What Is Sciatica? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Sciatica is a medical term used to describe nerve pain along the path of the sciatic nerve — the longest and thickest nerve in the human body, extending from the back of the pelvis down through the back of the thighs to just below the knees. (1,2,3,8)
Sciatica is a common manifestation of lumbar (or lumbosacral) radiculopathy, which refers to any disorder affecting the nerve roots in the lower back, often including the sciatic nerve. The terms sciatica and lumbar radiculopathy are sometimes used synonymously, though sciatica may also be referred to as lumbosacral radicular syndrome, nerve root pain, and nerve root entrapment. (4,5,6,7)
Up to 40 percent of adults in the United States experience sciatica at some point in their life. It most often affects people who are in their forties or fifties. (8)
Research suggests sciatica resolves spontaneously (without treatment) for most people, but others experience chronic (long-lasting) sciatica that may require medical intervention, such as physical therapy, spinal injections (for pain), or surgery. (8)
The hallmark symptom of sciatica is pain that radiates from the lower back down the buttock and back of one thigh. Sciatica usually only affects one side of the body at a time, but it can also occur along both sides, depending on where the nerve is affected along the spinal column. (2,3)
But sciatica pain can vary widely from person to person. It may: (2,3,9)
Sciatica pain may worsen: (1,9)
Sciatica originates from an issue with the sciatic nerve, a large nerve that provides innervation and physical sensations to various parts of the skin and muscles of the legs and feet. (10)
The sciatic nerve is made up of five nerve roots — two from the lumbar spine (lower back region) and three from the sacrum (the final section of the spine). These nerve fibers converge to form a left and right sciatic nerve, which run down the two sides of the body to the back of the knees. The sciatic nerve then branches into other nerves that continue down into the legs, feet, and toes. (2,10)
Sciatic pain is primarily caused by an injury to the nerve in your lower back region, such as from irritation, inflammation, pinching, or compression of the nerve.
The most common cause of sciatica is a herniated disc in your spine that puts pressure on the sciatic nerve roots. Some research suggests up to 90 percent of sciatica cases stem from herniated discs. (2,7)
Other spinal issues may also cause sciatica, including: (2,8)
Yet there are also other mimickers of lumbar radiculopathy that can produce sciatica-like symptoms, called nondiscogenic sciatica, and other non-spine-related injuries to the sciatic nerve, such as: (2,8,20,21)
There is no singular test that can diagnose sciatica. Instead, diagnosis is based on symptoms (and medical history), a physical examination, and imaging and other tests.
The physical exam, with special attention to your spine and legs, is an important part of the sciatica diagnostic process.
Your doctor will conduct a series of physical examination tests that will probe your muscle strength, nerve pain, reflexes, and flexibility. These tests aren’t perfect but may help to differentiate potential causes of your sciatica and may reveal if you have: (1,22)
The physical exam incorporates a number of different leg and foot tests that can help try to differentiate the potential cause or causes, including: (11)
During this physical exam, your physician will also see if you have any difficulty bending your foot, walking on your toes, or bending forward and backward. (1)
They may also order a number of tests, including any of the following: (2)
However, some experts only recommend these tests if your problem lasts for at least 12 weeks or if you have progressive numbness or weakness or worsening pain. The tests are not recommended for people who have nonspecific low back pain. (11)
Research shows most people with sciatica get better without medical intervention.
In fact, some reports suggest about 80 to 90 percent of people with sciatica get better over time — most often within a few weeks — without surgery. (2,9)
There is no consensus in the scientific literature regarding sciatica prognosis.
A study published in 2018 found that 55 percent of participants with back-related leg pain improved after a year. The research also showed that two factors — a longer duration of leg pain and patients believing their sciatica would persist — were associated with a poorer prognosis. (12)
In a separate study, researchers found that as much as 8 percent of participants with severe disc-related sciatica showed no signs of recovery five years after receiving either surgery or six months of conservative (physical therapy) treatment. (11, 13)
Results suggest that some patients continued to experience symptoms at five years out that fluctuated over time despite treatment.
A systematic review of patients that underwent spine surgery for sciatica, published in 2016, similarly showed that some people still experience sciatica symptoms and significant impact on their function five years after undergoing surgery. (14)
Because sciatica is usually self-resolving, initial treatment is palliative in nature.
Treatment options to relieve sciatica pain include: (1,2,3,15)
If these practices are not effective, your physician may recommend: (2,7,8,15,16)
Integrative, complementary, and alternative treatments may also help provide relief. These may include chiropractic treatments, yoga, acupuncture, deep tissue massage, and biofeedback. (2,7,15,23) Each has its own potential benefits, risks, costs, and levels of evidence for treating forms of sciatica. It’s best to speak to your primary physician or integrative medicine-informed physician or specialist to help guide which therapies may be used alone or in conjunction with your mainstream treatment plans.
Your physician may recommend surgery if you have chronic sciatica, sciatica that does not improve from other treatments, or symptoms that are worsening.
The specific type of surgery you receive depends on the cause of your sciatica. One technique, for example, is a minimally invasive procedure called microdiscectomy to remove fragments of a herniated disc. (2,8)
Some research suggests cannabis could help relieve chronic sciatic pain. For instance, a study published in 2018 found that marijuana may help relieve chronic nerve pain by modulating the connections in the brain involved in processing pain. (17)
Learn More About Sciatica Treatments
It’s not always possible to prevent sciatica. Risk may be reduced with exercise and maintaining a strong core.
Chronic sciatica, with or without surgical intervention previously, may lead to a few different complications, including: (2,3)
If the nerve is seriously damaged, it could lead to foot drop or drop foot, in which you’re unable to lift the front of the foot. Foot drop makes normal walking impossible and falls more likely. (2,18)
Research suggests 10 to 40 percent of people experience sciatica in their lifetime.
Most people get it in their forties, and sciatica rarely occurs before age 20 unless a traumatic injury is involved. Some other risk factors may include:
Depression, low socioeconomic status, and poor movement during work may also lead to an increased chance of chronic or recurrent sciatica. (2,7,15)
Because a number of conditions produce sciatica-like symptoms, sciatica may be misdiagnosed as another condition or disease (and vice versa). Conditions similar or related to sciatica include: (8,15,19)
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