Sciatic Nerve Pain

The sciatic nerve is a large structure that originates in your lower back and runs down the back of your legs. Occasionally, nerve compression can cause pain and other symptoms in the lower body. This sciatic nerve pain is also known as sciatica or lumbar radiculopathy.

This article will detail the typical symptoms, common causes, and evidence-based treatments associated with sciatic nerve pain.

What Does Sciatica Pain Feel Like?

The symptoms of sciatica can vary greatly from person to person. Some of the most common complaints include:

• Low-back pain that travels into the buttock and back of one thigh
• Radiating pain from your buttock to your foot in one leg
• Numbness in the buttock, back of the thigh, or down the leg
• Sudden or progressive weakness in one of your legs

Depending on the degree of sciatic nerve compression, the location and intensity of these symptoms can differ from person to person.

In some individuals, sitting or standing too long irritates their condition. Others experience the most symptoms while trying to rest at night. Finally, some people with sciatica complain of pain when straining or holding their breath.

What Causes the Sciatic Nerve to Flare Up?

Several different issues can cause sciatica to develop. A bulged or herniated disc in the low back commonly compresses the sciatic nerve and leads to symptoms. Other potential causes include:

• Obesity
• A tumor, blood clot, or abscess compressing the nerve
• Poor posture when seated
• Pelvic Injury or fracture causing damage to the nerve
• The piriformis muscle pushing against the sciatic nerve (called piriformis syndrome)

While anyone can get sciatic nerve pain, the condition is most prevalent in men between 30 and 50 years old.

How to Treat Sciatic Nerve Pain

In most instances, sciatica is a self-resolving condition that improves gradually with conservative interventions. Your healthcare provider may recommend one of several treatments meant to help alleviate your symptoms. These commonly include: 

• NSAID (nonsteroidal anti-inflammatory drug) medication
• Heating or Icing the affected area
• Gentle aerobic exercise, like walking, to help alleviate the
  pain
• Stretching exercises targeting the low back, hip, and
  buttocks muscles.
• Physical Therapy
• Spinal Injection

In 80% to 90% of cases, sciatic symptoms diminish after a few weeks without needing surgical intervention. In rare instances, however, an operation may be necessary to treat your nerve pain. This typically involves undergoing a laminectomy or a discectomy procedure.

This surgery usually reduces sciatica symptoms, particularly in the leg. That said, one systematic review found that most people never experience a full resolution of their pain or disability after the operation. 

Are There Tests to Diagnose the Cause of Sciatic Nerve Pain?

Several different tests are typically used to diagnose sciatic nerve pain. Among the most common are:

• A physical exam: Usually the first step in diagnosing the problem. During this evaluation, your medical provider may have you perform different movements or manipulate your leg in various directions. This helps them identify which nerve roots are involved.
• X-ray: This type of imaging displays the body’s bones and can be useful for diagnosing sciatica-causing arthritis or bone spurring in the spine.
• Magnetic resonance imaging (MRI): An MRI displays the body’s soft tissue structures and helps identify issues involving a spinal disc or muscle.
• Electromyography (EMG): EMG is often used to assess how the sciatic nerve functions. During this test, a fine needle is inserted into a muscle, and the electrical activity in the area is evaluated. This can help the provider identify the specific origins of your sciatic nerve issue.

When to See a Healthcare Provider

Any new or worsening pain in the back, leg, or foot should be evaluated by a trusted medical professional. This is especially true if you have progressive numbness, tingling, or weakness in any of these areas.

In addition, any urinary or fecal incontinence, urinary retention, sexual dysfunction, or sensory disturbances in the saddle region (anus, genitals, buttocks) should be immediately evaluated. This is because these symptoms may indicate the presence of a more serious condition—called cauda equina syndrome (dysfunction in a number of nerve roots resembling a horse's tail in the lumbar region.

Summary

Sciatic nerve pain can be caused by several issues, most commonly a bulged or herniated spinal disc. The condition can lead to pain, numbness, and tingling that originates in the low back and shoots down one leg.

Sciatica usually resolves over the course of several weeks and is treated with medication, stretching, physical therapy, and aerobic exercise. In rare instances, a laminectomy or discectomy surgery may be needed to alleviate the pain.