Sciatica: Causes, Symptoms, Treatment, Prevention
Many of us regularly contend with some form of pain or discomfort, from all-too-common menstrual cramps to serious medical conditions. Sciatica is a term commonly used to refer to pain, weakness, or numbness along the sciatic nerve pathway that runs from the lower back down each leg to the foot. Although most sufferers are middle aged or older, and sciatica is more common among men, pregnancy can also sometimes bring on sciatic pain.
Pain is a complex phenomenon. If a cause cannot be easily determined, getting diagnosis and treatment can become more elusive over time. Pain that radiates from the lower back down the leg—typically on one side only—can be caused by a variety of conditions that compress or otherwise irritate the sciatic nerve. Keep reading to find out more about sciatic pain, the possible causes, and how to get some relief.
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What is sciatica?
Sciatica, or sciatic neuritis, is a common condition affecting at least 40% of people at some point in their lives with the highest percentage of incidents between ages 30 and 50. The term “sciatica” refers to the location and type of pain rather than a specific medical diagnosis as there are many possible causes.
Everything in the body is connected. The health of the lower back is directly linked to the legs and other parts of the body. This was already noticed by Ancient Greeks. In fact, it is presumed that it was Hippocrates who coined the term sciatica to refer to pain in the lower back and leg area; coming from the Greek word ‘ischios’, meaning hip. Now we know more about anatomy, and the main nerve operating in this area of the body.
The left and right sciatic nerves originate from five points, or nerve roots, in the lower back—two in the lumbar spine and three in the sacrum—merging into one nerve that runs all the way down the back of each leg to the foot, branching off into various muscles along the way. At its widest point, the sciatic nerve is about as thick as your thumb.
The sciatic nerve transmits both motor and sensory information; it helps you feel sensations in your lower back and legs and helps you walk, stand, and run. Because it is a mixed function nerve, any damage can cause both discomfort and mobility issues.
Sciatic pain is most common in people who have either physically demanding jobs, especially those that require heavy lifting and twisting, and those who lead a sedentary lifestyle. Additional risk factors include smoking and having diabetes. Pregnant women and runners are also have an increased risk of developing sciatica.
What causes the sciatic nerve pain?
Undue pressure, irritation, or inflammation to any nerve at any point along its path can result in pain, numbness, tingling and other sensations in the innervated areas. The sheer size of the sciatic nerve means pressure or impingement at any point along the nerve can cause pain up or down the line. Injury or spinal misalignment in the lower back is the most common cause of lower back and leg pain. Trauma and spinal deformities become more likely with age as our bones grow weaker and physical patterns more set.
One of the most common causes of sciatica is a herniated disc. Between each of the vertebrae in our spines there is a rubbery cushion. These intervertebral discs are made up of concentric layers of collagen fibres forming a soft gel-like core or nucleus encased in tough exterior or annulus. They hold the vertebrae together, act as small shock absorbers, and give the spine its mobility.
When a disc herniates, usually in the lower back, the soft nucleus pushes through a rupture in the annulus and compresses one of the five roots of the sciatic nerve, causing sharp pain that radiates down the leg and can worsen with prolonged standing or sitting. External trauma or an extreme, sudden internal strain (for example, when lifting a heavy object with improper posture) can instantly cause a disc to herniate.
Some other conditions that can cause sciatic pain include:
Degenerative Disc Disease is when the discs between the vertebrae in the spine wear down over time. As the discs dehydrate and wear down with age, they lose their ability to compensate for compression and movement. This can put excess pressure on the nerves in the spinal canal, including the sciatic nerve, and cause a great deal of pain.
Spinal Stenosis occurs when the spaces within the spine narrow, putting pressure on the nerves that pass through. Spinal stenosis can be caused by osteoarthritis, bone spurs, degenerative disk disease, or ossified ligaments, all of which are common in older adults and can cause sciatica and other symptoms.
