What To Know About Sciatica

Pressure on the spinal nerves that form the sciatic nerve can lead to pain in the hip, buttock and thigh. Depending on which part of the nerve is affected, pain may also affect the lower leg and foot.

“Although each leg has its own sciatic nerve, sciatica usually affects only one side of the body at a time,” says Hani Malone, MD, a neurosurgeon at Scripps Clinic. “Sciatica is caused by pinching of the nerves in the lower back, usually from spinal arthritis or a herniated disk. The severity of symptoms varies. Some people have severe, constant pain that impacts their daily activities and even causes weakness. Others may have only mild or occasional pain.”

In addition to a cramp-like pain in the lower back and leg, the most common symptoms of sciatica include:

• A burning or tingling sensation in your buttock, hip or leg
• Difficulty moving your leg or foot
• Shooting pain upon standing
• Pain that worsens when you are sitting
• Pain when you sneeze or cough

Sciatica is rarely an emergency, but do seek immediate medical attention if you have:

• Severe weakness or numbness in your legs
• Loss of bladder or bowel control

Sciatica can affect people at any age, but is more common between the ages of 30 and 50. Pregnant women may be more likely to develop sciatica if the developing baby puts pressure on the sciatic nerve.

Arthritic changes due to normal aging and injuries are common causes of sciatica, as are spinal problems, such as a protruding or herniated disk, narrowing of the lower spinal canal (lumbar stenosis), and conditions that cause the vertebrae to slip out of place and put pressure on the sciatic nerve. In addition, a muscle spasm in the back or buttocks can trigger sciatica.

Mild cases of sciatica will usually go away on their own within a few weeks. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, can help relieve pain and inflammation. Massage therapy can relax the surrounding muscles that have tightened up in response to the pain. Acupuncture also may help relieve sciatica symptoms.

Avoid activities that aggravate the discomfort, but don’t confine yourself to a bed or chair. Spending too much time in one position can make sciatica worse. Do activities that feel comfortable to keep your body moving, which can help reduce inflammation and promote healing.

If you are not feeling better in a few weeks, make an appointment with your physician. Your doctor will ask you to describe your symptoms and perform a physical examination. You may need to stand or move in various positions to determine which part of the nerve is affected. If necessary, you may have X-rays or an imaging exam, such as a magnetic resonance imaging (MRI) scan. 

Depending on your diagnosis, your doctor may prescribe stronger anti-inflammatory medications or muscle relaxers. In some cases, you may receive a cortisone injection in the area to reduce the inflammation and allow your body to heal.

Your doctor also may refer you to a physical therapist trained in sciatica therapy. A therapist can show you exercises to help relieve symptoms while conditioning your body to prevent future recurrences. If your sciatica is caused by a herniated disk or other spinal problem and nonsurgical treatments aren’t effective, your doctor may recommend surgery.

“During this surgery, known as a laminotomy or mico-discectomy, we open the covering of the spinal canal and remove the damaged disk fragment, which releases the pressure on the nerve,” says Dr. Malone. “It is a common procedure with an excellent success rate. Using the latest techniques, the procedure can be performed minimally invasively with less than a one-inch incision. The sciatica pain is gone when patients wake up and they go home the same day.”

Sciatica caused by spinal problems or pregnancy cannot be prevented, but you can take steps to reduce your risk from other causes:

• Learn exercises to keep your core (back and abdominal) muscles strong and flexible, which can help protect your back. Yoga and Pilates combine movements to build strength and flexibility.
• Practice good posture to relieve lower back stress.
• Avoid sitting for long periods of time and take frequent breaks to stand and walk around.
• Lift objects using your legs, not your back. Keep your back straight and bend at your knees while holding the object close to you.