What is sciatica?
Sciatica is pain that’s felt along the back of the leg following the sciatic nerve, often on one side of the body. The sciatic nerve is the longest and widest nerve in the body. At its widest point, it’s about the size of your thumb. It runs from the low back and travels through the pelvis, hip, and thigh to the knee before splitting and continuing down the leg as other named nerves.
Irritation of the sciatic nerve causes symptoms down the leg and can sometimes be accompanied by pain in the foot, hip, buttocks, or low back. These symptoms can feel like sharp, shooting, or burning pain. There can be a numbness or tingling sensation associated with it and possible leg weakness. For some individuals, this condition plagues them for months or years.
Not all radicular leg pain is considered sciatica. A proper diagnosis can be made by a clinician through history taking and physical examination. Numbers on the prevalence of sciatica vary due to the difficulty in properly identifying it as true sciatica. Although it’s estimated that between 10-40% of individuals will experience sciatica at some point during their life (1).
What causes it?
Sciatica is the term used to describe the pain in the back of the leg, but this doesn’t tell us anything about what is causing that pain. Sciatica is the symptom, not the cause.
Sciatica is caused by compression or irritation of the sciatic nerve and often accompanied by low back pain. The following are potential sources that cause compression/irritation:
- Disc herniation – Puts undue pressure on the lumbar nerves that combine to form the sciatic nerve.
- Bone spurs (stenosis) – Additional bone is placed down in the spine by the body either pathologically or due to the normal processes of aging. This leaves less room for nerves to glide, which then become irritated or compressed.
- Tight muscles – The muscles of the hip can become tight from activities such as prolonged sitting. Tight muscles are less pliable and can close down and compress the space the sciatic nerve travels through.
- Trauma to the nerve – A blow to the hip or leg from something like a car accident or sport may cause compression and irritation of the sciatic nerve.
- Poor ergonomics – Occupations and activities that put us in awkward positions for extended periods of time place stress on the sciatic nerve. If this occurs for long enough or often enough, symptoms may be produced.
- Age – Higher likelihood of bone spurs and disc herniations being present.
- Obesity – Increased stress is placed on the body resulting in a higher chance of sciatica.
- Occupation – As mentioned previously, jobs that put us in compromised positions for long periods of time can irritate and cause sciatica.
- Diabetes – This condition eats away at nerves over time, potentially affecting the sciatic nerve.
While sciatica can be an annoying condition, it’s usually quite benign. However, if symptoms are worsening, there is loss of feeling and weakness in the leg, or loss of bowel and bladder function, immediate medical attention should be sought.
What can be done?
Sciatica can be a difficult condition to treat because of its many potential sources. Properly identifying and treating the cause is critical for successfully treating sciatica. There are many treatment options available for those suffering from this condition. It is recommended that conservative care be utilized in the first 1-2 months of treatment (2).
Conservative treatment options include stretching, exercise, chiropractic/physical therapy, lifestyle changes, heat, ice, etc. Other options may involve medication or surgery, which should be considered as a last resort.
Patients who sought early physical therapy had improved outcomes compared to “usual care” of back pain education and advice to stay active (3). It is important to not let your sciatica linger and hang around.
“Patients with sciatica and suspected disc herniation who have a centralization response (decreased symptoms down the leg) to a mechanical evaluation will have significantly better outcomes. Patients who do not have centralization will be 6 times more likely to undergo surgery” (4). To read more on this check out our McKenzie blog.
One study showed surgery, specifically discectomies, to be effective short-term, but long-term was no more effective than conservative care (5). For the cost and invasiveness of these types of procedures, they are potential viable options after failing conservative care.
Pregabalin (Lyrica), a common pain med for nerve pain, was shown to be an ineffective treatment option for sciatica (6). Medication is not a recommended treatment option for those seeking relief from sciatica. We want to fix the problem to get rid of the symptoms as opposed to covering them up.
Our team has over 250 hours of combined training in McKenzie method, a proven treatment for sciatica. Call 515-421-4018, email firstname.lastname@example.org, or book online to meet with one of our practitioners about your sciatica.
- Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
- Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313–1317. https://doi.org/10.1136/bmj.39223.428495.be
- Fritz, J. M., Lane, E., McFadden, M., Brennan, G., Magel, J. S., Thackeray, A., Minick, K., Meier, W., & Greene, T. (2020). Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica. Annals of Internal Medicine. https://doi.org/10.7326/m20-4187
- Skytte, L., May, S., & Petersen, P. (2005). Centralization: Its Prognostic Value in Patients With Referred Symptoms and Sciatica. Spine, 30(11), E293–E299. https://doi.org/10.1097/01.brs.0000164119.78463.0c
- Valat, J.-P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), 241–252. https://doi.org/10.1016/j.berh.2009.11.005
- Mathieson, S., Maher, C. G., McLachlan, A. J., Latimer, J., Koes, B. W., Hancock, M. J., Harris, I., Day, R. O., Billot, L., Pik, J., Jan, S., & Lin, C.-W. C. (2017). Trial of Pregabalin for Acute and Chronic Sciatica. New England Journal of Medicine, 376(12), 1111–1120. https://doi.org/10.1056/nejmoa1614292
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