Back pain comes in all shapes and sizes.
It can flare up immediately after an injury or appear slowly and mysteriously over a period of months. It can be sudden and short-lived (acute) or long-lasting (chronic).
Over-the-counter medications help with some types of back pain, but only powerful medications and surgery can fix others.
Sometimes it is difficult to identify the source of your back pain, but other times you can easily identify it. Sciatic pain is one of those that is quite simple to identify. Home remedies can work fast, so you may not even have to call a doctor.
How does sciatica work?
Sciatica usually begins with a herniated disc in the lumbar (lower) spine. Your vertebrae (the bones that make up your spine) are separated and cushioned by flat, flexible, round discs of connective tissue.
When a disc wears out, either from injury or simply from years of use, its soft center can begin to come out of the rigid outer ring.
When a disc herniates, it can put pressure on the nerves around it. This can cause a lot of pain when it happens to be the sciatic nerve.
The sciatic nerve is the longest nerve in your body. It starts at the lower back and splits to run through the hips, buttocks, legs, and feet on both sides.
Bone spurs and spinal stenosis (narrowing) can also put pressure on the sciatic nerve in the lower back. When that happens, it can cause a lot of problems throughout the entire nerve.
The most distinctive sign of sciatic pain is a condition that radiates from the lower back to the back, side, or legs. It can range from mild pain to sharp, severe pain. You may also feel numbness , tingling, and weakness in your leg or foot.
- Age: Most people with sciatic pain are between 30 and 50 years old.
- Weight – Extra pounds can put pressure on your spine, which means that overweight people and pregnant women are more likely to have a herniated disc.
- Diabetes can cause nerve damage.
- Your job: a lot of heavy lifting, or prolonged sitting, can damage your discs.
What are the symptoms of sciatic pain?
Common symptoms of sciatic pain include:
- Back pain.
- Pain in the butt or leg that worsens when you sit down.
- Hip pain.
- Burning or tingling in the leg.
- Weakness, numbness, or trouble moving the leg or foot.
- A constant pain on the side of your butt.
- A shooting pain in the leg that makes it difficult to stand up.
Sciatic pain usually affects only one side of the lower body. Often the pain spreads from your lower back to the back of your thigh and down through one of your legs. Depending on where the sciatic nerve is affected, the pain can also spread to the feet or toes.
For some people, sciatica pain can be severe, making it difficult for them to do the things they usually do. For others, it may not last long, but it bothers them and has the potential to get worse.
What causes it?
Sciatic pain occurs when the sciatic nerve is pinched, usually from a herniated disc or bone spur. Other common causes of sciatic pain include:
- Lumbar spinal stenosis (narrowing of the spinal canal in the lower back).
- Degenerative disc disease (ruptured discs, which act as shock absorbers between the vertebrae).
- Spondylolisthesis (a condition in which one vertebra slides forward over another).
- The pregnancy.
- Muscle spasm in the back or buttocks.
- Other things that can make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
When to call the doctor
Your sciatic pain may go away on its own, but if your pain is severe or doesn’t go away, you may want to see your doctor. Sciatica can be treated with physical therapy, medications, and surgery.
Seek medical attention immediately if you have any of the following symptoms:
- Weakness in the lower extremities.
- Numbness in your leg.
- Loss of bladder or bowel control.
- Severe pain in the lower back or leg.
How do I know if I have sciatic pain?
Most of us have had back problems of one kind or another, be it mild discomfort or excruciating pain that knocks you out. But with sciatica, you probably know right away that this is something different.
The tell-tale sign of sciatica is pain that begins in the lower back and shoots down one leg, sometimes to the foot.
Sciatic pain is triggered when something – usually a herniated disc but sometimes a bone spur – puts pressure on the sciatic nerve, which runs from the lower back to the legs and feet. This can occur with an injury or simply with the wear and tear of aging.
Mild sciatic pain generally responds well to do-it-yourself treatments such as over-the-counter medications and hot and cold packs. But if your back pain lasts longer than a week or gets worse, it’s time to call your doctor.
If you have pain that comes on suddenly, is caused by injury, or causes you to lose bladder or bowel control, these are emergencies and you should call your doctor immediately.
There are two types of sciatica pain:
- Referred to.
