Sciatica: Causes, Symptoms, & Treatment

Symptoms of Sciatica

The most common symptom of sciatica is mild to severe pain that radiates down the lower spine, typically only on one side of the body. The pain can be described as “sharp, burning, or aching.” The pain can also feel like a “jolting” or “pins and needles” sensation.

Additional symptoms that may accompany sciatica include:

• Pain in the hip.
• Difficulty standing due to pain.
• Pain that worsens when coughing or sneezing.
• Pain that is exacerbated by sitting for prolonged periods.
• Muscle weakness or numbness in the leg or foot.

A severe case of sciatica is often due to permanent damage to the sciatic nerve. It is accompanied by symptoms that can affect other areas of the body. These symptoms include:

• Bowel or bladder changes.
• Sexual dysfunction.
• Symptoms occurring in both legs.
• Severe leg weakness that can hinder mobility.

These symptoms can be unnerving, frustrating and, above all else, painful. However, there are often red flags present that indicate if immediate medical attention is needed.

When to see a Doctor

A mild case of sciatica will generally resolve over time. However, if the pain is severe, gradually increases, or lasts longer than a week, you should see a doctor.

Seek immediate medical attention if:

• Symptoms began after traumatic injury.
• Sciatic pain is accompanied by fever, nausea, or weight loss.
• Extreme weakness or numbness can be felt in the leg.
• Controlling bladder or bowels movements becomes difficult.

What Causes Sciatica?

Sciatica is caused by compression on the sciatic nerve, typically due to a disc herniation or bone overgrowth in the spine.

Common causes of sciatic nerve pain include:

Herniated Disc

The most common cause of sciatica is a herniated disc in the spine. This occurs when a disc is pushed into the spinal canal and presses against the sciatic nerve. Often caused by an injury or excessive pain, the ligaments that hold the disc can weaken and lead to a rupture.

Bulging Disc

A bulging disc occurs when the disc annulus remains together but forms a pouch-like structure that pushes into the nerve. This pouch builds when a crack or rupture in the disc allows the gel-like center to ooze out. Most cases of a bulging disc are the result of improperly lifting a heavy object.

Additional causes of sciatica symptoms can include:

Piriformis syndrome is a less common condition in which the piriformis muscle, located in the buttocks near the top of the hip joint, spasms and causes buttock pain. Due to its close proximity to the sciatic nerve, the piriformis can put pressure on the nerve resulting in numbness and tingling along the back of the leg and foot.

Sciatica can sometimes be caused by a tumor, blood clot, or other condition in the lower spine; however, this is rare. Conditions such as degenerative disc disease, spinal stenosis, cauda equina syndrome, and spondylolisthesis can also lead to symptoms of sciatica.

In addition to the various causes of sciatica, there are also risk factors that can increase the likelihood of experiencing the condition.

Risk Factors

There are several risk factors that can lead to sciatica. These include:

Age can cause the discs to break down over time leaving the body more susceptible to a herniated or bulging disc. This is often due to wear and tear; however, a family history of sciatica can exacerbate symptoms.

Prolonged sitting or a sedentary lifestyle can result in sciatica. Being active and regularly exercising can help prevent symptoms.

Occupations that involve carrying heavy loads, twisting the back, or driving a vehicle for extended periods can cause degeneration of spinal discs leaving them susceptible to fractures or herniation.

Obesity or excess body weight increases the stress put on the back and can lead to spinal changes that give rise to sciatica.

Diabetes affects the way the body uses blood sugar and can increase the risk of nerve damage.

A Vitamin B12 deficiency can prevent the myelin sheath or nerve covering from forming properly. These are crucial in nerve function and signal transmission. Loss of function can cause numbness, pain, and weakness.

Some risk factors are unavoidable, but there are steps that can be taken to help prevent sciatica.

Prevention

The following steps for preventing sciatica can be easily incorporated into everyday life…

Good posture when sitting and standing will help keep the spine aligned. Also, an ergonomic chair with proper lumbar back support can help provide comfort. A rolled towel or cloth may also be placed on the small of the back when sitting to help maintain normal spinal curvature. Click here to learn the risks of poor posture, and how to fix it >>

Regular exercise and strengthening the core muscles in the abdomen and lower back will help maintain proper posture and prevent sudden pulls. Yoga and pilates are particularly helpful, as they combine conditioning and stretching exercises.

Proper form when lifting heavy items can help keep the spine in order and prevent sciatica. When lifting heavy objects, make sure to lift with the legs and keep the back straight. Keep the item close to the body and avoid twisting while lifting. With particularly heavy items, a lifting partner will come in handy.

