About 40% of people will develop sciatica at some point in their lifetime1. While sciatica becomes more frequent as people age, it is still one of the most misunderstood types of pain. Since sciatica is largely misunderstood, this post aims to shed more light and provide useful information about its causes, symptoms, and treatment options.
What is sciatica?
Sciatica is a debilitating condition indicated by pain traveling along the sciatic nerve. As the longest and thickest nerve in your body, the sciatic nerve is formed by the union of five nerve roots from the lower spine area. The nerve extends from the lower back area to the hips and travels to the buttocks and down your legs.
The sciatic nerve participates in two important functions: motor and sensory function. In other words, it makes it easier for your legs and feet to move. At the same time, you have sensations in much of your legs thanks to this nerve.
Sciatica can affect everyone, but some people are at a higher risk. Common risk factors include older age, overweight or obesity, diabetes, prolonged sitting, and occupations that involve carrying heavy loads, twisting the back, or being behind the wheel for long periods.
Although painful, sciatica is manageable.
What causes sciatica?
Sciatica is caused when the sciatic nerve is pinched. For that reason, anything that deforms, pressures or pinches the sciatic nerve can cause this painful condition. The most common causes of sciatica are listed below2:
- Herniated discs with nerve root compression (in about 90% of the cases): disc is a cushioning pad between vertebrae of the spine. Sometimes disc can bulge or herniate out of its position due to pressure from vertebrae
- Degenerative disc disease: can cause spinal stenosis (narrowing of nerve passageways) and thereby pinch the sciatic nerve roots
- Osteoarthritis: sometimes bone spurs can develop in the aging spine and compress the sciatic nerve
- Spondylolisthesis: i.e. slippage of one vertebra, so it’s not aligned with the vertebra above; it pinches the sciatic nerve
- Cauda equina syndrome: compression of nerve roots in the lumbar spine
Other causes of sciatica include trauma or injury to the sciatic nerve or lumbar spine, tumors in the lumbar spine canal, and piriformis syndrome. The latter occurs when the piriformis muscle spasms or becomes tight, thus pressuring or irritating the sciatic nerve.
Often, these causes of sciatica are discovered using MRI. MRI is commonly used in cases of sciatica, but insurance companies do not like to authorize MRIs before certain criteria are met, like waiting for four weeks after symptoms started. Another method of finding the cause of sciatica is a specialized type of testing called electromyography (EMG) and a Nerve Conduction Velocity (NCV).
Symptoms of Sciatica
The most common symptoms of sciatica are listed below3:
- Moderate to severe pain intensity in the lower back area, buttock, and down the leg
- Pain in the lower back is less severe than pain in the legs
- Hip pain
- Worsening of pain with movement or when sitting
- Pain on one side of the rear is persistent
- Difficulty standing up due to shooting pain
- Weakness or numbness in the lower back area, buttock, and down the leg to the foot
- Loss of bladder and bowel control due to cauda equina
- Experiencing “pins and needles” sensation in legs, feet, or toes
The hallmark symptom of sciatica is pain, but it can occur anywhere along the nerve pathway. Sometimes sciatica makes one part of the leg numb, whereas the other part is in pain.
Is it Actually Sciatica?
It is very common for people to present to medical provider’s offices complaining of sciatica, with pain in their hip or buttock or even down to the back of the thigh. In many cases, the pain is not in fact sciatica. Sciatica is typically talking about radiating down into the lower leg like into the calf or down in the foot. People that have pain not traveling past their knee may not be experiencing sciatica and it could be related to something completely different. Pain in the sacroiliac or hip joint and even lumbar pain can seem to radiate down into the buttock or even in the back of the thigh. Someone who is an expert in neuromusculoskeletal disorders must examine you to make the right diagnosis.
Typical Medical Treatment for Sciatica
The typical initial treatment for people suffering from sciatica is anti-inflammatories and muscle relaxers. This can help some people who are suffering from sciatica to decrease the pain intensity. Medications that your doctor may prescribe include anti-inflammatories, antiseizure medications, antidepressants, corticosteroids, and opioids.
Steroid injections are another invasive treatment that is often prescribed or performed in your doctor’s office. Since they can cause damage, people are usually limited to three injections in a year.
Occasionally, injections are done to facilitate a nerve block, which is something that is used to turn off pain signals from the nerve. A longer-term treatment that be done as a nerve ablation where the nerve is burned to stop it from causing pain.
