Burning, Achy Leg Pain: Symptoms of Sciatica and How To Get Relief
By Adam Spjute, M.D.
Sciatica is a condition where pain radiates from your buttocks and lower back, down your legs, following the same path as the sciatic nerve. However, sciatica is a bit of a misnomer. Most sciatica pain has nothing to do with the sciatic nerve. Sciatica is most commonly caused by issues above the sciatic nerve, in the lumbar spine. These spinal issues can cause pain that mirrors the path of the sciatic nerve.
There are many options for sciatica pain relief, ranging from physical therapy to medication to surgical intervention. However, the appropriate treatment is specific to the cause of your sciatica pain and the severity.
What Usually Causes Sciatica Pain?
Sciatica pain may be caused by a couple of different disorders. The most common cause of sciatica pain is a disc bulge. Intervertebral discs sit between the vertebrae in the spine and they look like little squishy discs. As our bodies age, the squishiness of these discs increases. Sometimes, the pressure on them in addition to that softness can cause them to slip out of place and push against a nerve root. That contact with the sensitive nerve root can cause pain to shoot down the legs.
Disc bulges usually cause pain when there is stress on the spine. Often, disc bulges protrude when someone attempts to lift something very heavy with poor form. You might hear or feel a small pop before the sciatica pain occurs. Most disc bulges can heal up on their own and patients can mitigate the pain by avoiding heavy lifting, as well as stretching before exercise. Sometimes, disc bulges are more challenging to heal. In certain cases, they may even require a surgical intervention.
Another possible cause of sciatica pain is piriformis syndrome. The piriformis muscle, located in the buttocks by the hip joint, may become compressed and tight if someone starts to exercise a lot suddenly without proper stretching before and afterward. The sciatic nerve can pierce the muscle if it gets too tight, which causes sciatica pain. Although this disorder is less common, it is seen more often in younger folks. Whether your sciatica pain is caused by a disc bulge or piriformis syndrome, it’s critical to be careful and deliberate when exercising and lifting heavy objects. Remember to lift with your legs and not your back, and be sure to stretch before and after exercise. These simple precautions can prevent sciatica pain flare-ups and aggravation.
Burning, Achy Leg Pain and Other Symptoms of Sciatica
The first symptoms of sciatica to watch out for are “electrical shocks” or tingle feelings shooting down your legs to your feet, either on the side or the back of the leg. If you are experiencing these electrical shock feelings, it might be a good idea to see your doctor. The tingles may be replaced by burning or achy pain following the same general path. Generally, sciatica pain is only felt on one side of the body.
If you are experiencing numbness or weakness in your legs and buttocks, or are having difficulty lifting your legs, you should go to the emergency room. Other red flag symptoms include the inability to use the bathroom or changing bowel habits. These more serious symptoms coupled with sciatica pain may be emblematic of a more serious issue, called stenosis. Stenosis occurs when the spinal column is too tight around the spine and compresses it. This compression can cause serious damage to the spine and needs to be addressed quickly.
How to Get Sciatica Pain Relief
For most patients with sciatica pain, the first line of treatment is physical therapy. Many patients will find relief with some combination of physical therapy, exercise, and over-the-counter pain medication. For most patients with piriformis syndrome, those techniques are likely to work.
However, disc bulges can sometimes be more complicated to treat. If physical therapy and over-the-counter pain medications are not working, other interventional pain management techniques may be necessary. If you come into APC to seek sciatica treatment, we’ll start with an exam and an MRI of the spine. We can discuss what pain treatment options you’ve tried so far and decide on a course of action going forward.
Many patients with severe sciatica pain benefit from epidural injections. These localized injections are placed near the inflamed and painful nerve root to calm it and reduce pain while the disc bulge heals. The injection includes a steroid and a bit of a numbing agent to facilitate healing and bring down the inflammation. Each injection provides about 3 months of relief, but hopefully, the disc bulge will heal over time and prolonged injections are unnecessary.
However, if a patient has already had a course of epidural injections and they aren’t working, there are more options. Severe or stubborn disc bulges can be targeted with a minimally invasive surgical procedure, called a microdiscectomy, to remove the part of the disc that is protruding and rubbing against the nerve root. This surgery can be done at APC with our neurosurgery team. If someone is eligible for this surgery a spinal cord stimulator may also be helpful.
A spinal cord stimulator is an implanted device that sends low levels of electricity into the spine to disrupt pain signals and manage chronic pain. It consists of a small battery pack implanted in the abdomen or lower back, as well as electrodes placed between the spinal cord and the vertebrae. Patients can control the level of stimulation and turn it on and off if the pain is not constant. Spinal cord stimulation generally works well for sciatica pain and can help patients find long-lasting relief.
How APC’s Multidisciplinary Model Benefits Sciatica Patients
Sciatica pain can be complicated because it straddles the disciplines of interventional pain management, neurosurgery, and orthopedics. However, at APC patients don’t have to worry about referrals, waiting periods, or communication issues between different providers. All of our specialties are housed in the same clinic system and often in the same building. Communication is easy and streamlined. Plus, behind the scenes, we can coordinate across disciplines to ensure each patient receives the best possible quality of care. If you have sciatica pain that won’t go away, come into APC today!