Sciatica: Types, Causes, Symptoms, Diagnosis & Treatment

Sciatica is a nerve pain that result from an injury or irritation to your sciatic nerve. In addition to pain, it can involve tingling or numbness in your back or butt that may also radiate down your leg.

It often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with it can be severe, most cases clear up with treatment in a few weeks. People who have severe and serious leg weakness or bowel or bladder changes might need surgery.

Study shows about 40% of people in the U.S. experience some form of sciatica during their lifetime. It rarely happens before age 20 unless it’s injury-related. It is a very common condition.

Sciatic nerves

Sciatic nerve is the longest and thickest nerve in your body. It’s up to 2 centimeters wide. Despite its name, it’s not just one nerve. It’s actually a bundle of nerves that come from five nerve roots branching off from your spinal cord.

You have two sciatic nerves, one on each side of your body. Each sciatic nerve runs through your hip and buttock on one side. They each go down the leg on their side of your body until they reach just below your knee. Once there, they split into other nerves that connect to parts farther down, including your lower leg, foot and toes.

Symptoms of sciatica

If you’re experiencing pain that shoots from your lower back through your buttock area and into your lower limbs, it’s typically sciatica.

It is the result of damage or injury to your sciatic nerve, so other symptoms of nerve damage are usually present with the pain. Other symptoms may include the following:

• numbness, burning, or weakness in your legs or feet along your sciatic nerve pathway, which may become a loss of feeling or movement in severe cases
• pain that gets worse with movement
• sensation of pins and needles, which involves a painful tingling in your toes or feet
• incontinence, the inability to control your bladder or bowels, which is a rare symptom of cauda equina syndrome and calls for immediate emergency attention

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Causes of sciatica

The following are the possible causes:

• Degenerative disk disease.
• Herniated disks.
• Spinal stenosis.
• Foraminal stenosis.
• Spondylolisthesis.
• Osteoarthritis.
• Injuries.
• Tumors, cysts or other growths.
• Conus medullas syndrome.
• Cauda equina syndrome.
• Pregnancy.

More rarely, a tumor can put pressure on the nerve. Or a disease such as diabetes can damage the nerve.

Classification of sciatica

There are two main types and regardless of what type you have, the effects are the same. This include:

• Sciatica-like conditions. These are conditions that feel like sciatica, but happen for other reasons related to the sciatic nerve or the nerves that bundle together to form it.
• True sciatica. This is any condition or injury that directly affects your sciatic nerve.

The differences between the two usually only matter when your doctor determines how to treat it.

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Risk factors of sciatica

The following are the risk factors for developing this condition:

• Obesity. Being overweight increases stress on the spine.
• Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of it.
• Occupation. A job that requires twisting the back, carrying heavy loads or driving a motor vehicle for long periods might play a role in developing it.
• Diabetes. This condition, which affects the way the body uses blood sugar, increases the risk of nerve damage.
• Prolonged sitting. People who sit a lot or don’t move much are more likely to develop it than active people are.

Complications of sciatica

A possible complication is a chronic (long-term) pain.

• If there’s serious damage to an affected nerve, chronic muscle weakness, such as a “drop foot,” might happen. That’s when nerve damage causes numbness in your foot, which makes normal walking difficult or even impossible.
• It can also potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs.

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Prevention of sciatica

The following steps can help you prevent it or keep it from occurring again:

• Check your posture. Make sure your chairs offer proper support for your back, place your feet on the floor while sitting, and use your armrests.
• Mind how you move. Lift heavy objects in the proper way, by bending at your knees and keeping your back straight.
• Exercise often. Strengthening your back muscles and your core muscles is the key to maintaining a healthy back.
• Reach and maintain a weight that’s healthy for you. Your primary care provider can guide you on how to eat and get physical activity. Make sure you get enough calcium and vitamin D for bone health, too.
• Quit (or don’t start) using tobacco products. Nicotine from any source (including vaping) reduces blood supply to your bones, which can weaken your spine and its various components.

Diagnosis of sciatica

Sciatica is diagnosed using a combination of methods. Your healthcare provider will review your medical history and ask about your symptoms. You will also undergo a physical examination. That exam will include:

• Straight leg raise test. This involves having you lie on an exam table with your legs straight out. They’ll slowly raise your legs one at a time toward the ceiling and ask when you start to feel pain or other symptoms. These can help pinpoint the cause of sciatica and how to manage it.
• Walking. Sciatica often causes visible changes in how you walk. Your provider will watch for those changes as part of diagnosing sciatica.
• Other flexibility and strength checks. These can help your provider determine if any other factors are causing or contributing to your sciatica.

There’re several test that can be used in diagnosing sciatica and ruling out similar conditions. The most common or likely tests include:

• Spine X-rays or computed tomography (CT) scans: An X-ray of the spine may reveal an overgrowth of bone that can be pressing on a nerve.
• Magnetic resonance imaging (MRI) scans. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of the back.
• Electromyography. This test measures the electrical impulses produced by the nerves and the responses of the muscles.
• Myelogram.
• Nerve conduction velocity studies

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Treatment of sciatica

The aims of treating sciatica usually involves trying to decrease pain and increase mobility, and most of this treatments can be self care or things you can do for yourself at home.

If you have sciatica that won’t go away or is more severe. There are several treatment options which include surgery, that might be an option if your case is severe or other treatments not helping.

Self-care treatment

Depending on the cause, milder cases usually get better with self-treatment. Pain that’s moderate to severe, and with numbness and tingling or muscle weakness are all symptoms that need a doctor medical care. You shouldn’t try to treat that by yourself.

The following are the safest self-care treatment:

• Using Cold or ice. You can use ice packs or even use a package of frozen vegetables. Wrap the ice pack or frozen vegetables in a towel and apply it to the affected area for short intervals several times per day, during the first few days of symptoms. This can help to reduce swelling and ease pain.
• Using heat. You can also use hot packs or a heating pad. It’s recommended that you use ice during the first couple of days to reduce swelling. After 2 or 3 days, switch to heat. Heat can help relax muscles in the back, which can spasm when an injury occurs. If you continue to have pain, try alternating between ice and heat therapy.
• Stretching and regular exercise. By gently stretching your lower back can also be helpful. To learn how to stretch properly, get one-on-one physical therapy or even yoga instruction from a physical therapist or instructor trained to deal with your injury, if it’s available. You may also look for free videos online to help you find the proper stretches. Make sure to consult with a medical professional first before starting a stretching routine.
• Over-the-counter drugs. Over-the-counter medications, such as aspirin and ibuprofen, can also help with pain, inflammation, and swelling. Be careful about using aspirin excessively, since it could cause complications, such as stomach bleeding and ulcers.

Sciatica medications

The types of drugs that might be used to treat sciatica pain include:

• Anti-inflammatories
• Opioids
• Corticosteroids
• Anti-seizure medications
• Antidepressants

Other treatment options include:

• Physical therapy. Once the pain improves, a health care provider can design a program to help prevent future injuries. This typically includes exercises to correct posture, strengthen the core and improve range of motion.
• Steroid injections. In some cases, a shot of a corticosteroid medication into the area around the nerve root that’s causing pain can help. Often, one injection helps reduce pain. Up to three can be given in one year.
• Surgery. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the nerve. But surgery is usually done only when sciatica causes severe weakness, loss of bowel or bladder control, or pain that doesn’t improve with other treatments.

Using complementary treatments alongside medical treatments helps relieve sciatica.

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