Sciatica: Causes, Home Care and When to Be Seen

What it involves

MedlinePlus describes sciatica as pain, weakness, numbness, or tingling in the leg caused by injury to or pressure on the sciatic nerve. It stresses that sciatica is a symptom of another problem, not a condition by itself. The nerve starts in the lower back and runs down the back of each leg, so pain usually shows up on one side.

Who this is for

• Patients with back pain that travels into the buttock, thigh, or calf
• Patients with leg numbness, tingling, or a weak foot that catches when walking
• Patients whose back pain has lasted several weeks without improving
• Patients who want to know whether imaging, therapy, or a specialist is needed

What to expect

• Questions about where the pain travels, what brings it on, and what eases it
• A physical exam that checks leg strength, reflexes, sensation, and how you walk
• A plain explanation of the likely cause and which movements to keep doing
• A plan that may include medicine, an exercise program, or a referral for imaging or therapy

What can pinch the nerve

MedlinePlus lists the common causes of sciatica:

• A slipped or herniated disk in the lower spine
• Spinal stenosis, a narrowing of the space around the spinal nerves
• Piriformis syndrome, a pain disorder involving a narrow muscle in the buttocks
• Spondylolisthesis, where one spine bone slips forward over another
• A pelvic injury or fracture, or, less often, a tumor

How it feels

MedlinePlus says sciatica can feel like a mild tingling, a dull ache, or a burning sensation, and can be severe enough to keep a person from moving. It most often affects one side, and the pain or numbness may reach the calf or the sole of the foot. It may get worse after standing or sitting, at night, or with sneezing, coughing, or straining, especially when a herniated disk is the cause. Back pain without leg symptoms is covered in the low back pain guide.

Call or book promptly if

MedlinePlus says to contact your provider right away for any of these signs:

• Back pain with an unexplained fever, or after a severe blow or fall
• Weakness or numbness in the buttocks, thigh, leg, or pelvis
• Pain that is worse when you lie down or wakes you at night
• Loss of control of urine or stool
• Burning with urination or blood in the urine

What treatment usually looks like

MedlinePlus says that in most cases no surgery is needed and recovery comes with conservative care. That means over-the-counter pain relievers such as ibuprofen or acetaminophen, ice for the first 48 to 72 hours and then heat, and reduced activity for a couple of days before slowly returning to normal. It says bed rest is not recommended, that gentle back exercises should start early, and that heavy lifting or twisting should be avoided for the first six weeks after pain begins.

When testing or other treatment enters

MedlinePlus says tests are often not needed unless pain is severe or long-lasting. If they are ordered, they can include an x-ray, an MRI or other imaging of the spine, or blood tests. Physical therapy may help you learn an exercise program, and injections to reduce swelling around the nerve or medicines for nerve pain may follow if basic steps fail. Surgery is usually a last resort. Imaging and therapy are arranged through a referral, and the practice's joint injections page explains the injections it offers at two offices.

What to expect over time

MedlinePlus says sciatica often gets better on its own, but that it commonly returns. It also warns that, depending on the underlying cause, sciatica can lead to permanent numbness or weakness of the leg, which is one reason a pattern that keeps coming back is worth a visit. It adds that strong back and abdominal muscles help prevent it. If numbness or tingling is the main symptom, the numbness and tingling guide explains what a provider asks about.

Sources

• MedlinePlus — Sciatica
• MedlinePlus — Sciatica health topic