Sciatic nerve pain presents as a kind of discomfort that’s unmistakable. Often a combination of numbness and piercing pain, it torments a surprisingly large number of people. This type of pain starts as what some colloquially call lumbago, that is an ache in the lumbar region of the back. Unfortunately, it usually doesn’t stop there. Sciatic nerve pain often proceeds to radiate down the lower extremities, through the buttocks, into the back of the thigh, and down the leg. Sometimes these sensations shift. Pain gets replaced by a burning sensation, and even moving or bending over can increase the agony. Walking can become impossible for some.
Dealing with sciatic nerve pain can seem somewhat slippery. Though it has become popularly known as sciatica, it is not actually a medical condition. Rather, sciatic nerve pain is a bundle of symptoms linked to number of different conditions, each with its own underlying cause. One individual’s sciatic nerve pain might originate from a relatively minor source, while another’s could indicate a serious medical problem.
Sound confusing? It often can be for patients simply trying to navigate a way out of chronic pain. That’s why The Spine Center has compiled this guide to sciatica pain. It will explain what typically causes such pain, risk factors you should know about, how to avoid such discomfort, when it constitutes a medical emergency, and how to treat it. This guide will also highlight various myths related to sciatic nerve pain that might harm rather than help.
What Causes Sciatic Nerve Pain?
The causes of sciatic nerve pain always come back to the same thing: the sciatic nerve. Anything that irritates or compresses this nerve can lead to it. JAMA explains, “Sciatica can be caused by a number of conditions that lead to compression or irritation of nerves as they exit the spinal canal (space through which the spinal cord travels) in the region of the lower back where they come together to form the sciatic nerves at the end of the spinal column.”
Most of the time, physicians trace sciatic nerve pain back to an injured disc in a patient’s lower backs. “In nine out of 10 cases, sciatica is caused by a displaced disk in the lower spine,” states Harvard Medical School. Such displacements aren’t uncommon among Americans, particularly as people age. According to the National Institutes of Health’s Genetics Home Reference, “Intervertebral disc disease is estimated to affect about 5 percent of the population in developed countries each year. Most individuals experience disc degeneration as they age.”
While displaced discs might be the most common cause of sciatic nerve pain, there may be other causes including:
- Spinal Stenosis: Defined as the narrowing of the spinal canal, spinal stenosis often results from degenerative arthritis as ongoing wear and tear collapses the vertebrae.
- Spinal Tumors: Spinal tumors are incredibly rare, so much so that the University of California San Francisco notes “that they account for only a half of one percent of all newly diagnosed tumors.” They do occur, though, and can cause sciatic nerve pain.
- Tarlov Cysts: Less troubling than tumors, Tarlov cysts may prompt sharp shocks of agony. According to the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, such cysts appear around the base of the spine and can compress the sciatic nerve. In addition to sciatic symptoms, they may also lead to sexual dysfunction, bone deterioration, headaches, and incontinence.
- Piriformis Syndrome: The piriformis muscle is a rarely considered band stretching from the front of the sacrum to the top of the femur, a band that can put pressure on the sciatic nerve. Sometimes even the presence of a wallet in a back pocket can cause piriformis syndrome.
- Sacroiliitis: Journal of Inflammation Research describes sacroiliitis as “inflammation of the sacroiliac joint,” which is the joint that links the ilium and the sacrum. This disorder is often very hard to diagnose and may lead to sciatica symptoms.
- Muscle Inflammation
- Injury or Fractures
Sciatica can serve as a wake-up call for patients. Whether the underlying cause is severe, or relatively benign, such persistent pain indicates that you need to see a doctor and get a diagnosis.
What are the Risk Factors?
You might think that older adults are the most at-risk demographic for developing sciatic pain symptoms. It’s true that underlying conditions such as spinal stenosis tend to affect those 50 years old and up. But that’s not the primary age group that ends up dealing with sciatica. The American Academy of Orthopaedic Surgeons explains, “You are most likely to get sciatica between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, plus any sudden pressure on the disks that cushion the bones (vertebrae) of your lower spine.”
Indeed, the nature of sciatica pain — which basically always involves some pressure on or damage to the sciatic nerve — means a wide range of individuals may have to face it. Some may find it surprising to learn that pregnant women often develop sciatic nerve pain when the uterus presses against the sciatic nerve. So while increasing age does play a role, it’s far from the only one.
A study published in Physiotherapy Research International discovered five risk factors: age, history of lower back pain, a history of smoking, obesity, and work-related activities (i.e., manual labor). Out of those five, three are modifiable, as the study’s author’s note. “Preventable and modifiable risk factors associated with sciatica include smoking, obesity and a number of occupational factors,” they say. They also point out why we should examine risk factors: “Primary prevention endeavors to avoid the suffering, cost and burden associated with a disease, thus eliminating the costs and morbidity associated with the disease process. Understanding risk factors associated with the disease process may enable clinicians to target preventative interventions in an attempt to address possible risks and subsequently prevent a primary episode.”
