Sciatica Symptoms and Diagnosis
Sciatic pain can be relatively straightforward to identify because it runs along the sciatic nerve — and the pain can be unlike anything you have ever felt.
The sciatic nerve is the longest and widest nerve in the body, running from the lower back, through the hip area and down each leg all the way to the feet.
Sciatica is pain along the sciatic nerve caused by compression. Symptoms of sciatica can include any or all of the following:
For the most part, sciatica only affects one side of the body at a time.
The pain of sciatica can be mild or severe and can range from an ache to a sharp pain. It may feel like a jolt or feel excruciating. Sitting for too long — or even sneezing — can exacerbate the pain.
“The majority of sciatica cases are caused by nerve compression, which is most commonly caused by herniated disks in the low back,” said Neel Anand, MD, a professor of orthopedic surgery and the codirector of spine trauma surgery at Cedars-Sinai Medical Center in Los Angeles.
Though disk herniation in that area of the spine is quite common, it will only cause sciatica symptoms about 5 percent of the time, Dr. Anand says.
“These symptoms can occur anywhere along the pathway of the sciatic nerve and may include pain, numbness, tingling, and muscle weakness in some cases,” Anand says. “For most people experiencing sciatica, the pain is often described as sharp, searing, electric-like, or shooting.”
Other possible causes of sciatica include spinal stenosis, or narrowing of the spinal canal, bone spurs, and, rarely, spinal tumors, infections, and vascular disease.
There are several factors that may put you at risk of experiencing sciatica. These include the following:
For the most part, diagnosing sciatica is fairly simple, requiring only a physical exam and a description of your symptoms, when and how they started, how long you have had them, and what worsens or relieves them.
To assess your condition your doctor may also check your reflexes using a reflex hammer and move your legs in various ways while you lie on the exam table.
If it appears you have sciatica, many physicians will take a conservative approach and suggest you wait a few weeks to see if the pain clears up.
If the pain persists, a doctor will likely order imaging tests to make sure the pain is, in fact, due to sciatica. Potential causes of sciatica, such as herniated disks or bone spurs, will show up on MRI scans, computed tomography (CT) scans, or X-rays. Typically, your doctor will start with an X-ray because they are quick, low-cost, and able to show major abnormalities of the spine.
Your doctor may also test the functioning of your muscles and nerves using electromyography. This test involves inserting a fine needle into various muscles to record the electrical activity of your muscle fibers when they are contracted and at rest.
In the nerve conduction portion of electromyography, small electric shocks are sent through the nerves to measure how fast they conduct electricity and to determine whether there is damage to the nerves.
Any of these tests can help determine what is causing your pain.
Praveen Prasad, MD, a neurosurgeon with Dignity Health Mercy Medical Group in Sacramento, California, says people who think they are experiencing sciatica should see their primary care doctor.
“Often, patients will research and find that sciatica related to nerve pain and think that they should see a neurologist,” Dr. Prasad says. But that’s often not necessary.
A primary care doctor, much like a neurologist, can order an MRI, recommend physical therapy, or assist with pain management.
About 5 to 10 percent of people with sciatica will have disabling pain or weakness and numbness that does not improve with conservative treatment. Those people will be referred to a neurosurgeon, who can perform microsurgery or recommend steroid injections to alleviate the pain.
Although the pain and other symptoms of sciatica can be hard to cope with, the good news is that they typically resolve for most people in about six weeks.
But sciatica can recur. People who have experienced sciatica in the past and know what the pain feels like may not require extensive testing if it happens again.
Even if you do have to undergo imaging tests and the like, most people do not need surgery for sciatica, says Stephen Tolhurst, MD, an orthopedic spine surgeon at the Texas Back Institute in Flower Mound.
“Physical therapy, medication, and epidural steroid injections are all effective, nonoperative treatments that can help improve pain and function,” Dr. Tolhurst says. “If these treatments fail — or in rare cases where there is severe weakness, numbness, or pain — surgery can substantially and durably improve sciatic pain.”
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