or dull and aching, pain that runs through the buttock or hip, thigh, calf, and foot. As symptoms worsen, the patient may begin to experience weakness, numbness and tingling in their legs, as well.
Not all back pain needs to be treated with surgery. Many nonsurgical approaches can enable patients to adequately manage pain. Oral medications, steroid injections, physical therapy and other approaches can be beneficial to patients with chronic episodes of lumbar radiculitis.
Magnetic resonance imaging (MRI) is a very sensitive tool that is may assist in accurate diagnosis of the cause of an individual’s back pain.
Loss of bowel or bladder control, worsening weakness or loss of sensation all are causes for immediate medical attention.
8 red flags your back pain could be something more serious
Back pain is common but it can be serious. iStock
- Back pain that persists and doesn’t get better may indicate something more serious.
- Numbness, tingling, and weakness in your lower body are all signs of an injury that is more serious than common back pain.
- Visit INSIDER’s homepage for more stories.
Back pain affects most of us at some point in our lives. In fact, it is one of the most common health complaints made by Americans. And while back pain can originate from something as simple as bending over or using improper lifting form at the gym, it can also be a sign that something more serious is going on.
INSIDER asked two experts to share eight red flags that indicate you may be dealing with sometime other than common back pain.
Of course, this list is not complete and you should visit your doctor if you’re concerned about your pain even if your symptoms aren’t described here.
You’re experiencing pain that also affects your legs, hips, and glutes
A simple muscle pull may be sore for a few days, but if you’re experiencing pain longer than that, and you are having intense leg or back pain, Dr. Allen Conrad, BS, DC, CSCC, owner of Montgomery County Chiropractic Center said you might have a herniated disc.
“A herniated disc occurs when the jelly-like substance between your vertebrae in your back becomes misaligned,” he told INSIDER. Additionally, Grayson Wickham, PT, DPT, CSCS, a physical therapist and founder of Movement Vault told INSIDER that weakness in your hips, legs, glutes, or muscles of the foot could point to an injured vertebral disc, again compressing your sciatic nerve causing these symptoms.
Your back pain won’t go away with any types of treatments
Stress fractures happen as a result of overuse injuries or trauma. If you’re dealing with a stress fracture of the spine, Conrad said you will most likely experience persistent back pain that will not go away with any types of treatments. “These tiny fractures in the bone will not resolve until the area is stabilized,” he explained.
You have pain in your kidneys
In addition to flu-like symptoms, kidney infections can also cause persistent back pain.
“This pain is commonly associated in the flank area of the back on either side, under the side of the ribs,” explained Conrad. The pain can come on suddenly or build up over time. He also pointed out that kidney pain may have sharp pain if you push on the sides of your back which overlap the kidneys.
You’re experiencing heartburn with back pain
Heartburn can be a sign of something more serious. Getty Images
When stomach acid flows back into your esophagus, the lining of the esophagus can often feel irritated. When this happens, many people experience heartburn. Otherwise known as Gastroesophageal Reflux Disease or GERD, Conrad said this can cause upper to mid back pain and stiffness, which is usually associated with certain foods you eat.
You’re experiencing numbness, tingling, and a burning sensation
If you’re experiencing numbness, tingling, or a burning pain in your back or your legs, Wickham said these are all symptoms of nerve pain. “This is a sign that you may have injured a vertebral disc, which then compresses your sciatic nerve causing these symptoms,” he said.
Your back pain is localized
If your back pain only happens in specific positions such as when you bend forward, Wickham said this could indicate that you either strained an erector muscle in your lower back or sustained a vertebral disc injury such as a bulging disc or herniated disc.
You’re not getting better
If it’s not going away, it’s time to go to the doctor. Rawpixel.com/
If you injured your back, and it does not get any better within five days, Wickham said you might be dealing with more than sore muscles. This is also true if you haven’t exercised in the previous two to three days, but you’re experiencing back pain. “This indicates that you injured your back in one way or another,” he explained.
You’re experiencing chest pain
Although it doesn’t always present this way, Conrad said a heart condition or underlying cardiovascular blockage might present itself as upper mid back pain or arm pain. “If you believe that your back pain is related to your heart, proceed to the emergency room as soon as possible for an evaluation,” he said.