Surgery is often the last resort, and the type of surgery depends on the underlying cause of sciatica. For example, the patient may need the removal of a bone spur (laminectomy) or a part of a herniated disc (microdiscectomy) that’s pressuring or pinching the sciatic nerve. Recovery after surgery varies from one patient to another. It can take anywhere from six weeks to three months to achieve full recovery.
Conservative treatments for sciatica
The first treatments for sciatica should be conservative methods that are non-invasive and rely on relief based on natural non-pharmacological approaches.
Medical doctors will commonly write prescriptions for physical therapy. It helps treat and prevent sciatica by mobilizing and strengthening tissues in the lower back area. The main goals of physical therapy for sciatica include pain relief4, restoring functional movements and joint function, decreasing muscle spasms and preventing future flare-ups. Individualized rehabilitation program usually lasts four to 12 weeks or longer. Patients learn exercises that can help them recover.
Chiropractic care is a conservative treatment strategy that uses noninvasive and nonpharmacological approaches. When people think of chiropractic, they typically think of spinal adjustments that improve the movement of spinal structures. This leads to better spine function and pain relief. Many do not know that there is a specific treatment method used in many chiropractic offices to directly treat sciatica. It is known as flexion distraction technique and is when a slow, gentle stretching or manual decompression of the spine is used to decrease the pressure in the spinal disc and widens the spinal canal.
Many do not realize that physical therapists are not the only healthcare providers to utilize exercises to help their patients suffering from sciatica. Some chiropractors have training in McKenzie Method, which is where you discover a patient’s preferred position or movement to decrease pain and increase function. Chiropractors can also utilize corrective exercises to improve a patient’s sciatica and leg pain.
Who You See First Matters
As I stated, it is important to see a neuromusculoskeletal expert first for correct diagnosis. It also ends up being important to see someone like a chiropractor to help reduce opioid prescriptions and decrease healthcare costs, according to research. Multiple studies show that seeing a chiropractor first or engaging conservative healthcare providers like chiropractors decrease opioid prescriptions from MDs by allowing effective non-pharmacological interventions to take place first5,6. Initial treatment by chiropractors has the lowest rate of prescription medication, the lowest cost per episode of low back pain in the closest adherence to guidelines for usage of medications and imaging7,8. This is important because the amount paid in a claim that was initiated by a chiropractor was almost 40% less than episodes that were initiated with a medical doctor9. Part of the reason for this increased expense is the fact that when people see surgeons early in their treatment, 43% of them have surgery within three years, but when someone sees a chiropractor first only 1.5% have surgery10.
Sciatica is one of the most common types of pain that people experience in the lower back and legs. Even though it is common, sciatica is poorly understood. The main cause of sciatica is a pinched sciatic nerve, which can occur due to various factors. A herniated disc is usually the main culprit for a pinched sciatic nerve. Pain can be debilitating, but fortunately, it’s possible to manage sciatica effectively.
- Sciatica: Of all the nerve (2016) Harvard Health. Available at: https://www.health.harvard.edu/pain/sciatica-of-all-the-nerve (Accessed: November 9, 2022).
- Sciatica. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507908/ (Accessed: November 9, 2022)
- Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317. doi:10.1136/bmj.39223.428495.BE
- Fritz JM, Lane E, McFadden M, et al. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial. Ann Intern Med. 2021;174(1):8-17. doi:10.7326/M20-4187
- Kazis LE, Ameli O, Rothendler J, Garrity B, Cabral H, McDonough C, Carey K, Stein M, Sanghavi D, Elton D, Fritz J, Saper R. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019 Sep 20;9(9):e028633.
- Azad T, Vail D, Bentley J et al. Initial Provider Specialty is Associated with Long-term Opiate Use in Patients with Newly Diagnosed Low Back and Lower Extremity Pain. Spine (Phila Pa 1976). 2018 Aug 7.
- Dagenais S, Brady O, Haldeman S, Manga P. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC Health Serv Res. 2015 Oct 19;15:474.
- Allen H, Wright M, Craig T, Mardekian J, Cheung R, Sanchez R, Bunn WB 3rd, Rogers W. Tracking low back problems in a major self-insured workforce: toward improvement in the patient’s journey. J Occup Environ Med. 2014 Jun;56(6):604-20.
- Liliedahl RL, Finch MD, Axene DV, Goertz CM. Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer. J Manipulative Physiol Ther. 2010 Nov-Dec;33(9):640-3.
- Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM. Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976). 2013;38(11):953-64.