Sciatica Pain, Explained

Experiencing severe lower back or leg pain? It may be caused by an injury or irritation to the sciatic nerve. Here's what you need to know to find relief.

Lingering pain in your lower back and legs can be difficult or even devastating. The first step toward relief is figuring out what's making you hurt.

One common reason for radiating discomfort in the lower back or legs is a condition known as sciatica, or sciatica pain. It is nerve pain caused by an injury or irritation to the sciatic nerve. Here's how you can identify and resolve it.

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What is  sciatica  pain and how does it happen? 

Sciatica happens when the sciatic nerves—the two thickest and longest nerves in the body—become injured, irritated, pinched, or compressed, explains David Woznica, M.D., M.S., director of clinical medicine at Vori Health, a virtual holistic health provider that offers an integrated approach to treating muscle and joint pain.  

There is one on each side of your body, starting in the lower back and traveling through your hip and buttocks and down the back of the leg. Just below the knee, it branches off into other nerves that reach down to your foot and toes.

Sciatica pain can be caused by several different things, including: 

• A bulging or herniated disc in the lower back puts pressure on the sciatic nerve. This is the most common cause.  
• A narrowing of the spinal canal (called spinal stenosis) due to arthritis or other age-related changes in the spine.  
• Slippage of a vertebra, called spondylolisthesis, that can pinch the nerve. 
• Osteoarthritis, tumors, or a tight muscle in the hip and buttock, called the piriformis, can also put pressure on the sciatic nerve.  

What are the symptoms of sciatica? 

You can feel sciatica pain anywhere along the sciatic nerve. It usually occurs on only one side of the body, and it may start in the lower back and radiate to the hip, buttocks, down the leg, even reaching the calf or foot.

The pain may feel sharp, tingly or burning, depending on the cause. You may also experience numbness or muscle weakness.

Sciatic pain may come and go or stick around all the time. Sudden movements may make the pain worse, as can sitting or standing for long periods of time.

Who is at risk for sciatica pain? 

Anywhere from 10 to 40 percent of people will experience sciatica pain in their lifetime, according to the National Institutes of Health. It's most common in middle age.

Age is a risk factor, along with being overweight, and having health conditions like diabetes or osteoarthritis. Frequent heavy lifting, sitting for long periods of time, and smoking can also increase your risk for sciatic pain. 

What is the difference between  sciatica  pain and other back or leg pain? 

Sciatica pain is nerve pain, which usually feels like a shooting or burning sensation. Other types of back or leg pain might be due to muscular pain, which will feel sore, like when you work out too hard. Back and leg pain from arthritis is typically located in the joints.

When should I see a doctor? 

Most cases of sciatica resolve within four to six weeks, according to the National Institutes of Health. If the pain is moderate and not constant, you should start managing it with self-care measures first, such as heat and ice packs and moderate exercise, adds Dr. Woznica. There are more details about this below.

If you're not getting better after six weeks, or the pain gets worse after a week or two of self-care, you should see a healthcare professional. Your general practitioner can help, but those who specialize in musculoskeletal and nerve issues, like physical medicine and rehabilitation physicians, osteopaths, neurologists, physical therapists, and chiropractors are also experts you can consult.

They may prescribe muscle relaxants or other pain medications. Anti-inflammatory corticosteroid injections in the affected area are another method that may relieve pain.

Recommended reading: Sciatica Pain? 6 Myths and Truths You Need to Know 

How is sciatica pain diagnosed? 

If you go to a healthcare provider for sciatica pain, they will ask about your symptoms and do a physical examination.   

They may do tests that check muscle strength and ask you to do a straight leg raise test. You will lie on your back with your legs straight, then the provider will lift one leg and ask you to tell them when the pain starts. This helps determine if you have a herniated disk.

Depending on the results of a physical examination, your provider may decide you need other tests, like an X-ray, MRI, or CT scan to look at the bones and soft tissues to determine factors that might be causing the pain, like fractures, disc problems, and arthritis. 

What are self-care steps I can take for sciatica pain? 

If you have sciatica pain, your first action should be to ice the area for 20 minutes several times a day to reduce swelling. You can also take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, or naproxen.

After a few days, switch to applying heat to the affected area for 15 minutes and no longer than two hours. You'll also want to find ways to do light exercises and gentle stretches that don't aggravate your pain.

Rest when you need to, but you should resist the urge to stay in bed. Too much bed rest can weaken muscles and can cause other problems, like constipation or blood clots, according to the medical experts at Harvard Health.  

Practice good posture and avoid sitting or standing for long periods of time, which can make the pain worse. 

Recommended reading: 5 Ways to Manage Chronic Pain Without Opioids 

How does exercise help with  sciatica  pain? 

When you're in pain, exercising might not sound appealing. But in the case of sciatica, it can help alleviate it, says Dr. Woznica.

Exercise brings relief by limiting sciatica's aggravating factors, such as friction or compression between muscles. It also helps people move better despite the pain.

Exercise won’t fix a herniated disk or arthritis, but it can help your body ease the pressure put on the sciatic nerve, which makes the situation less painful. 

Light aerobic exercise like walking, biking, or swimming, along with strengthening exercises and stretches will help build muscles and improve flexibility. It’s especially important to strengthen and stretch the core muscles that support the spine.   

Listen to your body, and don’t try to push through anything that doesn’t feel right for you.  

See your healthcare provider before starting any new exercise program. Your SilverSneakers class instructors can show you safe modifications so you can continue to exercise. 

Press play on the video below to try some simple exercises to help prevent and relieve sciatica pain. Practice more soothing stretches in the 15-minute Gentle Stretch Express class through SilverSneakers LIVE — view the schedule and RSVP here. 

Recommended reading: 9 Best Sciatica Stretches: How to Ease the Pain 
4 Exercises to Avoid With Sciatica (and What to Do Instead)
6 Must-Know Exercise Modifications if You Have Back Pain 

What other therapies can help my symptoms? 

In addition to the methods already described, you may able be able to get relief from sciatic pain with alternative therapies. These include: 

• Deep tissue massage 
• Acupuntura 
• Chiropractic care 
• Yoga 
• Biofeedback 

Will I need surgery for sciatica pain? 

Very few people with sciatica end up needing surgery. Signs of more serious nerve damage include:

• Pain that has not improved after self-care and other non-invasive treatment methods 
• Unrelenting pain or numbness 
• Pain that gets worse 
• One leg is getting weaker or smaller 

In these cases, surgery might be needed to keep the nerve damage from becoming permanent.   

There are different minimally-invasive surgical options for sciatica. A microdiscectomy removes herniated disk fragments, and a laminectomy removes part of the vertebral bone that is putting pressure on the nerve. In both cases, patients are usually up and walking the same day as their surgery.

See our sources:
How common is sciatica: National Library of Medicine
Sciatica causes, symptoms, and treatments: Cleveland Clinic
Rest recommendations for back pain: Harvard Health
Spinal stenosis: National Institutes of Health  

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