Sciatica or sciatica pain refers to back pain and leg pain experienced as a result of pinching or irritation in the sciatic nerve.
While sciatica may be a type of back pain, it is different as the pain originates with the sciatic nerves and radiates to a vast area. The sciatic nerves are the largest nerves in the human body, extending from the lower portion of the spinal cord all the way down the thighs to the soles and toes of the feet. With the path of the sciatic nerves being that long, pain can be experienced anywhere along the branches of the sciatic nerves — buttocks, low back, thigh, leg, calf, or feet — and is not limited to the lower back alone.
Those with acute or chronic lower back pain are more prone to developing sciatica, with anywhere between 5 to 10% of them developing sciatica pain1. It has been estimated that at least 40% of people develop it at some point in their lives2, with the prevalence increasing post the age of 453.
What causes sciatica pain?
It is crucial to understand that not all types of lower back pain or radiating pain in the lower part of the body can be categorized as sciatica pain. Sciatica refers only to lower back pain or radiating pain that originates from the sciatic nerves.
Sciatica most commonly occurs when an underlying medical condition causes pain, inflammation, or numbness in the affected regions. Some of the most common medical conditions that can cause pinching or irritation of the sciatic nerves include:
- Inflammation of the pelvic or lumbar muscles
- Lumbar degenerative disc disease
- Herniated lumbar disc
- Piriformis syndrome
- Nerve damage from diabetes
- Sacroiliac joint dysfunction
- Bone spurs on the spine
- Lumbar spinal stenosis
Several of these medical conditions develop as a result of a trauma or an injury. Some may also be as a result of physical stress injuries; for example, herniated discs could occur due to weightlifting or prolonged manual labor. It has been estimated that approximately 90% of all sciatica conditions are caused by lumbar herniated discs with nerve root compression4. A herniated disc can cause nerve compression either directly or when an acidic chemical substance can leak from the herniated disc and cause inflammation or irritation near the sciatic nerve.
There are some rare instances where sciatica can occur due to tumors, blood clots, infections, the formation of scar tissue, spinal tuberculosis, or fractures in the spine. An estimated 1% of women also experience sciatica at some time during their pregnancies. This can be due to a bulging of the intervertebral disc or a herniation, which causes nerve compression5. In some cases, the cause of sciatica can be attributed to a post-surgical complication6.
What are the symptoms of sciatica pain?
The hallmark of sciatic nerve pain is a pain that radiates from the lumbar region or the lower spine all the way down to the sole of the feet. While the pain can be experienced at any point through that specific nerve anatomy, the path that it takes is quite typical – from the lower back to the buttocks, back of the thighs, calves, and feet.
Sciatica usually affects only any one leg at a time and can cause pain in any part of the said region. Some of the most common signs and symptoms of sciatic nerve pain include the following:
- Pain ranging in intensity from mild aches to sharp, burning, and even electrifying sensations
- Constant or intermittent sensations of pain felt more severely in the leg than in the back
- Sensations of numbness or tingling in the affected side
- Muscle weakness in the affected side
- Sensations of heaviness in the affected leg
- Increased pain in specific postures and movements
- Loss of function in legs in extreme and rare cases
- Loss of bladder/bowel movement in extreme and rare cases
The symptoms of sciatica are typically manifested when specific nerve roots are affected. For example, the following symptoms may be experienced if the compression is on the L4 nerve root:
- Pain in the thigh, hip, and inner parts of the knee and calves
- Loss of sensation in these regions
- Loss of reflexes in the knee
The following symptoms may be experienced if the compression is on the L4 nerve root:
- Pain in the outer part of the leg and thigh
- Loss of sensation in the toes
- Difficulty moving the ankle
The following symptoms may be experienced if the compression is on the S1 nerve root:
- Loss of reflexes in the ankle
- Pain in the back of the calves, buttocks, and in the side of the feet
- Difficulty moving the heel
What are the types of sciatica?
Sciatica pain can be classified into different types based on the duration and affected regions7. It can be as follows:
- Acute sciatica — Sudden, persistent pain that lasts anywhere between 4 to 8 weeks.
- Chronic sciatica — Persistent sciatic nerve pain lasts over 8 weeks.
- Alternating sciatica — Pain affecting both legs alternatively. This type of sciatica is extremely rare and is caused primarily by conditions such as sacroiliac joint dysfunction.
- Bilateral sciatica — Pain affecting both legs simultaneously. This type of sciatica is rare and is caused primarily by conditions such as cauda equina syndrome.
What are the risk factors associated with sciatica pain?
Sciatica pain can occur due to a host of risk factors ranging from aging to obesity. The most common risk factors associated with the condition are as follows:
- Age-related changes in the spine such as bone spurs and degeneration of discs
- Prolonged exposure to heavy activities and sports
- Prolonged manual labor
- Sedentary lifestyle
- Anxiety and stress
What are the complications that can arise due to sciatica pain?
Sciatica pain, even in a more acute manifestation, can be completely treated. However, when there is a lack of timely medical intervention, it can lead to nerve damage and loss of functions in the affected regions. Some of the possible complications that can arise due to sciatica include:
- Inability to move specific parts of the affected regions
- Loss of function in affected regions
- Loss of bowel/bladder control
- Chronic pain
- Loss of feeling in the affected regions
- Permanent nerve damage
- Weakness in the legs
When should I see a doctor for sciatica pain?
Sciatica in its milder form usually goes away on its own with simple self-care routines and painkillers. However, if you have been experiencing persistent or progressive pain that has lasted over a week and found no relief, it is important to consult your pain care physician or sciatica pain doctor at Advanced Pain Care for sciatica pain management immediately.
