Sciatica – causes, symptoms, and effective treatment methods
Sciatica is a condition that causes intense, sharp, and radiating pain in the lower back, often spreading to the buttocks, thighs, and feet. It can result from various underlying causes and may also be accompanied by neurological symptoms. Because it tends to recur, preventive measures are essential in reducing the risk of future flare-ups. What exactly is sciatica? Where does it hurt? Is it better to rest or stay active during an episode? How can sciatica be treated, and what steps can be taken to prevent future attacks?
Table of contents
What is sciatica?
Sciatica, also referred to as ischialgia (from the Latin term ischias), is a set of symptoms caused by irritation of the nerve structures that form the sciatic nerve, the largest peripheral nerve in the human body. The condition is marked by sudden, intense, and debilitating pain in the lumbar spine, often triggered by compression or pressure from a damaged intervertebral disc – commonly known as a herniated disc – on the nerve roots.
There are two common types of sciatica:
- Acute sciatica, which comes on suddenly;
- Chronic sciatica, which persists over a longer period.
Sciatica vs. “pinched nerves”
The term “pinched nerves” is often used colloquially to describe sciatica. However, it actually refers to the nerve roots located within the spine that may be compressed by herniated discs. Still, many people use the phrase to describe lower back pain in general.
How long does sciatica last?
Sciatica typically lasts between 2 to 6 weeks. However, in chronic cases, pain and other symptoms may persist for several months or even up to a year. Additionally, about two-thirds of patients experience a recurrence of symptoms within twelve months of the initial episode.
What causes sciatica?
Sciatica usually develops due to irritation or damage to the sciatic nerve, most often caused by a herniated disc. Intervertebral discs separate the vertebrae and act as shock absorbers, supporting spinal mechanics. A disc herniation occurs when the outer ring (annulus fibrosus) tears, allowing the inner core (nucleus pulposus) to protrude. This can lead to inflammation and irritation of the nerve root, triggering sciatica.
Besides disc herniation, sciatica can also result from spinal degeneration due to aging, overuse injuries, or trauma. Other contributing factors include prolonged sitting, excess weight, obesity, spinal stenosis, tumors, or infections.
Additional causes may include:
- Spondylolisthesis – a forward slip of one vertebra over another;
- Piriformis syndrome – compression of the sciatic nerve by the piriformis muscle located in the buttock;
- Pregnancy – as the uterus enlarges, it can compress internal organs and increase muscle tension, potentially affecting the sciatic nerve. Changes in posture and increased curvature of the lumbar spine during pregnancy may also elevate the risk.
Symptoms - what does sciatica feel like?
A hallmark symptom of sciatica is sudden, sharp, and burning pain that radiates along the sciatic nerve – from the lower spine through the buttocks and down to the feet. The pain may also shoot through the thighs, calves, or hips and can intensify even with slight movements, sometimes leading to temporary immobility that makes walking or getting out of bed difficult.
In addition to pain, neurological symptoms may also occur. These include numbness, tingling, sensory disturbances, muscle weakness, or difficulty with movement in the affected leg. In severe cases, sciatica may cause loss of bowel or bladder control or muscle dysfunction, requiring immediate medical attention.
Increased pressure in the cerebrospinal fluid may further compress the sciatic nerve, meaning that laughing, coughing, sneezing, or bending can worsen the pain and accompanying symptoms.
Which doctor should you see for sciatica?
People suffering from sciatica often wonder which specialist to consult. The choice depends on the severity and duration of the symptoms.
Most patients start with a general practitioner or primary care physician, who can assess the condition and refer the patient to a specialist – typically a neurologist, orthopedic doctor, or physical therapist.
Since sciatica involves nerve irritation, a neurologist usually handles diagnosis and treatment. However, if the cause is a herniated disc or joint degeneration, consulting an orthopedic specialist may be beneficial. A physical therapist can then help develop a tailored rehabilitation plan.
Diagnosing sciatica
Diagnosis generally begins with a physical examination and a detailed medical history to identify the nature and intensity of the pain. One commonly used test is the straight leg raise, or Lasègue’s sign, in which the patient lifts a straightened leg while lying on their back. A positive test – marked by sharp pain – indicates nerve root irritation.
Additional diagnostic tools may include:
- MRI to identify and measure the size of a herniated disc;
- CT scan to detect serious abnormalities;
- X-ray of the lumbar spine to evaluate conditions such as spondylolisthesis;
- EMG to assess the function of the sciatic and spinal nerves.
Treatment for sciatica
Treatment depends on the cause and severity of symptoms. Initially, conservative methods are recommended, including over-the-counter pain relievers, muscle relaxants, anti-inflammatory medications, rest, and avoiding spinal strain. In some cases, intramuscular injections may be necessary.
If symptoms worsen, further diagnostics and a more comprehensive treatment plan are needed. A specialist may prescribe stronger prescription medications to manage pain and inflammation. Once the acute phase subsides, additional therapies such as:
- physical therapy,
- physiotherapy,
- rehabilitation,
- massage,
- manual therapy
can support recovery.
If conservative treatment fails or if nerve damage is suspected, epidural injections or even spinal surgery may be required. Surgical options may include decompression of the nerve roots or partial disc removal.
Preventing sciatica
Since sciatica involves severe pain and discomfort, preventive care is essential. Good posture – both when walking and sitting – is key. Providing proper lumbar support and avoiding excessive spinal bending can help. If you spend long hours sitting, such as at a desk job, take regular breaks to stretch and move around.
Physical activity also plays a crucial role in prevention. Regular exercise, such as swimming, cycling, or spine-focused workouts, can strengthen the back muscles and help maintain a healthy weight, both of which reduce the risk of sciatica.
Proper sleep hygiene is equally important. This includes using a mattress with the right firmness and getting adequate rest. Many people wonder about the best sleeping position for sciatica. Observations suggest that lying flat on your back may help relieve symptoms, while sleeping on your stomach could make them worse.
Other preventive strategies include using correct lifting techniques, ensuring proper ergonomics at work, and maintaining a balanced diet. Nutrient deficiencies – particularly in vitamins and minerals like calcium – may increase the risk of developing sciatica. Dietary supplements with ingredients like turmeric, nettle, licorice root, or linden flower, as well as herbs like St. John’s wort, mullein, and elderberry, may also be beneficial.
Complications of sciatica
In most cases, sciatica resolves on its own or with conservative treatment. However, if the nerve compression is severe, it may lead to permanent nerve damage. This can result in sensory loss, difficulty moving the affected leg, or loss of bowel or bladder control. In such cases, surgery may be the only viable solution.
Chronic or untreated sciatica can lead to serious neurological complications. Therefore, if symptoms persist or worsen, they should not be ignored.
Sciatica – summary
Sciatica is a condition caused by irritation of the sciatic nerve or associated lumbar and sacral nerves. It is characterized by sharp, burning pain that may radiate to the buttocks, thighs, and feet. While the condition often resolves on its own or with medication, physical or physiotherapy may also be necessary. In severe cases, surgery and post-operative rehabilitation may be required.
To prevent sciatica, adopt healthy lifestyle habits, including regular exercise, proper lifting techniques, ergonomic workplace practices, a balanced diet, and the use of supportive supplements.
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