Sciatica describes persistent pain felt along the sciatic nerve. This nerve runs from the lower back, down through the buttock and into the lower leg. It is the longest nerve in the body. Pain results when this nerve is compressed or injured. It most commonly results from inflammation, bony enlargement due to arthritis or a displaced (herniated) disk in the lower spine.
Sciatica causes pain that begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain generally will feel dull, aching or burning. Sometimes, it starts gradually, worsens during the night, and is aggravated by motion. Sciatica also can cause tingling, numbness or muscle weakness in the affected leg.
Your doctor will review your symptoms and your medical history. He or she will want to know if you have low back pain that spreads to the leg and if you have muscle weakness in your leg or foot. Your doctor will also ask questions that might suggest a serious condition, such as a bone fracture or infection. He or she will want to know if you've had:
Your doctor will examine you, paying special attention to your spine and legs. To look for problems in your spinal column and related nerves, your doctor may ask you to perform a series of tests that will check your muscle strength, reflexes and flexibility.
The diagnosis is based primarily on your symptoms. The physical examination is important to look for weakness and loss of sensation in the leg. The exam might indicate another explanation for the symptoms. However, a normal physical examination is common in people with sciatica. While testing may be important in some cases, the diagnosis can be made even when all test results are normal.
Your doctor may send you for X-rays, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These tests check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve. These tests are most helpful to rule out other causes of symptoms or if surgical options might be considered.
Sciatica usually goes away on its own after a period of rest and limited activities. Most people with sciatica feel better within 6 weeks. Pain that lasts longer than 6 to 12 weeks should prompt a follow-up visit to your doctor. If symptoms are severe or prolonged, you may be referred to a doctor who specializes in treating back pain.
Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. Your doctor may refer you to a physical therapist to develop a personalized program. Here are some steps you can take in the meantime:
Sciatica usually can be treated successfully by a brief period of resting and limiting activity. Avoid prolonged bedrest that can actually make sciatica worse. Start gentle exercises to improve mobility and strengthen the back as soon as you can. If you are not making any progress, notify your doctor. Physical therapy can be helpful.
To ease inflammation around the nerve, your doctor may recommend that you alternate using hot and cold compresses.
You also may need to take acetaminophen (Tylenol) for pain, or anti-inflammatory drugs, such as naproxen (Aleve, Anaprox), ibuprofen (Motrin, Advil and others) or aspirin for pain and inflammation. Medications used to treat chronic nerve pain may be helpful. They include amitriptyline (Elavil, Endep) or gabapentin (Neurontin). In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. These injections typically are done in centers specializing in pain management. Other non-medication options, including chiropractic manipulation, acupuncture, massage and yoga can be helpful, though how well they compare to more conventional treatment is uncertain.
Rarely, surgery is required, such as when sciatica is caused by a bulging disc.
Contact your doctor if sciatica pain grows worse over a few days, or if it begins to interfere significantly with your daily activities. Call your doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. These symptoms may indicate that nerves leading to the pelvis are compressed. This condition can cause permanent damage if not treated promptly.
The vast majority of sciatica cases can be controlled with simple home care. For most people, basic preventive measures are enough to keep sciatica from coming back although it can be chronic or recurrent. Some people do require surgery for persistent pain or leg weakness.
American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd.
Rosemont, IL 60018-4262
National Institute of Arthritis and Musculoskeletal and Skin Diseases
1 AMS Circle
Bethesda, MD 20892-3675
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824