Sciatica refers to the pain that radiates down the path of the sciatic nerve. While sciatica typically only affects one side of the body, it is often reported as one of the most painful forms of back pain due, mainly due to the overall size of the nerve.
What is the Sciatic Nerve?
The sciatic nerve (scientifically known as the ischiadic nerve) is the longest and largest single nerve in the human body; about the diameter of a finger. It begins in the lower back with contributions from the L4-S3 nerve roots. The nerves branch out from the spine and pass through the sciatic foramen just below the piriformis muscle (the muscle responsible for rotating the thigh back and forth), they then travel deep through the buttocks, down the posterior of the leg until it splits into smaller nerves behind the knee which go all the way to the feet.
The sciatic nerve is an important part of the body’s nervous system. Not only does it provide sensation to the skin all the way throughout the lower leg, it also serves a critical role in connecting the spinal cord to the muscles in the leg and the foot.
Pain that radiates from the lower spine to the buttock and down the back of the leg is a tell-tale sign of sciatica. You can feel pain almost anywhere along the nerve pathway, but it typically follows a path from the lower back to the buttock and the back of your thigh and calf. It also usually only affects one side of the body.
The pain caused by sciatica can vary dramatically, ranging from a dull ache to a sharp, burning or excruciating pain. Some patients have even reported that it feels like “an electric shock” running down their leg. Other symptoms can include:
Tingling and numbness throughout the leg
Pain that is aggravated by coughing and/or sneezing
Pain that is caused by sitting or standing for prolonged periods of time
Pain that intensifies when standing up or is relieved by lying down
What Causes Sciatic Nerve Pain?
The term sciatica is typically used to describe pain that is felt throughout the distribution of the sciatic nerve. This being the case, it’s more accurate to say that sciatica is a symptom of a spinal disorder, not necessarily the spinal disorder itself.
More often than not, sciatic nerve pain is caused by nerve compression within the spine. The nerve roots that exit the spine and form the sciatic nerve are incredibly sensitive and any spine material that presses up against these nerves, or causes inflammation, can easily cause pain.
There are a number of spinal conditions that are known to cause sciatic nerve pain including:
Herniated discs are the most common cause of sciatic nerve pain in the lumbar spine. When a disc herniates, the jelly-like material inside can press out through the annulus (the outer shell). Depending on the location of the herniated disc, the material can put pressure on the nerve roots and cause sciatic nerve pain.
Degenerative Disc Disease
Degenerative disc disease is a term used to describe natural aging in the spine and is known to cause disc weakness that can lead to herniation. Additionally, degenerative disc disease can cause disc collapse which can narrow the gap between the vertebrae and the spinal column and put pressure on the nerve roots.
Bone spurs typically form as a preventative measure when there is excess movement within the spine. While these spurs can stop disc movement, they can also put pressure on the nerve roots, causing sciatic pain.
Spinal stenosis is a narrowing of the canal that houses our spinal cord/nerves. The narrowing is usually a result of the build up of bone spurs and thickened ligaments which occur as a response to degenerative disc disease. The sciatic nerve may be impinged as a result of this narrowing.
Spinal tumors can put pressure on the sciatic nerve, but this condition is relatively rare.
It’s important to note that not all pain in the legs and buttocks can be associated with sciatica. There are a several other structures within the spine that can cause similar types of pain including inflammation in the facet joints and disc tears.
When should you see a doctor for sciatic nerve pain?
While mild cases of sciatica can be painful, they often don’t require surgery to correct. Most of the time the pain will go away on its own within a couple of days.
However, if you’re noticing that the pain is not going away after a week or growing progressively worse, you should set up an appointment with your spine care specialist.
Additionally, you should seek immediate medical care if:
You have sudden numbness or severe pain in your lower back or leg
You have sudden muscle weakness in your leg
The pain follows a violent, traumatic injury like a car accident or severe fall
You have trouble controlling your bowels or bladder
If you end up visiting a doctor for your sciatic nerve pain, you will likely receive a physical and neurologic examination in conjunction with a review of your medical history and, possibly an x ray, MRI or CT-scan if applicable.
During the physical examination, the physician will observe the patient’s range of motion along with their reflexes and muscle strength. These tests are used primarily to determine the source of the pain and the extent of the condition.
Often the pain associated with sciatica can be relieved through self-care measures like stretching, rest, or anti-inflammatory medication like ibuprofen.
If this treatment doesn’t help, the problem may be a more serious spinal issue and your doctor may recommend some of the following treatments:
Medication. Often times sciatica pain can be relieved simply by reducing the inflammation affected the nerve roots in the spine or relaxing any muscles or tendons that are tight and putting unnecessary pressure on the spinal column. Prescribed medications can often help accomplish this goal.
Steroid injections. In some cases, your spine specialist might recommend an injection of a corticosteroid medication into the area of the nerve root affected by inflammation. This injection often also includes a nerve blocking agent like lidocaine. The nerve blocking agent numbs the area of pain and provides immediate but short acting relief while the steroid reduces the inflammation to provide more long lasting relief.
Surgery. In rare cases, your spinal condition might be serious enough to warrant surgery. Typically, this option is recommended only for patients who are experiencing weakness in their legs, loss of bowel control, and/or have pain that is growing consistently worse and isn’t responding to other therapies. In minimally invasive spine surgery, the spine specialist can remove the bone spur or herniated disc that is putting pressure on the nerve roots via an incision that is 1 inch or less. This is an outpatient procedure that can be performed in about 1 hour