Ask your doctor or physical therapist for additional information regarding specific activities that target these areas. If sciatica is suspected by your physician, there are various diagnosis techniques that can be used to confirm this condition.

Diagnosing Sciatica

Typically, a muscle strength and reflex test will take place to diagnose sciatica. This may include walking on the tip of the toes or back of the heels, performing a squat, or lifting the legs when lying down. If pain increases when completing these actions, sciatica may be the cause.

If the symptoms of sciatica do not improve within a few weeks, additional tests may be performed. These tests may include:

An X-ray is a common course of action to determine whether an overgrowth is present in the bone.

A Magnetic Resonance Imaging (MRI) scan provides images of soft tissue and can be used to diagnose a herniated disc.

CT scans provide pictures of the spinal canal. A contrast dye is often ingested to aid in detection. The colorant will circle the spinal cord and provide more clarity. The body will generally flush out the dye within 24 hours.

Electromyography (EMG) measures electric pulses given off by nerves and muscles. This test can be used to confirm a compressed nerve.

Following diagnosis, your physician will present you with a variety of options depending on the severity of the case.

Treatment Options for Sciatica

An appropriate treatment plan for sciatic nerve pain is determined based on the cause and severity of symptoms.

Treatment options may include:

Medications such as over-the-counter NSAIDs (such as ibuprofen or aspirin) can be taken to reduce inflammation and pain. Muscle relaxants, anti-inflammatories, narcotics, tricyclic antidepressants, and anti-seizure medications may be prescribed to lessen symptoms.

Ice and heat can be used to alleviate symptoms and reduce inflammation. Ice packs and heating pads can be applied to the buttock or back of the leg for twenty minute intervals every few hours.

Physical therapy can help relieve symptoms and prevent further damage. A therapy program will typically include various exercises to strengthen muscles, correct posture, and improve flexibility. Click here to learn more about physical therapy at OrthoMaryland>>

Massage therapy or acupuncture can help relax the muscles and alleviate pain.

Corticosteroid medication, commonly known as steroid injections, may be recommended. These injections can help to decrease inflammation surrounding the nerve and relieve pain.

Surgery may be recommended in more severe cases or when symptoms continue despite therapy or other non-surgical treatment options.

Sciatica is a fairly common condition that can manifest over time and cause permanent nerve damage if not treated properly. Our specialized team of orthopedic doctors are here to provide you with the diagnosis and treatment options you need to get back to your daily life.  Call 410-377-8900 today!

2 Sciatica Symptoms That Require Immediate Medical Attention

While your sciatica pain can be severe and cause your leg to feel weak, the symptoms typically do not produce any long-term complications.

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Davis D, Vasudevan A. Sciatica. [Updated 2019 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
Rarely, if the underlying cause of your sciatica becomes severe, it may produce troubling symptoms when your spinal nerve roots and/or spinal cord get compressed, sometimes triggering a medical emergency.

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The symptoms of sciatica radiate from the lower back to the buttock, thigh, and leg. Common symptoms include pain, numbness, tingling, and/or weakness. Watch: Sciatica Causes and Symptoms Video

Below are the descriptions of two serious sciatica symptoms that must be urgently evaluated and treated:

1. Changes in bowel and/or bladder control

Consult your doctor immediately if you have any sudden, unexplained changes in your bowel and/or bladder control. These changes may include:

• An inability to control your bowel and/or bladder movements.

  ²
  Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x

• Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, or a poor stream.

  ²
  Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x
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  Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988

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These symptoms indicate a rare, but serious medical condition called cauda equina syndrome. In addition to incontinence problems, cauda equina syndrome may also cause:

• Sudden pain and weakness in both your legs

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  Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:10.1016/b978-141603618-0.10020-7

• Numbness in your groin, buttocks, genitals and/or inner thighs (saddle numbness).

  ²
  Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x

• Sexual dysfunction

  ³
  Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988
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  Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:10.1016/b978-141603618-0.10020-7

Read more about Cauda Equina Syndrome Symptoms

Cauda Equina Syndrome Video

Cauda equina syndrome can occur suddenly or gradually and typically requires immediate surgery to control the symptoms.

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Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988
If patients with cauda equina syndrome do not receive prompt treatment, it can result in difficulty in walking and/or other neurological problems, including lower-body paralysis. Doctors advise treating this condition within 24 to 48 hours of symptom occurrence in order to preserve lower limb function.

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Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x
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Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988
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Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295

See Treatments for Cauda Equina Syndrome

While rare, sciatica caused due to severe disc herniation(s) in the lower spine may progress into cauda equina syndrome.

2. Worsening neurological symptoms

Severe damage to your sciatic nerve roots can cause progressive neurological symptoms and requires immediate treatment.

