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What is Sciatica

Sciatica is pain, numbness, weakness, or tingling along the path of the sciatic nerve. The sciatic nerve starts in the lower back and runs down the back of each leg. The nerve controls the muscles in the lower leg and in the back of the knee.

It also provides feeling (sensation) to the back of the thigh, the lower leg, and the sole of the foot. Sciatica is a symptom of another medical condition that pinches or puts pressure on the sciatic nerve.

Generally, sciatica only affects one side of the body. Sciatica usually goes away on its own or with treatment. In some cases, sciatica may keep coming back (recur).

The simplest definition of sciatica is back pain that radiates down one leg below the knee.

The character of the pain is usually sharp or burning. Occasionally, dermatome numbness and paresthesias of the lower limb are also reported.

Valsalva maneuvers or flexion and extension of the lumbosacral spine may exacerbate these symptoms.

Sciatica pain is suggestive of nerve root irritation and usually occurs as a consequence of nerve root impingement by structures either within the central canal (disc protrusion, facet or ligament flavum hypertrophy, synovial cyst, etc.) or upon exiting the neural foramen (disc protrusion, congenital narrowing, spondylolisthesis).

What are the causes of Sciatica?

Sciatica is caused by pressure on the sciatic nerve, or pinching of the sciatic nerve.

This may be the result of:

A disk in between the bones of the spine (vertebrae) bulging out too far (herniated disk).
Age-related changes in the spinal disks (degenerative disk disease).
A pain disorder that affects a muscle in the buttock (piriformis syndrome).
Extra bone growth (bone spur) near the sciatic nerve.
An injury or break (fracture) of the pelvis.
Pregnancy.
Tumor (rare).

What increases the risk of Sciatica?

The following factors may make you more likely to develop Sciatica:

Playing sports that place pressure or stress on the spine, such as football or weight lifting.
Having poor strength and flexibility.
A history of back injury.
A history of back surgery.
Sitting for long periods of time.
Doing activities that involve repetitive bending or lifting.
Obesity.

What are the symptoms of Sciatica?

Symptoms of Sciatica can vary from mild to very severe, and they may include:

Any of these problems in the lower back, leg, hip, or buttock:
- Mild tingling or dull aches.
- Burning sensations.
- Sharp pains.
Numbness in the back of the calf or the sole of the foot.
Leg weakness.
Severe back pain that makes movement difficult.

These symptoms may get worse when you cough, sneeze, or laugh, or when you sit or stand for long periods of time. Being overweight may also make symptoms worse. In some cases, symptoms may recur over time.

How is Sciatica diagnosed?

Sciatica may be diagnosed based on:

Your symptoms.
A physical exam. Your health care provider may ask you to do certain movements to check whether those movements trigger your symptoms.
You may have tests, including:
- Blood tests.
- X-rays.
- MRI.
- CT scan.

How is Sciatica treated?

In many cases, Sciatica improves on its own, without any treatment. However, treatment may include:

Reducing or modifying physical activity during periods of pain.
Exercising and stretching to strengthen your abdomen and improve the flexibility of your spine.
Icing and applying heat to the affected area.
Medicines that help:
- To relieve pain and swelling.
- To relax your muscles.
Injections of medicines that help to relieve pain, irritation, and inflammation around the sciatic nerve (steroids).
Surgery.

Follow these instructions at home:

Medicines

Take over-the-counter and prescription medicines only as told by your health care provider.
Do not drive or operate heavy machinery while taking prescription pain medicine.

Managing pain

If directed, apply ice to the affected area.
- Put ice in a plastic bag.
- Place a towel between your skin and the bag.
- Leave the ice on for 20 minutes, 2–3 times a day.
After icing, apply heat to the affected area before you exercise or as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
- Place a towel between your skin and the heat source.
- Leave the heat on for 20–30 minutes.
- Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

Activity

Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
- Avoid activities that make your symptoms worse.
Take brief periods of rest throughout the day. Resting in a lying or standing position is usually better than sitting to rest.
- When you rest for longer periods, mix in some mild activity or stretching between periods of rest. This will help to prevent stiffness and pain.
- Avoid sitting for long periods of time without moving. Get up and move around at least one time each hour.
Exercise and stretch regularly, as told by your health care provider.
Do not lift anything that is heavier than 10 lb (4.5 kg) while you have symptoms of sciatica. When you do not have symptoms, you should still avoid heavy lifting, especially repetitive heavy lifting.
When you lift objects, always use proper lifting technique, which includes:
- Bending your knees.
- Keeping the load close to your body.
- Avoiding twisting.

General instructions

Use good posture.
- Avoid leaning forward while sitting.
- Avoid hunching over while standing.
Maintain a healthy weight. Excess weight puts extra stress on your back and makes it difficult to maintain good posture.
Wear supportive, comfortable shoes. Avoid wearing high heels.
Avoid sleeping on a mattress that is too soft or too hard. A mattress that is firm enough to support your back when you sleep may help to reduce your pain.
Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

You have pain that wakes you up when you are sleeping.
You have pain that gets worse when you lie down.
Your pain is worse than you have experienced in the past.
Your pain lasts longer than 4 weeks.
You experience unexplained weight loss.

Get help right away if:

You lose control of your bowel or bladder (incontinence).
You have:
- Weakness in your lower back, pelvis, buttocks, or legs that gets worse.
- Redness or swelling of your back.
- A burning sensation when you urinate.

Sciatica Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.

Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your hips and your back. These exercises also help to relieve pain, numbness, and tingling caused by Sciatica.