In neurogenic sciatica pain, the pain is caused by compression of the sciatic nerve or the smaller nerve roots that form it, symptoms can vary in severity due to the amount of pressure on the nerve. This can be caused by a variety of problems, from bulging discs to tight muscles.
With neurogenic sciatic pain, there are usually abnormal findings on neurological examination, such as loss of normal reflexes, muscle weakness, and sensory changes.
Referred sciatic pain is pain due to a muscle and joint problem in the spine and pelvis, it can simulate sciatica and it is important to determine the cause of your pain.
Referred pain is usually dull and achy, but it can also be acute in nature. It usually does not cause a tingling sensation, feeling hot or cold, numbness, or muscle weakness.
Abnormal neurological findings, such as reflex changes, objective weakness, and sensory changes, are unlikely.
The first thing your doctor is likely to do is ask you questions about your back pain: Do you have numbness or weakness in your legs? Do certain positions help your discomfort? Has the pain prevented you from doing any activity? Did any home remedy relieve your pain at all?
He will also want to know about your lifestyle: Do you do a lot of physical work, like lifting heavy objects? Do you sit for long periods of time? How often do you exercise?
Next, you will want to do a physical exam to try to find out which nerve is causing your problem. You may do some exercises to see if they make your pain worse, such as getting up from a squat, walking on your toes and heels, and lifting one leg while lying on your back.
If your pain is ongoing (chronic) or severe, your doctor may also have some imaging tests. X-rays, CT scans, and MRIs can look for herniated discs or bone spurs that would clearly be the causes of sciatica pain.
An electromyography (EMG) test can also tell you which nerves in your back are being compressed.
If your doctor diagnoses you with sciatic pain, the good news is that most cases clear up within a few weeks without surgery. If over-the-counter medications haven’t decreased your pain, your doctor will likely prescribe anti-inflammatories or muscle relaxants.
You may also need physical therapy or steroid injections to help ease your discomfort. The conversation about surgery will start only after you have tried everything else.
What is the treatment for sciatic pain?
These cases cause pain and discomfort, but there are many effective treatments for it. Most people with sciatic pain do not need surgery, and about half improve within 6 weeks with just rest and medication.
So what should you do after your doctor diagnoses you with sciatic pain?
Most people with sciatic pain improve within a few weeks with home remedies. If your pain is fairly mild and does not prevent you from doing your daily activities, your doctor will first recommend trying some combination of these basic solutions.
- Physical Therapy: A physical therapist can develop a stretching and exercise routine for you, and can also help improve your posture to relieve pressure on the sciatic nerve.
- Stretching: You can help ease your sciatica pain with lower back stretches.
- Exercise – Inflammation can improve when you’re on the go, so short walks may be a good idea. Your physical therapist can make sure your form is correct so you don’t hurt yourself further.
- Limit bed rest: three days of rest usually does the trick, and it is important to be on a firm mattress or on the floor. After that, it is best to return to your normal activities.
- Hot and Cold Packs – Apply each for several minutes to the lower back, a few times a day. Cold packs first for a few days, then warmed up.
- Alternative Therapies – Many people believe that alternative therapies like yoga, massage, biofeedback, and acupuncture help with sciatic pain.
- Medicines: Your first choice should be over-the-counter pain relievers. Acetaminophen and MANEs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, and naproxen are very helpful, but you should not use them for long periods without consulting your doctor.
If over-the-counter options don’t help, your doctor may prescribe stronger muscle relaxants or anti-inflammatories. Tricyclic antidepressants such as amitriptyline (Elavil) and anti-seizure medications sometimes improve, too. Steroid injections directly into the irritated nerve can also provide limited relief.
When all else fails, surgery is the last resort for about 5% to 10% of people with sciatic pain. If you have milder sciatica pain but still feel pain after 3 months of resting, stretching, and taking medicine, you and your doctor will likely need to discuss surgery.
In rare cases, sciatica pain can cause cauda equina syndrome, a condition that causes you to lose control of your bowels and bladder. That is a direct situation to surgery.
The two main surgical options for sciatica are discectomy and laminectomy.
During this procedure, your surgeon removes anything that is pressing on your sciatic nerve, be it a herniated disc, bone spur, or something else.
The goal is to remove only the part that is causing the sciatic pain, but sometimes surgeons have to remove the entire disc to fix the problem. You will have general anesthesia for a discectomy, and you may be able to go home the same day.