Seek immediate medical attention if you are experiencing:
- Severe pain along with numbness and weakness
- Loss of control over body functions
If you have been experiencing pain after an accident or trauma, consult your physician right away. Call Advanced Pain Care at 512-244-4272.
How is sciatica pain diagnosed?
The effectiveness of the sciatica pain treatment plan depends on the diagnosis of the medical condition causing the pain. In order to arrive at an accurate diagnosis, physicians and sciatica pain doctors at Advanced Pain Care will approach the evaluation in the following manner to understand the pain patterns:
- Medical history — Understanding the patient’s medical history helps to discern the pain patterns. The physician may review the following information to do so:
- Onset of pain
- Onset of other symptoms
- Type and duration of the pain
- Recent trauma or injuries
- Physical examination — During a physical examination, the physician may check for the following parameters:
- Localized pain experienced in specific regions along the nerve path
- Response to external stimuli
- Response to specific movements such as walking on heels or toes, or transitioning between movements and postures
- Clinical tests — In order to check for sciatic nerve pain, the physician may conduct the following clinical tests:
- Slump test — This involves the patient bending forward at the hip to check if the pain is manifested in this position.
- Straight leg raise test
- These tests are done to isolate mechanical causes leading to sciatica and cannot confirm any other causes such as chemical irritation.
- Diagnostic tests — Medical imaging tests help diagnose the cause of the pain especially in chronic cases. They also help during the course of minimally-invasive and surgical procedures as a part of the sciatic nerve pain treatment plan. Some of the commonly used diagnostic tests are as follows:
- Diagnostic nerve block injections
- CT scans
- Selective nerve root blocks
How is sciatica pain treated?
Once the physician arrives at the diagnosis, a structured plan for sciatica pain treatment is created, which can include simple self-care treatments, non-surgical treatments, and surgical procedures. The treatment for sciatica is primarily focused on treating the underlying causes of the pain and managing the pain itself. The treatment plan includes:
- Self-care treatments typically include rest; use of ice packs for the first few days followed by the use of hot packs; medications (prescription and non-prescription) to reduce pain and inflammation; and simple stretching exercises as recommended by the physician.
- Non-surgical treatments at Advanced Pain Care include the following:
- Diagnostic nerve block injections
- CT scans
- Selective nerve root blocks
Is surgery required for sciatica pain?
Surgery to cure sciatica pain is considered an option only if none of the other treatments have helped in relieving the pain and you are also experiencing the following signs:
- Progressively worsening pain
- Severe muscle weakness in the lower body
- Loss of body functions such as bowel and bladder control
Surgery is usually considered based on the progression of the symptoms in each specific case. However, if the diagnosis for the underlying cause proves to be one among the following, the doctors at Advanced Pain Care will advise an emergency surgery:
- Cauda equina syndrome
- Bilateral sciatica
- Non-responsive infection in the pelvic region
- Tumors in the lumbar region
- Collection of fluid in the lumbar region
- Fractures in the lumbar spine
This surgery will be performed to remove the pressure on the nerves and stabilize the spine. Some of the commonly advised surgical options include:
- Microdiscectomy to remove fragments of a herniated disc that are pressing on the nerves
- Laminectomy to remove a part of the vertebral bone that is laying pressure on the sciatic nerve
- Foraminotomy to enlarge the neuroforamen and give more room to the nerve roots
- Facetectomy to relieve pressure on nerves caused by degenerated facet joints
Post-surgery recovery is case-specific; however, the time taken to recover is usually 6 weeks to 3 months. Before opting for a surgical procedure, talk to your surgeon at Advanced Pain Care to understand the entire recovery process as well as the possible risks involved.
What precautions can I take to prevent sciatica pain?
As sciatica pain is caused due to varied medical conditions, prevention may not always be possible. There are some basic steps that you can take to protect your back from any possible injury, trauma, or irritation that can lead to sciatica. These include:
Sciatica can be an extremely painful condition and limit the patient’s ability to perform even the most routine of daily tasks. The good news is sciatica pain management and treatment can be easily achieved, with the physicians and pain management specialists at Advanced Pain Care enabling ways for complete pain alleviation. Visit https://austinpaindoctor.com/pain/sciatica-pain for more information or call on 512-244-4272 to schedule an appointment with a pain management specialist.
Q: How do I relieve sciatic nerve pain?
A: Most cases of sciatic nerve pain can be treated with rest, application of ice and hot packs, as well as simple stretching exercises, to relieve the pressure on the nerves. In case of more acute or chronic pain, it is advised to consult with a pain management specialist at Advanced Pain Care to follow a comprehensive sciatic nerve pain treatment plan.
Q: How long will sciatica take to heal?
A: Sciatica pain can be categorized as acute or chronic. In acute pain cases, with the right treatment, the patient may find pain relief in 4 to 8 weeks. However, in certain medical conditions, the pain can prove to be a chronic one and even last from 2 months up to 2 years.
Q: What causes sciatica to flare up?
A: Sitting for prolonged periods of time has been known to cause sciatica to flare up. Additionally, wrong postures and body mechanics, prolonged manual labor, and obesity are also said to cause sciatica to flare up.
Q: Is walking good for sciatic nerve pain?
A: Walking is considered to be very effective when it comes to relieving sciatica pain. Regular walking helps to reduce inflammation and also releases pain-fighting endorphins into the bloodstream. However, if you do not adhere to proper body mechanics while walking – incorrect posture and walking patterns – it can lead to further pressure on the sciatica nerves, making the pain even worse.