Sciatica

Medically Reviewed on 11/14/2023

What is sciatica?

What Are the 4 Types of Sciatica
The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee.

Sciatica is a pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. Lumbar radiculopathy is sometimes referred to as sciatic nerve pain.

What are the 4 types of sciatica?

1. Acute sciatica

  • Caused by sudden irritation to the nerves due to pinching, compression, or a combination of both.
  • Symptoms may include:
    • A burning or shooting sensation throughout the lower back, buttocks, and down the leg
    • Hip pain
    • Difficulty sitting as symptoms get worse
  • Pain can last 1-2 weeks.

2. Chronic sciatica

  • Can last months or years and may occur intermittently.
  • Some conditions that can worsen the pain include:
    • Inflammatory conditions, such as rheumatoid arthritis
    • Injuries
    • Infections
    • Spinal misalignment issues
  • May resolve temporarily but can recur without treatment or lifestyle and activity adjustments.

3. Bilateral sciatica

  • A rare type of sciatica that affects both legs.
  • May be caused by multiple herniated discs or disc degeneration.
  • The pain may be felt in both legs and buttocks at the same time.
  • At times, pain in one leg might be more severe than pain in the other leg.

4. Alternative sciatica

  • A rare type of sciatica that can cause pain in both legs alternatively.
  • Can result from degenerative problems in the sacroiliac joint or sacroiliac arthritis.

What are the causes of sciatica?

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Aside from a pinched nerve from a disc, other causes of sciatica include:

Risk factors for sciatica include:

What are the symptoms of sciatica?

Sciatica often results in:

Sciatica causes:

  • pain,
  • a burning sensation,
  • numbness, or
  • tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg.

Sometimes the sciatic pain radiates around the hip or buttock and feels like hip pain.

  • While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain.
  • Severe sciatica can make walking difficult if not impossible.
  • Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down.
  • The numbness and pain relief by changing positions can be partial or complete.

SLIDESHOW

What Is Sciatica? Symptoms, Causes, Treatments See Slideshow

Diagnosis of sciatica

Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health care professional to diagnose sciatica. Sometimes, X-rays and other tests, such as CT scans, MRI scans, and electromyograms, are used to further define the exact causes of sciatica.

Physician specialties that evaluate and treat sciatica range from generalists to subspecialists. These specialties include

  • general medicine,
  • family medicine,
  • internal medicine,
  • gynecology,
  • orthopaedics,
  • neurosurgery,
  • rheumatology,
  • pain management, and
  • physiatry.

Other healthcare providers for low back pain include

  • physical therapists,
  • chiropractors,
  • massage therapists,
  • psychologists, and
  • acupuncturists.

What is the treatment for sciatica?

How can I get immediate relief from sciatica?

Bed rest has been traditionally advocated for the treatment of acute sciatica. But how useful is it?

To study the effectiveness of bed rest in patients with sciatica of sufficient severity to justify treatment with bed rest for two weeks, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for this period.

To gauge the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and 12 weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.

The results, reported in the New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the aggravation of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers concluded that "among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes, conventional wisdom is not as wise as research!

What are other treatment options for sciatica?

Other treatment options for sciatica depend on its cause and include addressing the underlying cause and physical therapy.

  • Transcutaneous nerve stimulators (TENS units) are sometimes useful for more chronic forms of sciatica.
  • A variety of low back conditioning and stretching exercises are employed to help people recover from sciatica.
  • Medications used in the treatment of sciatica include pain relievers, muscle relaxants, anti-inflammatories, and antidepressants.
  • Antidepressants actually can help by reducing pain perception in the brain.
  • Other medications that may be helpful include gabapentin (Neurontin) and duloxetine (Cymbalta).

Cortisone medications, given orally or by local injection (epidural injection), can sometimes be helpful in relieving sciatica pain.

Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine. Sometimes pain management specialists help with chronic sciatica conditions.

What causes sciatica to flare up?

Most sciatic flare-ups are due to the herniated or slipped disk or overgrowth of a bone called bone spurs that occur on the spine, resulting in pressure on the nerve and causing severe pain and inflammation.

Subscribe to MedicineNet's General Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

Home remedies and exercises for sciatica

Keys to the management of acute sciatica include relief of pain and relaxing associated muscle spasms. Home remedies include:

What are the best exercises for sciatica pain relief?

  • Physical therapy that incorporates gradual exercises and stretching.
    • Exercises and stretching can sometimes best be guided by physical therapists.
    • Mobility and strengthening: If sciatica is caused by a lumbar disk prolapse (slipped disk), then extension exercises are recommended to help reduce the compression of the disk on the nerve root.
    • Core exercises: Core strengthening exercises to strengthen the core muscles of the trunk is a popular option for managing back conditions.

What is the prognosis for sciatica?

Depending on the precise cause of sciatica and the duration of symptoms, the outlook for recovery from sciatica ranges from excellent to having long-term chronic symptoms.

The duration of sciatica is critically dependent on its cause. A herniated disc, back sprain, shingles, and degenerative lumbar spine can all cause temporary forms of sciatica, lasting from days to weeks. Each can also cause chronic sciatica.

Sometimes degeneration of the lumbar spine and discs can cause chronic sciatica that persists unless surgical intervention is performed.

Is it possible to prevent sciatica?

Sciatica can be prevented to some extent by avoiding low back trauma injuries. Conditioning exercises, such as yoga and Pilates, can sometimes help to prevent injury to the low back.

Medically Reviewed on 11/14/2023
References
Cass, Shane P. "Piriformis Syndrome: A Cause of Nondiscogenic Sciatica." Current Sports Medicine Reports 14:1 : 41-44.

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, Ninth Edition. China: Elsevier Health.

Vroomen, P.C., et al. "Conservative treatment of sciatica: a systematic review." J Spinal Disord 13(6) : 463-469.

Mayo Clinic: Sciatica
https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

Cleveland Clinic: Sciatica
https://my.clevelandclinic.org/health/diseases/12792-sciatica

New York Presbyterian: Sciatica Symptoms and Causes
https://www.nyp.org/ochspine/sciatica/symptoms

Science Direct: Sciatica
https://www.sciencedirect.com/topics/medicine-and-dentistry/sciatica