How to Avoid or Prevent Sciatic Nerve Pain
Because the majority of risk factors associated with sciatic nerve pain can be ameliorated by dedicated patients, one encouraging thought is that you have a fair bit of control over avoiding or preventing it. First steps involve losing weight, ceasing smoking, and modifying heavy lifting at work. For instance, if your job requires you to shift bulky objects, make sure that you are using correct form (i.e., lifting with your legs) and consider wearing supportive bracing. Similarly, embarking on a smoking cessation program will not only help with any sciatic nerve pain, it will also improve your health in general. Finally, carrying too much weight can lead to all sorts of back problems, not just sciatica. Also, remaining physically active is one of the best sciatic pain treatments available. (See the section “What Treatment Options are Available for Sciatic Nerve Pain?” for more information.)
What are the Symptoms?
JAMA describes sciatic nerve pain as follows: “Sciatica is the term for low back pain that radiates into the buttock, hip, and down one leg to the foot. The pain often is associated with tingling, numbness, or weakness of the leg. It may be sudden in onset and can persist for days or weeks.” In essence, it’s often a lumbar pain that radiates down into the legs in a sharp shock of agony. But that general definition misses out on some important particulars.
The weakness caused by sciatic nerve pain can manifest as a lack of strength in the knee or ankle in a single leg. Many people suffering from the condition find that they can’t run and find their gait reduced to an ungainly shuffle. Some patients may even experience a “foot drop”. Others may discover that they have the urge to urinate far more frequently. (Weakness or the need to urinate can indicate far more serious medical conditions. If you’re experiencing either, see a doctor as soon as possible. Read our “When is it a Medical Emergency?” section to learn more.) Sciatic pain won’t respond to pushing a prodding around your muscles, which is a good way to know that you aren’t just dealing with an achy back. Should a medical professional have you lie down and help raise your straightened hurting leg 30 to 70 degrees, you’ll feel it if you have sciatica. Why? Because it will stretch your sciatic nerve — and trigger the pain.
When is it a Medical Emergency?
Part of the problem with sciatic nerve pain is that it can obscure other more serious conditions. For instance, a recent article in World Neurosurgery indicated that lumbar radiculopathy (i.e., a technical term describing nerve compression that’s lumped in with sciatica) can mask tumors growing alongside the nerve. If pain persists when palpating the cleft between the buttocks, further scans may be necessary. Any abnormal readings on those scans may indicate the presence of tumors.
As mentioned above, sciatic nerve pain symptoms can include weakness along the legs, urinary problems, and/or incontinence. These may indicate a serious medical condition, particularly if they occur suddenly. The most likely culprit would be cauda equina syndrome, a severe compression of the bundle of nerves at the end of the spine. The American Association of Neurological Surgeons notes that cauda equina syndrome “most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.”
Why is cauda equina syndrome so serious? Because this kind of nerve compression can quickly lead to permanent nerve damage, including long-term paralysis and incontinence. If you’ve developed suddenly weakness in your legs or find yourself suffering from urinary problems after developing leg or back pain, see a medical professional immediately. Prompt surgical treatment is necessary in order to prevent long term problems.
What Treatment Options are Available for Sciatic Nerve Pain?
If you find yourself concerned about potential complications from and interventions for sciatic nerve pain, take heart! According to JAMA, “Approximately 80% to 90% of people with sciatica recover over time without any surgical intervention.” Harvard Medical School seconded that, stating, “The best medicine is often patience — with some stoicism mixed in — because the pain often goes away, even if the problem disk does not. Researchers have found that the pain usually improves within a month. No one is quite sure why the pain subsides on its own, but it does.”
But is there anything you can do other than grit your teeth, grind out a smile, and wait for the discomfort to subside? Absolutely. Over-the-counter painkillers such as ibuprofen or naproxen often help. Harvard Medical School also recommends exercise of basically any type. Running, dancing, swimming, weightlifting (within reason), yoga, Pilates — all can help alleviate sciatic nerve pain. So does strengthening your core (i.e., torso) muscles, avoiding slouching, and trying not to sit for long periods.
Sometimes sciatic nerve pain doesn’t go away, and surgery may be the best option in such cases. As reported by UPI, a recent study in the New England Journal of Medicine demonstrated that patients with chronic sciatica who underwent surgery had a 70 percent greater chance of having their symptoms improve over the space of six months. Because the underlying issue with most sciatic nerve pain scenarios is a damaged disc, the two most common procedures are a discectomy and/or a laminectomy. The doctors at The Spine Center have extensive experience with these procedures and will happily answer any of your questions regarding them.
Common Myths Debunked
Most American adults will experience lower back pain at some point during their lives, and a fair percentage of those will have to manage sciatica symptoms. Unfortunately, as tends to happen with common maladies, a number of myths regarding the nature of sciatic nerve pain have taken root. For instance, some people say that leg pain without lumbar pain doesn’t constitute sciatic nerve trouble. (It very much can.) Others maintain that staying bed bound is the best course of treatment. In reality, exercise almost always helps. Still others say that once you have sciatic nerve pain, you’re stuck with it for life. That simply isn’t true.
While some patients face truly unfortunate cases, most can realize a substantial improvement in or elimination of their sciatica. In addition to multiple world-class procedures, The Spine Center specializes in patient education. Call us at (847) 628-8147 to learn how we can help your sciatic nerve pain.