Krina Vyas, MD
Krina Vyas, MD, a physiatrist with the Hospital for Special Surgery and assistant professor of clinical rehabilitation medicine at Weill Cornell Medical College, New York.
Sciatica is surprisingly common. According to a study published in 2020 in the Journal of the AAOS (the American Academy of Orthopaedic Surgeons), one-quarter of people on Medicare have been diagnosed with it. The condition isn’t limited to people over 65: It can happen at any age. Just what is sciatica and what can be done to ease its painful symptoms?
You have two sciatic nerves that run down either side of the lower half of your body, through your buttocks to your feet. Each is formed from a group of nerves that branch out on either side of the lower spine and come together to form two thick, long nerves.
When people experience sciatica, they may feel back pain accompanied by leg pain. The pain might feel dull, achy, shooting, or burning. You might also feel some numbness or a “pins and needles” tingling sensation. Usually only one side of the body is affected.
While the name sciatica means irritation of a sciatic nerve, the pain rarely starts with the sciatic nerve itself, but rather with one of the nerves from which it is formed. Typically, the cause is a pinched nerve or what’s called nerve root entrapment. The true medical term for sciatica is lumbar radiculopathy. It’s often called sciatica because the pain radiates along the sciatic nerve.
Depending on the location of the pinched nerve, you may feel pain only during certain activities or when you’re in certain positions—when you sit or stand, bend over, lift objects, or simply cough or sneeze. The degree of pain depends on the degree to which the nerve is being pinched.
If you have feelings of muscle weakness or numbness, especially severe numbness in the groin, along with bladder dysfunction or incontinence, seek emergency help right away. It could be a serious condition called cauda equina syndrome, which typically requires immediate surgery.
One of the chief causes of sciatica is having a herniated (“slipped”) disc. Discs are the cushions that sit between each of the vertebrae. An injury or bad body mechanics can lead to a tear in the outer ring of a disc, allowing its gel-like center to protrude and put pressure on the adjacent nerve root. A herniated disc can occur over time from wear and tear, or very suddenly as a result of a movement such as bending over the wrong way.
As you age, it’s also possible to experience spinal stenosis, a narrowing of the canal that houses the spinal nerves. This puts pressure on them and causes pain. While spinal stenosis can happen anywhere along the spine, the lumbar area is a common place.
Mild sciatica may go away on its own with self-care, such as resting, applying heat or cold packs, and taking over-the-counter medications such as a nonsteroidal anti-inflammatory drug or acetaminophen.
If you don’t get relief within a couple days, it’s a good idea to see a physiatrist, a doctor who specializes in musculoskeletal problems, or an orthopedist.
Many people muddle through their first bout of sciatica and wait to see a doctor until it happens again or becomes persistent. But over time, untreated sciatica can lead to poor sleep, being afraid to exercise, and even depression. There’s no reason to delay. By seeing a doctor, you’ll get relief as well as modifications in body mechanics that can help prevent a recurrence.
Physical therapy. A physiatrist or orthopedist will likely start with a conservative approach to treatment, such as physical therapy (PT). A course of six to eight weeks of therapeutic exercises, including ones you’ll do at home between PT sessions, is crucial to recovery. The goal is to strengthen your core and back muscles to improve mobility in your low back, hips and legs. Keep in mind that, although you may have some pain, moving through PT exercises won’t damage you physically.
Another important part of this therapy is learning better ergonomics. Your therapist can show you ways to move with greater ease and to prevent the repetitive motions that may have led to the problem. These include how to bend and lift properly, such as using the hip hinge when picking something up from the floor. You may also be shown how to modify movements to ease discomfort.
Complementary therapies can also help. Pilates is excellent because it focuses on developing core strength. Yoga improves stiffness and increases flexibility. A research analysis published in Evidence-Based Complementary and Alternative Medicine found that acupuncture may help ease sciatica pain because it has an analgesic effect, similar to pain-relief medication.
If these steps aren’t helpful enough, your doctor is likely to order an MRI to better identify the source of the problem and create a different game plan. Options include:
Injections. Epidural steroid injections may provide the relief you need. Some people respond to a single injection, while others need more than one to get through an episode of sciatica. Doctors must be well trained in administering these injections and proceed with caution because repeated use of steroids can cause tissue degeneration. It is recommended not to have more than three injections within a 12-month period.
Surgery. This is an option when all other treatments fail to relieve the pain from a disc herniation or stenosis, and when the pain is eroding your quality of life. There are various types of what’s called spinal decompression surgery available, depending on which nerve roots are affected. They can be helpful in easing refractory back and leg symptoms that have not responded to conservative management. But it’s important to have a candid conversation with an orthopedic surgeon to understand the benefits and the risks.