Piriformis Syndrome is what happens when the small, flat, pear-shaped piriformis muscle—one of six external rotator muscles in the hip/thigh—becomes tight or inflamed, compressing the adjacent sciatic nerve. Running, heavy lifting, climbing stairs, or even sitting in the car for long periods can trigger or aggravate such pain.
Spondylolisthesis is when a spinal vertebra slips out of place, usually in the lumbar region. Vertebral displacement narrows the spinal canal, compressing the nerves that pass through it and causing lower back pain.
Obesity can also contribute to sciatic pain as excess weight can put pressure on the spine, affecting the sciatic nerve.
Is this sciatic pain?
The experience of sciatic pain can vary from person to person, but sufferers often describe it as a sharp, shooting pain that starts in the lower back or buttocks and then travels down the leg. The pain may be constant or intermittent and can range from a mild ache to debilitating agony that makes it difficult to stand, walk, or even sit.
Some also experience a tingling or burning sensation, numbness, or weakness in the affected leg. They may also have difficulty bending or twisting their back and may experience decreased reflex reaction or loss of mobility in the leg or foot.
Many people with sciatica report their pain is intensified by certain activities, such as sitting or standing for long periods of time, coughing or sneezing, or bending over to pick something up. They may get temporary relief from changing positions frequently, using heat or cold therapy, or taking over-the-counter pain medication.
How to relieve pain of sciatica
Acute sciatica often resolves on its own in a week or two, but in certain cases it can become chronic. There are several different ways to approach pain relief for sciatica. However, it is important to know the underlying cause if you want to determine the best course of action for your specific case. You will come to an answer more quickly if you seek medical advice. Those who suffer from severe symptoms will be motivated to seek help but don’t wait if you don’t have to.
One of the best approaches to dealing with sciatica pain is physical therapy (PT). A therapist can assess your body’s strengths and weaknesses to design exercises and stretches specific to your needs. Following a PT regimen over a period of weeks or months will improve the strength and flexibility of the affected muscles and nerves, reducing pain and improving mobility.
Both yoga and pilates are low-impact exercise systems that train your core and include specific exercises to address the nerves and muscles involved in sciatic pain.
Applying heat or cold to the affected area can help reduce inflammation and numb the pain. Use a thermal gel pack or have a nice, long soak in the tub.
Another way to reduce pressure on the sciatica nerve is simply to rest. However, rest must always be balanced with gentle movement to prevent stiffness and muscle weakness, especially during painful episodes.
A massage therapist or someone who specializes in myofascial release can do some of the work for you and give you real relief from pain, at least for a while.
Mild to moderate sciatica pain can be managed by over-the-counter pain medications such as ibuprofen, acetaminophen, or naproxen. In severe cases, your doctor may prescribe a muscle relaxant or an opioid to help alleviate the pain. However, such medications should be used with caution and only as prescribed. Chemical pain management only masks symptoms, it does not address the cause of the problem, so, if possible, use a pain reliever in the short term for new symptoms and flare ups while you also work to heal your body.
Shoes for sciatica treatment
The shoes we wear can have a significant effect on our posture and general health. Choosing the right footwear is especially important if you suffer from sciatica, where the posture and positioning of your body can affect nerves and pain.
Which shoes are the best for relieving sciatica? Shoes that fit well, provide proper arch support, and have a low heel or no heel.
While the shoes themselves won’t improve your alignment or flexibility, wearing appropriate shoes can help alleviate sciatic pain by supporting better posture and weight distribution, cushioning your feet to reduce the impact of each step, and reducing pressure on the lower back.
Every day, we train our bodies into the shapes they have by the way we move and hold ourselves. Sciatica sufferers should avoid wearing shoes with a high heel, as they tilt the pelvis forward, increasing the pressure on the lower back. Wearing a low heel or no heel—zero drop shoes—is optimal for posture and alignment, but shoes with minimal cushioning, like flip-flops, offer little protection from the impact of your steps. Because most of us live in urban environments and walk on concrete instead of earth and grass, the striking impact can potentially affect your ankles, knees, and spine. The same goes for walking barefoot—weigh the potential benefits against the drawbacks.
