9 Myths About Sciatica
Separate the misconceptions about sciatica from the truth with this guide.
Sciatica is pain or numbness anywhere along the sciatic nerve — which runs from the lower spine, through the buttocks, and down the backs of the legs — caused by compression of the nerve.
The pain of sciatica can range from mild to excruciating, but in most cases it’s self-limiting, meaning it goes away on its own. Of course, while you have it, it feels like it’ll never go away.
What are some common myths about sciatica? And what’s the truth of the matter?
Fact: People commonly call sciatica a condition or a diagnosis, but it is really a symptom, indicating that something is irritating a nerve root in the lower back.
“The important thing is to decipher what is causing the pressure on the nerve,” says Peter Ottone, a chiropractor in Brick, New Jersey.
Fact: Ottone often hears from people who believe that any leg pain qualifies as sciatica, but that’s not true.
“Leg pain can be induced by vascular issues, muscle strains, cellulitis, or a different nerve being irritated, such as the femoral nerve, which would cause pain in the front of the leg,” Dr. Ottone says.
“A true sciatic symptom runs from the mid-buttock down the back of the leg, commonly past the knee and down through the calf.”
Fact: Sciatica occurs when the sciatic nerve becomes pinched or compressed, and that typically is caused by a bulging or herniated disk between the vertebrae in the lower spine.
It can also be caused by a bone spur, or bony growth, on the spine itself or by spinal stenosis, a narrowing of the spinal canal. In rare cases, a spinal tumor can compress the nerve, causing sciatic pain.
Fact: “People often think if they didn’t lift that suitcase, sit on a long flight, or help a friend move they would not have pain,” said David A. Spinner, DO, the director of pain management at White Plains Hospital in New York.
“Most of the time, the intervertebral disk has a small defect and is ready to herniate, and [the sciatica is] not necessarily caused from that specific event,” Dr. Spinner says.
According to Loren Fishman, MD, the medical director of Manhattan Physical Medicine and Rehabilitation in New York City, most people have isolated or, occasionally, repeating episodes of sciatica; it’s major when it happens, but overall it’s a minor part of their lives.
“After all, 80 percent of Americans have back pain or sciatica at one point or another, so it’s really part of being normal,” says Dr. Fishman.
While a specific event may not lead to sciatica, certain jobs may. One study found that physically demanding work is a strong risk factor for sciatica. For men, the jobs associated with higher risk included metal, machine, and other industrial work. For women, the risk was higher among nurses, sales workers, and industrial workers. (1)
Fact: “Most patients do better if they remain active and avoid excessive rest,” says Atul Patel, MD, a physiatrist at the Kansas City Bone and Joint Clinic, with locations in Kansas and Missouri.
Numerous studies have found that there is little to no benefit to staying in bed compared with staying active for people with sciatica. (2)
Fact: You might think that taking an analgesic or anti-inflammatory drug could ease the pain of sciatica, but in fact, a systematic review and meta-analysis found a lack of evidence of the efficacy of drugs including NSAIDs, corticosteroids, antidepressants, and opioid analgesics.
“There is at best only low-quality evidence to judge the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care,” the authors concluded. (3)
But short-term treatment with an anti-inflammatory or the antiseizure medication gabapentin (Neurontin) can be helpful for some people, the study notes. (3)
For people with persistent severe symptoms that don’t respond to analgesics or improve with activity modification, another treatment option is receiving epidural steroid injections — injections into the epidural space around the spinal cord.
But as Dr. Patel notes, “Epidural steroid injections are typically indicated for acute radiculopathy [pinched nerve root]. They do not typically help for chronic sciatica.”
Fact: Most cases of sciatica resolve within about six weeks and do not need surgery, says Stephen Tolhurst, MD, an orthopedic spine surgeon at the Texas Back Institute in Flower Mound.
Other treatments, including physical therapy and epidural injections, can be useful. But “if these treatments fail, or, in rare cases, where there is severe weakness, numbness, or pain, surgery can substantially and durably improve sciatic pain,” Dr. Tolhurst says.
Fact: “I commonly hear patients worry that there is no cure or that nothing can be done to improve their symptoms. I also hear patients worry that surgical treatment might not be successful,” Tolhurst says. “Fortunately, very high quality scientific studies have repeatedly shown that most symptoms improve and that, if needed, surgery is highly effective.”
Fact: Not all cases of sciatica can be prevented, but staying active — and using proper form during activities — can go a long way toward reducing the incidence and recurrence of lower back pain, according to Fishman.
Spinner adds that maintaining a strong core — that is, strengthening the muscles in your abdomen and back — can also help prevent sciatica recurrence.
Pilates is notable for increasing core strength and can be adapted to many health conditions, including sciatica.
Ottone adds a few more suggestions: “Sciatica can be prevented by practicing good posture, minimizing sitting, managing weight, maintaining good hamstring flexibility, and maintaining good spinal alignment.”
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