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Sciatica Pain in the Back or Legs Has Many Possible Causes

Man waking up with back pain

It may start with pain radiating down from the lower back, and can also lead to tingling or weakness in the leg. These symptoms are all related to irritation, inflammation or compression of the sciatic nerve, or sciatica.

The sciatic nerve is the longest and largest nerve in the body, and is made up of five different root sources in the lower back (lumbar spine) and the lowest part of the spine that connects to the pelvic, or the sacrum. The sciatic nerve runs from the lower back down through the hips, buttocks and upper leg. So sciatica can result from trauma at any point along this nerve or its nerve roots.

What Causes Sciatica?

While sciatica is a recognized medical diagnosis in itself, it can also be thought of as a symptom with many possible causes, explains Michael Schaefer, MD, chief of Physical Medicine and Rehabilitation at University Hospitals.

The most common causes include herniated discs and spinal stenosis (narrowing of the spinal canal) in the spine. These conditions can cause compression or irritation of the nerves in the spinal canal.

Other causes include:

  • Spondylolisthesis, or when a vertebra slips out of alignment in the spine
  • Injuries or trauma to the lower back, hip joint, sacroiliac joint (connecting the hip to the sacrum), or back of the thigh
  • Osteoarthritis of the spine
  • Piriformis syndrome, which causes the piriformis muscle that lies across the back of the hips to spasm or tighten
  • Tumors in the lumbar spinal canal or pelvis

Sciatica symptoms include mild to severe pain in the lower back, hips, buttocks or leg. The pain may get worse when coughing, sneezing or sitting for long periods of time. Another symptom that may suggest sciatica is foot drop, when you are unable to hold your toes or foot up at the ankle. Sciatica can also cause numbness, tingling or weakness, which can be a sign of nerve damage.

In the majority of cases, sciatica symptoms will go away on their own. You should seek medical intervention if the symptoms persist after two weeks, or if you experience signs of nerve damage. A typical case of sciatica will usually last eight weeks or less.

Sciatica Treatment, from Home Remedies to Surgery

At-home treatments include over-the-counter pain medications (such as Advil or Tylenol), ice and heat packs, maintaining good posture and using a supportive chair.

If sciatica symptoms do not go away on their own, you should seek care from a medical professional. Your doctor will go over your medical history and perform a physical exam. They also may order tests such as an X-ray or magnetic resonance imaging (MRI) scan of the spine, pelvis or hips. If nerve damage is suspected, your doctor may perform electromyography (EMG), which uses small needles to measure how long it takes the nerve to conduct electrical activity from the muscles.

Depending on the severity and location of the symptoms, recommended treatments may include:

Physical therapy or chiropractic care. Often used as a first-line treatment for sciatica, a physical therapist, physiatrist or chiropractic doctor can provide manual therapy, exercise programs and other methods to reduce pain and increase mobility. 

Medications, such as anti-seizure medications, anti-inflammatory medications and antidepressants to help control sciatica pain. Doctors aren't exactly sure why antidepressants help with pain, but one theory is that they affect the neurotransmitters in your spinal cord that send pain signals to the brain. These medications are often prescribed in combination with each other and with other therapies and are very safe and effective.

Dr. Schaefer notes that opiates do not work for nerve pain, so they are not usually prescribed. Oral corticosteroid medications are the most effective, but they have more serious side effects so they are only used for severe cases.

Cortisone injections. Administered as an epidural injection into the low back, the joints or along the nerve root to decrease inflammation and reduce pain

Surgery. Less than 10 percent of people with sciatica need surgery, typically if there’s nerve damage, such as with a severe pinched nerve. Procedures include:

  • Lumbar laminectomy: Removes the back part of the vertebrae in the lower back to create space in the spinal canal
  • Lumbar discectomy: Removes disc material that is bulging to relieve pressure on the nerve
  • Implanted nerve stimulators: Used as a last resort when patients don’t respond to other therapies or surgery, these implants provide low intensity electrical stimulus that interrupts painful nerve signals.

Sciatica is a very common condition that in most cases resolve with non-surgical management, and many options exist for pain control. Dr. Schaefer stresses that it is important to seek care from a medical professional if symptoms persist, especially if you notice signs of nerve damage. With early detection, conservative treatment is more likely to be effective without the need for surgery.

Related Links

University Hospitals offers expert diagnosis and treatment for pain related to acute injuries, trauma and chronic conditions, including sciatica and the conditions that may cause it. Our spine and physical medicine and rehabilitation specialists have experience in treating pain and mobility issues related to these conditions and helping improve quality of life for patients.