First, let’s figure out if you actually have sciatica. About 25% of my patients that come in saying they have sciatica, actually have it. What they usually have is one-sided low back that is referring down to the buttocks. Sciatica has somehow become synonymous with low back pain. However, low back pain may or may not be present with sciatica. It turns out that leg pain is the primary symptom of sciatica. There are some stretches for sciatica, but whether they work will depend on the cause of your sciatica.
So what is sciatica?
Sciatica occurs when the sciatic nerve is injured, compressed, inflamed, or pinched. This will cause pain, numbness, tingling, and/or muscle weakness along it’s distribution down the leg. The sciatic nerve is the largest nerve in the body and is made up of 5 nerve roots. These nerve roots originate at the low back and pelvis. They then come together to make up the sciatic nerve.
The sciatic nerve travels down the leg to activate different muscles and provide sensation. It innervates the muscles on the back of the thigh, the inner thigh, the calf, the front of the lower leg, and the some of the foot muscles. These include the hamstrings, adductors, gastrocnemius, soleus, and some of the intrinsic foot muscles. The sciatic nerve provides sensation to the back of the thigh, outside of the lower leg and also to the bottom of the foot.
What are the symptoms of sciatica?
There are several symptoms associated with sciatica. These include:
- Pain anywhere along the pathway of the nerve. This includes from the low back down to the foot. I have had many patients with sciatica with no pain in the back but significant pain in the thigh and/or lower leg.
- The pain could be mild, sharp, or burning. It could also feel like an electric shock.
- Pain is worse with sitting for a long time.
- Pain is worse with sneezing or coughing.
- Numbness and/or tingling in the leg or foot.
- Muscle weakness in the leg or foot.
- Usually is only one side of the body
You do not have to have all of these symptoms to have sciatica. Even a mild pain in the leg that originates from the sciatic nerve, is considered sciatica. Having numbness, tingling, and/or weakness indicates a more severe irritation or compression on the nerve.
What causes sciatica?
There are several things that can cause irritation to the sciatic nerve. Some of these include:
- Disc herniation – This is the most common cause of sciatica. When a disc herniates it tends to go in the direction of the nerve root. This can cause irritation or pressure on the nerve.
- Spinal stenosis – This is an age related wear and tear condition. It includes a narrowing of the area for the spinal cord or the area of the vertebrae where the spinal nerves exit.
- Spondylolisthesis – This occurs when one vertebra slips forward on the other. It can decrease the space for the nerve to exit and possibly pinch the nerve.
- Piriformis syndrome – The piriformis is a muscle in the buttocks that can compress the sciatic nerve if it becomes overly tight or spasms.
- Pregnancy – The increased weight in the front of the body and the increased loosening of ligaments can cause compression or pinching of the sciatic nerves.
- Tumors – Tumors in the spine or pelvis can compress the sciatic nerve.
- Trauma – Trauma to the leg, low back, or pelvis could damage the sciatic nerve.
What are the risk factors for sciatica?
Sciatica is very common with a lifetime incidence rate of up to 40%. However there are some risk factors that make it more likely to occur. These include:
- Previous injury
- Obesity
- Active, physical job
- Diabetes
- Osteoarthritis
- Sedentary lifestyle
- Smoking
What can I do?
Sciatica can be treated with conservative measures for the majority of cases. Things that you can do at home include:
- Relative rest – This includes continuing to do all the activities and chores in your normal, daily life that do not aggravate your symptoms. It is important to stay active but at the same time you do not want to make your condition worse. For example, if vacuuming increases your pain but washing dishes doesn’t, then stop vacuuming but continue to wash the dishes.
- Heat and ice – A heating pad can help with comfort and to decrease stiffness. A nice ice pack can help decrease inflammation and pain after activity.
- Exercise
- Aerobic exercise – Regular light aerobic exercise that does not aggravate symptoms is important in recovery and prevention. It brings gentle motion and blood flow to the area. Light aerobic exercise includes walking, swimming, or biking.If you do not regularly exercise, then begin slowly at about 5 to 10 minutes. You can increase your exercise time gradually over weeks or months. Work up to 30 to 60 minutes of aerobic activity most days of the week.
- Light stretching – Stretching of the tissues around the low back and hips can help decrease tension and pain in the area.
- Core strengthening – Strengthening of the abdominals, back extensors, and hip muscles are important in being able to stabilize and control the low back.
- Below is a video of gentle low back exercises to aid in mobility, strength, and flexibility.
When do I need to see a professional?
If you have tried all the previously mentioned treatments for a week and your pain has not changed or has gotten worse, then it is time to see a healthcare professional.
- Physical therapy – Your physical therapist can examine you and help determine what is causing the sciatica. The treatment would be more specific to the diagnosis and your unique symptoms. Treatment could include joint mobilization or manipulation, soft tissue mobilization, dry needling, stretching, and strengthening.
- Primary care physician – Your primary care physician can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging might also be ordered to provide more detailed information. A referral to an orthopedic spine specialist or neurologist might also occur depending on your symptoms and the results of the imaging.
Red flags
If you are having difficulty controlling your bowel or bladder and the pain is down both legs, that is considered a red flag for cauda equina syndrome. This is cause for an immediate trip to the ER and/or call to your physician. This occurs when the bundle of nerves at the end of the spinal cord are compressed. These nerves are called the cauda equina. If not treated this can lead to permanent loss of bowel and bladder functions as well as other problems.
Cauda equina syndrome is very rare. I have been practicing since 2009 and have only seen it once. Interestingly enough, it was a physician who had it. She has been a patient of mine on and off for years. She called me frantically asking what she should do. I am pretty sure that she suspected what it was but needed a trusted source to confirm her suspicion. After concurring that I also thought it sounded like cauda equina syndrome, she went to the ER and had surgery within a day or two. She was in therapy for several months after surgery but was back to skiing later that year.
In review
- Sciatica is an irritation, compression, or pinching of the sciatic nerve.
- The primary symptom is leg pain.
- Low back pain may or may not be present. You could also have weakness, numbness, and/or tingling in the leg.
- There are many conditions that can cause sciatica.
- Sciatica can be resolved with conservative methods the majority of the time.
- See a healthcare professional if symptoms have not improved within a week.
- Seek immediate medical attention if you are unable to control your bowel or bladder.
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Sciatica
https://www.statpearls.com/articlelibrary/viewarticle/28772/