Sciatica

Also known as: Sciatic neuralgia, Lumbar radiculopathy, Pinched sciatic nerve, Sciatic nerve irritation, L4-S1 radiculopathy

Last updated: December 18, 2024

Sciatica is pain that travels along the sciatic nerve, running from the lower back through the hips and buttocks and down a leg. It often happens when a herniated disc, bone spur, or spinal stenosis presses on the nerve, leading to inflammation and pain, sometimes with numbness or weakness. Symptoms can include sharp, burning, or electric shock-like pain. Most cases improve within weeks with conservative care.

Key Facts

  • •Sciatica refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back through the hips and buttocks and down each leg
  • •Pain radiating from the lower back through the buttock and down the back of the leg
  • •Diagnosed through history, physical exam, and imaging
  • •First-line treatment includes exercise, weight management, and activity modification

What It Is

Sciatica refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back through the hips and buttocks and down each leg. It typically occurs when a herniated disc, bone spur, or spinal stenosis compresses part of the nerve, causing inflammation, pain, and often numbness or weakness in the affected leg.

Affected Anatomy

This condition affects several structures in and around the joint:

  • •Sciatic nerve (formed from L4-S3 nerve roots)
  • •Lumbar nerve roots, particularly L4, L5, S1
  • •Intervertebral discs of the lumbar spine
  • •Piriformis muscle (may contribute in piriformis syndrome)
  • •Spinal canal and neural foramina
  • •Buttock, posterior thigh, and leg along the sciatic nerve distribution

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

  • •Pain radiating from the lower back through the buttock and down the back of the leg
  • •Pain that may be described as sharp, burning, or electric shock-like
  • •Numbness or tingling in the leg or foot
  • •Weakness in the affected leg or foot
  • •Pain that may worsen with sitting, coughing, or sneezing
  • •Pain typically affecting only one side of the body
  • •Difficulty moving the leg or foot in some cases
  • •Lower back pain may or may not accompany leg symptoms

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

  • •Lumbar disc herniation is the most common cause, compressing nerve roots
  • •Lumbar spinal stenosis may cause nerve compression, particularly in older adults
  • •Degenerative disc disease may contribute to nerve irritation
  • •Spondylolisthesis (vertebral slippage) may compress nerve roots
  • •Piriformis syndrome, where the piriformis muscle irritates the sciatic nerve
  • •Bone spurs (osteophytes) from spinal arthritis may impinge on nerves
  • •Rarely, tumors, infections, or other conditions may cause sciatic symptoms

Risk Factors

  • •Age-related spinal changes, including disc degeneration and stenosis
  • •Obesity may increase stress on the spine and contribute to disc problems
  • •Prolonged sitting or sedentary occupations may increase risk
  • •Occupations involving heavy lifting, twisting, or driving
  • •Diabetes may increase risk of nerve damage
  • •Smoking may contribute to disc degeneration
  • •Prior episodes of sciatica may increase risk of recurrence

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

  • •Medical history focusing on pain characteristics, distribution, and aggravating or relieving factors
  • •Physical examination including straight leg raise test and neurological assessment
  • •Assessment of reflexes, muscle strength, and sensation in the legs
  • •MRI is often the preferred imaging study to identify the underlying cause
  • •CT scan may be used when MRI is contraindicated
  • •Electrodiagnostic studies (EMG/nerve conduction) may help in certain cases
  • •X-rays may help assess spinal alignment and bony abnormalities

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

  • •Activity modification, avoiding prolonged sitting and positions that worsens symptoms
  • •Short-term relative rest followed by gradual return to activity
  • •Muscle relaxants may help manage associated muscle spasm
  • •Heat or ice application for symptom relief

Physical Therapy and Exercise

  • •Physical therapy focusing on stretching, strengthening, and proper body mechanics

Medications

  • •Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation

Injections and Office-Based Procedures

  • •Oral corticosteroids may be used short-term for severe symptoms
  • •Epidural steroid injections may provide temporary relief for some individuals

Surgery

  • •Surgical intervention (such as microdiscectomy) may be considered for severe or persistent symptoms with identifiable structural cause

Prognosis and Recovery

The course of this condition varies between individuals:

  • •Most cases of sciatica improve within several weeks with conservative treatment
  • •Symptoms may resolve as inflammation decreases or disc herniation resorbs
  • •Some individuals may experience recurrent episodes
  • •Chronic sciatica may develop in a minority of patients
  • •Surgical outcomes are generally favorable when conservative treatment fails and clear structural pathology exists

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