⁵
Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295
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Selz AF, Morard M, Buchard PA, Frochaux V. [When should a patient with low back pain/sciatica be referred to the emergency ward?]. Rev Med Suisse. 2010;6(259):1540-2, 1544-5.
The symptoms may affect one or both legs and typically include the following:

• Numbness
• Weakness
• Tingling
• Abnormal sensations, such as crawling
• An abnormally increased sensitivity to pain (hyperalgesia)

It is also possible for the symptoms to occur only below the knee without involving the entire limb.

²
Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4. 00001-x
While these symptoms may not warrant surgery, some form of immediate medical treatment is usually needed.

⁵
Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295
Your doctor may recommend pain management procedures, such as epidural steroid injections or radiofrequency ablation. If your symptoms are severe, do not improve with these treatments, and/or continue to worsen, surgery may be advocated.

⁵
Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295

See Sciatica Surgery

Failure to treat severe or progressive neurological symptoms can cause irreversible nerve damage over time. These symptoms may also indicate slow-onset cauda equina syndrome and must not be ignored.

More red-flag symptoms to watch out for

You should also consult a doctor if your sciatica symptoms:

• Started after an accident or injury
• Are accompanied by fever, nausea, and/or loss of appetite
• Include unrelenting night pain or pain at rest

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These symptoms may indicate serious medical conditions such as an infection or spinal tumor.

Talk to your doctor if you have troubling symptoms related to sciatica. A doctor can accurately diagnose the underlying cause and recommend a specific treatment plan for your symptoms.

See When Sciatica Pain Is a Medical Emergency

Learn more:

Myths About Sciatica Treatment Options

Causes of Cauda Equina Syndrome

Dr. Larry Parker is an orthopedic surgeon at the Spine Center at TOC in Huntsville, AL. Dr. Parker has specialized in spine surgery for more than 25 years. He has given several scientific presentations and published numerous papers in medical journals.

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Sports and sciatica

The pain of sciatica can be incapacitating for days or sometimes weeks. Is it worth doing physical education, is physical activity necessary for chronic sciatica, how useful is sport for those suffering from sciatica? And finally, what kind of sport to choose for periodic back pain? This will be discussed in this article.

The structure of the spine is the sum of complex structures (bones, muscles, tendons, nerves) that sometimes counteract and sometimes reinforce each other’s activity. Physical effort at the level of the lower back will actively mobilize muscles located far from each other, such as the abdominals, psoas and paravertebral muscles. Such a difficult interaction with serious muscle efforts and weakness of certain segments sometimes provoke displacement of the vertebrae, compression of the sciatic nerve and the onset of severe pain.

Physical exercise is not only the most effective means of preventing disease, but often helps to fight it, especially when it comes to diseases of the spine. With the right exercises, you can build targeted muscles and keep your spine safe and sound. But doctors warn that it is necessary to conscientiously approach the choice of a sport if the patient has a history of sciatica attacks.

Sports contraindicated in sciatica

The most common vertebral problems occur in the following sports:

• asymmetrical sports such as tennis, golf, squash, badminton are the main providers of sciatic pain;
• all sports that require sudden movements and changes in the position of the feet, such as rugby or football, should be practiced with caution, especially after a certain age;
• there is also some risk of vertebral displacement when riding;
• high-intensity running workouts where the legs are raised high and the muscles contract, causing the pelvis to tilt forward and the likelihood of damage to the sciatic nerve becomes high

In fact, virtually any sufficiently abrupt and unnatural movement (twisting, bending over, lifting heavy weights) can cause sciatic nerve occlusion.

Recommended sports for people with sciatica

1. Normal walking. Walking is the best.
2. Yoga. This sport combines relaxation techniques with muscle building. Yoga is ideal for people who suffer from sciatic pain, but when it gets worse, you should not even try to do twisting exercises.
3. Back School: An exercise program that trains back muscles over time. In this way, the lumbar spine is strengthened and the pressure on the sciatic nerve can be reduced. Back training also requires posture training.
4. Aqua fitness: For those who suffer from very severe back pain, water activities are especially recommended. Thanks to the properties of water, movements become easy and do not require serious effort. Water unloads the joints, nutrition of cartilage due to movement becomes complete. But the temperature of the water in the pool should not be cold.
5. Swimming: same benefits as aqua aerobics. But improper swimming technique can bring some harm (for example, breaststroke swimming). Therefore, it is advisable for non-professional swimmers to swim on their backs and practice in the pool under the supervision of an instructor. When swimming on your back, the spine is in a relaxed position and the intervertebral discs are resting.
6. Nordic Walking: The use of poles results in better muscle training during Nordic walking compared to normal walking.
7. Other sports that cannot be too hard on the back (rowing, cycling, jogging) in remission

Most sports are good for your back, provided you follow a few rules.