The lamina is part of the ring of bone that covers the spinal cord. During a laminectomy, your surgeon removes the lamina and any tissue that is pressing on the nerve that causes pain.
You will receive general anesthesia, which means that you will not be awake during the operation, which can take up to 2 hours. You will be discharged from the hospital that day or the next with instructions to begin walking the day after you get home.
Sciatica pain relief
Up to 4 out of 10 people will develop sciatica pain or sciatic nerve irritation at some point in their life. This nerve comes from both sides of the lower spine and travels through the pelvis and buttocks. The nerve then passes along the back of each upper leg before dividing at the knee into branches that go to the feet.
Anything that presses on or irritates this nerve can cause pain that shoots up the back of a buttock or thigh. The sensation of pain can vary widely.
Sciatica pain can feel like a mild ache; a sharp, burning sensation; or extreme discomfort. Sciatic pain can also cause numbness, weakness, and tingling.
The pain can be made worse by sitting, standing, coughing, sneezing, twisting, lifting, or stretching for a long time. Treatment for sciatic pain ranges from hot and cold compresses and medications to complementary and alternative remedies and exercises.
Medications to relieve sciatica pain
Several types of medications can be used for sciatic pain. Oral medications include:
- Over-the-counter pain relievers such as acetaminophen, aspirin, or ibuprofen (Advil, Motrin), ketoprofen, or naproxen .
- Prescription muscle relaxants to relieve muscle spasms.
- Antidepressants for chronic low back pain.
- Prescription drugs for the most severe pain.
Do not give aspirin to a young person 18 years of age or younger due to the increased risk of Reye’s syndrome.
In some cases, a steroid medicine is injected into the space around the spinal nerve. Research suggests that these injections have a modest effect when the irritation is caused by pressure from a herniated or ruptured disc.
Physical therapy for sciatic pain
Sciatica pain can make activity difficult. But bed rest is not recommended as the main treatment. To control sciatica pain, certain positions and activities may be more comfortable than others.
If symptoms are not severe but persist beyond a couple of weeks, your doctor may recommend physical therapy. Proper exercises can actually help reduce sciatic pain. They can also provide conditioning to help prevent pain from returning.
The recommended exercises will depend on what is causing the sciatic pain. It is important to work with a specialist who has experience working with people with sciatica pain. It is also important to do the exercises exactly as directed.
To get the right address, you will most likely work with one of the following specialists:
- Physiatrist: A physician who specializes in physical medicine.
Complementary and alternative remedies to relieve sciatica pain
Some people find pain relief with complementary and alternative therapies, such as biofeedback and acupuncture. Keep in mind, however, that these therapies have not been proven by scientific studies to help sciatica.
Biofeedback is a technique that helps control body processes such as heart rate, blood pressure, and muscle tension. It works by using a machine that provides information about the process that is being addressed.
By displaying that information, the person can often find ways to achieve conscious control of these processes. Probably the most common use of biofeedback is to treat stress and stress-related conditions.
Acupuncture is a treatment that uses fine needles inserted into specific places on the skin called acupuncture points. Points are located along meridians or channels. The channels are believed to conduct qi, which is said to be the body’s energy or life force.
The theory behind the use of acupuncture is that pain is due to imbalances or blockages of the flow of qi. Acupuncture is supposed to remove those blocks to restore balance.
One theory is that stimulating these points has an effect by stimulating the central nervous system. This, in turn, would trigger the release of chemicals that would alter the experience of pain or produce other changes that promote a sense of well-being.
Surgery for sciatica pain
Only a very small percentage of people with sciatica pain will require surgery. If sciatica pain persists for at least 6 weeks despite treatment, you may be referred to a specialist.
At that point, surgery may be an option. The goal of surgery is to remedy the cause of sciatica. For example, if a herniated disc puts pressure on the nerve, surgery to correct the problem can relieve sciatica pain.
If the symptoms of sciatica pain are severe or progressively worsening, it is necessary to immediately refer them to a specialist.
How to stop the return of sciatica pain?
To reduce the chances of having sciatica pain again:
- Staying active: that is, exercising regularly.
- Use safe technique when lifting heavy objects.
- Make sure you have good posture when sitting and standing.
- Sit properly when using a computer.
- Lose weight if you are overweight.
- Don’t smoke: Smoking can increase your risk of getting sciatica pain.