More serious treatment options of sciatica
For severe pain, your doctor may recommend an injection of corticosteroids or an anesthetic directly into the affected area to reduce inflammation and pain.
On rare occasions, surgery may be recommended to relieve the pressure on the sciatic nerve. Before agreeing to such a procedure, it is essential to carefully consider the risks and benefits of surgery with your health care provider.
What causes sciatica pain in pregnancy?
The body goes through many changes during pregnancy, some of which can lead to greater-than-usual pressure on the sciatic nerve and associated painful symptoms. This can occur at any time during pregnancy, but it is most reported in the second and third trimesters.
Possible causes of pregnancy-related sciatica include:
Weight gain and postural changes. As the baby grows, the mother’s center of gravity shifts forward, increasing the curvature of the lower back. At the same time, the uterus is also expanding and taking up more space. These changes also affect how the internal organs sit within the body and how much pressure they exert on the sciatic nerve in various positions.
Hormonal changes. During pregnancy the body produces a hormone called relaxin, which loosens the ligaments in the pelvic area to prepare for childbirth. This change can also cause the pelvis to shift slightly, and depending on how the body is aligned, may pinch or put pressure on the sciatic nerve causing pain in the lower back and legs.
Exercises for sciatica
Exercises that improve core strength and flexibility can be an effective way to alleviate sciatica pain. As you do your sciatica exercises, be sure your lower back and neck are properly supported and stop exercising immediately if you feel any sudden or persistent pain.
Some exercises that can help alleviate or prevent sciatica include walking, stretching the hamstrings, practicing the cat-cow yoga pose, and doing glute bridges.
Walking can help improve circulation, reduce inflammation, and strengthen the muscles in the legs and back. If you lead a more sedentary lifestyle, start with short walks, then gradually increase distance and speed as the pain lessens and you develop your stamina. Walking provides many benefits with minimal effort and no equipment beyond a good pair of shoes.
Tight hamstrings can pull on the lower back and exacerbate sciatica pain. The safest way to stretch your hamstrings is to do it lying down on your back with your legs outstretched. Slowly raise one leg toward the ceiling until you feel a stretch in the back of your thigh. Hold and breathe into the stretch for 30 seconds, then repeat on the other side. To avoid involving your back and arm muscles as you lift your legs, place a strap (or scarf or old necktie) around the bottom of your foot that is long enough to hold comfortably in both hands. When your leg is high enough to give your hamstring a good stretch, use the strap to hold it as you relax your leg and back.
The cat-cow stretch is a gentle yoga pose that is hugely popular for improving flexibility in the spine and releasing unnecessary pressure. Get down on all fours with your hands shoulder-width apart and your knees hip-width apart. Breathing out, arch your back up towards the ceiling, then lower your back down towards the floor, “dropping” your stomach as you breathe in. Repeat 5 to 10 times.
Glute bridges can help strengthen the muscles in the hips and lower back. Lie on your back with your knees bent and your feet flat on the ground. Lift your hips up towards the ceiling, squeezing the gluteus muscles of your buttocks as you lift. Hold for several seconds and release. For maximum effect, focus on your form and on breathing instead of on how high you can lift your hips.
All exercises should be done with caution. If you have severe or chronic sciatica, consult a medical professional before starting something new. Some exercises may not be appropriate and might make the pain worse. It is always best to talk to your doctor or physical therapist about personalized treatment options.
How to overcome sciatica nerve pain
Untreated sciatic pain can become chronic and difficult to overcome. To prevent sciatica, or to avoid making it worse:
- avoid sitting or standing in the same position for prolonged periods
- practice good posture as you go about your day
- avoid lifting heavy objects
- wear supportive shoes with low heels
Monitor your health and look for help from healthcare professionals as necessary.
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