Expert advice for sciatica

1. Warm up before exercise. Warming up the muscles is a prerequisite for any sports activity. This applies to all segments of the body. The warm-up should include stretching and relaxation exercises.
2. Wearing a lumbar stabilizer is desirable for any athlete who experiences intermittent sciatica. There are very practical (inflatable and adaptable to the force of the muscles) belts that prevent excessive movements of the lumbar spine.
3. Gradual complication of training. Progression must be adapted to the physical capabilities of the patient.
4. Mastering the technique of exercises.
5. Quality Equipment
6. Good health. You can’t do it during an exacerbation, with a fever, etc. Pay attention to the signals of your body and do not strain yourself. If pain, even transient, occurs, sports abstinence for several days is recommended. Your doctor may also prescribe pain medication if necessary. Only with a decrease in pain can you start enhanced training.

Conclusion

In sciatica, regular physical activity is especially recommended, but it must be adapted to the condition, age and capabilities of the body. Sports improve muscle tone and help prevent recurrence of sciatica. Targeted physical activity, reducing muscle contractures, strengthens the back and unloads the spine. But asymmetrical jerky movements, such as volleyball serves or tennis shots, should be avoided. On the other hand, water aerobics, swimming, cycling, stretching, Pilates – on the contrary, are welcome. Anyone who doesn’t find time to take up a particular sport should incorporate exercise into their daily routine. In addition to basic morning exercises with elements of stretching, patients can, for example, take short walks, ride a bicycle to work, or take the stairs instead of the elevator.

Characteristics of sciatica pain

Sciatica is also called sciatic neuralgia. This nerve is the longest in our body. There are two of them. They start at the level of the lumbar spine, continue at the level of the buttocks, the back of the leg, and separate behind the knee. As a result of damage to the sciatic nerve, sensory and motor disorders can appear: difficulty walking and reduced sensation in the leg. The main sign of pinching or inflammation of the sciatic nerve is intense pain. Its nature depends on the location of the pathology. Pain is varied. Usually affects one side. Moreover, in women – the right, in men – mainly the left.

The nature of sciatica pain

It is often described as dull, throbbing, burning, or stabbing like an electric shock. Sensation varies and can manifest itself differently in one person. For some people, it feels like a debilitating intense burning sensation, while for others, a sharp tingling or intense pain passes quickly and occurs from time to time. Each case is different and each sensation is unique for each patient. These painful symptoms often begin suddenly, “out of the blue,” but sometimes they can be provoked by a sharp turn or lifting of weight. It can become unbearable with exertion, coughing, standing or sitting for long periods of time. As a rule, sciatica increases with movement and decreases during rest. But in the case when sciatica is caused by an infection or tumor, the pain appears, paradoxically, at night or when the patient is motionless. In addition, symptoms worsen and may be associated with fever.

Localization of sciatica pain

Usually the pain appears in the buttocks and descends in a burning strip to the thigh in front and side, then down the back of the leg, reaching the foot and toes. Sometimes the pain stops in the knee. With inflammation of the piriformis muscle, burning or pulling pains in the buttock radiate to the middle of the back of the thigh, they usually do not go further. Sometimes there is pain in the lumbar spine, which increases with prolonged sitting. Lower back pain may be present at the same time as leg pain, but usually the pain in the legs is much worse than in the lower back. Complaints of back pain may not bother the patient.

Typical manifestations of pain in sciatica

The combination of the following pain symptoms is the most common:

• pain usually occurs on one side of the buttocks or leg, rarely on both sides;
• pain descends from top to bottom;
• pain has a characteristic trajectory – originating in the lower back or buttocks and continuing along the path of the sciatic nerve along the back of the thigh and lower calf and foot;
• the pain disappears when the person lies down or walks, but worse when he stands or sits;
• the pain is usually described as sharp or burning rather than monotonous.
• intense flash of pain in one limb, it becomes impossible to lean on it, this makes it difficult not only to get up, but also to walk;
• numbness in the fingers of the lower extremities;
• pain in the lower back (if present) is usually not as severe as in the extremities;
• the pain is most intense in the morning and after a long rest;
• complaints may be aggravated during sudden movements, such as sneezing, coughing, when changing position, for example, when moving from a sitting position to a standing position, when turning, when trying to stand on tiptoes.

Some symptoms are unique depending on the underlying cause of sciatica. For example, bending the body backwards or walking short distances often causes symptoms when spinal stenosis is the cause. Leaning forward can cause pain if the cause is a bulge in the lumbar spine. If sciatica is due to a herniated disc, the pain is often worsened by coughing, sneezing, or straining (during a bowel movement), or movement.