Sciatica 101: Why Nerve Pain Shoots Down the Leg (and What Helps)

Sciatica is a common term used to describe nerve pain that travels down the leg from the lower back. While often used as a diagnosis itself, sciatica is actually a symptom of an underlying issue affecting the sciatic nerve or the nerve roots that make it up. Understanding the causes, symptoms, and various treatment options available can help you navigate this often debilitating condition.

Imagine your spinal cord as a main highway for nerve signals, and the nerve roots branching off it as exit ramps leading to different parts of your body. The sciatic nerve is the longest and thickest nerve in your body. It’s formed by several nerve roots exiting the lower part of your spinal cord, specifically from the lumbar (L4-S3) and sacral regions (S1-S3).

Once formed, the sciatic nerve travels down through your buttocks, along the back of your thigh, and then branches into smaller nerves that go all the way down to your foot. When something presses on or irritates one of these nerve roots in the lower back, it can cause pain, numbness, tingling, or weakness anywhere along the path of the sciatic nerve – this is what we call sciatica.

It’s important to differentiate sciatica from general back pain. While back pain often remains in the lower back, sciatica typically manifests as symptoms radiating into the buttock, thigh, calf, or foot. Occasionally, both back pain and leg pain can occur together.

The Sciatic Nerve’s Journey

To better understand sciatica, let’s trace the path of the sciatic nerve:

Origin: Nerve roots from the L4, L5, S1, S2, and S3 levels of the spinal cord.
Path through the pelvis: These roots converge to form the sciatic nerve, which then passes through the piriformis muscle in the buttock.
Down the leg: It continues down the back of the thigh, often splitting into two main branches (the tibial nerve and the common peroneal nerve) above the knee.
To the foot: These branches then supply sensation and muscle control to the lower leg and foot.

Any compression or irritation along this extensive pathway, but most commonly at its origin in the lower back, can lead to sciatica.

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Common Causes of Sciatica

Sciatica is usually caused by something putting pressure on or irritating the sciatic nerve roots in the lower back. Think of it like a garden hose: if something kinks the hose, the water flow (nerve signals) gets disrupted, causing issues further down the line.

The most frequent culprits include:

Herniated Disc (Slipped Disc)

This is by far the most common cause. Your spine is made up of bones called vertebrae, separated by soft, gel-filled cushions called intervertebral discs. These discs act as shock absorbers. If the outer layer of a disc tears, the soft inner gel (nucleus pulposus) can push out – or “herniate” – and press directly on a nearby nerve root.

For example, a disc herniation at the L5-S1 level (the lowest part of your lumbar spine) can compress the S1 nerve root, leading to sciatica symptoms down the back of your leg and into your foot.

Spinal Stenosis

Spinal stenosis refers to the narrowing of the spaces within your spine, which can put pressure on the spinal cord and the nerves that travel through it. This narrowing can occur in the central spinal canal or in the foramina (the smaller openings on either side where nerve roots exit).

Causes of stenosis: This is often a degenerative condition meaning it develops over time due to age-related changes like bone spurs (osteophytes) and thickening of ligaments (ligamentum flavum). Arthritis in the spine can also contribute.
Symptoms: With stenosis, the narrowing can squeeze the nerve roots, leading to sciatic symptoms. Often, symptoms are worse when standing or walking and improve when sitting or leaning forward.

Spondylolisthesis

Spondylolisthesis is a condition where one vertebra slips forward over the vertebra below it. This slippage can happen due to a fracture in a small bone segment (pars interarticularis) or as part of a degenerative process. When a vertebra slips out of alignment, it can narrow the spaces where nerves exit, leading to compression and sciatica.

Piriformis Syndrome

The piriformis muscle is a small muscle located deep in your buttock, connecting your sacrum (a triangular bone at the base of your spine) to your thigh bone. The sciatic nerve usually runs underneath this muscle. In some people, the sciatic nerve passes through the piriformis muscle. If the piriformis muscle becomes tight, inflamed, or goes into spasm, it can compress the sciatic nerve, causing symptoms similar to sciatica. This is often called “piriformis syndrome” and is technically not a “true” sciatica originating from the spine, but it mimics it very closely.

Less Common Causes

While the above are the most frequent causes, other conditions can also lead to sciatica, including:

Spinal tumors: Although rare, growths in or near the spine can press on nerve roots.
Spinal infections: Infections can cause inflammation and swelling that compress nerves.
Trauma: Injuries to the spine from accidents or falls can sometimes lead to nerve compression.

Recognizing the Symptoms

The symptoms of sciatica can vary greatly from person to person, depending on which nerve root is affected and how severely it’s compressed. Think of it like tuning a radio: sometimes you get clear static, other times it’s a garbled mess, and occasionally the signal is completely lost.

Classic Pain Characteristics

The hallmark symptom of sciatica is pain that radiates from your lower back, through your buttock, and down the back of one leg. This pain can be described in many ways:

Sharp, burning, or searing: Often feels like an electric shock or a hot poker.
Shooting: Pain that travels quickly down the leg.
Dull ache: Can also have a constant, deep ache.
Stabbing: Intense, localized pain.

The pain typically affects only one side of the body, although in rare cases, severe bilateral (both sides) sciatica can occur, usually indicating a more significant spinal issue.

Other Accompanying Symptoms

Beyond pain, you might experience other neurological symptoms along the path of the affected nerve:

Numbness: A loss of sensation, feeling like your leg or foot “fell asleep.”
Tingling (“pins and needles”): A prickling or buzzing sensation.
Weakness: Difficulty moving your foot or toes, or a feeling of your leg “giving out.” This can range from mild weakness to a significant “foot drop,” where you can’t lift the front part of your foot.
Muscle spasms: In the back or leg.

How Symptoms Can Be Affected

The severity and location of your symptoms can be influenced by various factors:

Sitting: Often worsens sciatica, as it increases pressure on the spinal discs.
Standing or walking: Can sometimes relieve but also aggravate symptoms, especially with spinal stenosis.
Coughing, sneezing, or straining: These actions can briefly increase pressure on the spinal nerves, causing a sudden jolt of pain.
Changing positions: Worsening pain when twisting or bending.

Safety Red Flags – When to Seek Immediate Medical Attention

While most cases of sciatica are not medical emergencies, certain symptoms warrant immediate evaluation by a qualified clinician. These are “red flags” that could indicate a more serious problem:

Sudden onset of severe weakness or numbness in both legs.
Sudden loss of bowel or bladder control (incontinence).
Numbness in the “saddle area” (groin, buttocks, and inner thighs).
Sciatica that follows a severe injury, like a car accident.
Rapidly worsening symptoms.
Sciatica accompanied by fever, chills, or unexplained weight loss (could indicate infection or tumor).

If you experience any of these symptoms, call your doctor or seek emergency medical care right away.

Diagnosing Sciatica: What to Expect

Diagnosing sciatica involves a thorough evaluation of your medical history, a physical examination, and often imaging tests. The goal is to pinpoint the exact cause of your nerve compression.

Medical History and Physical Exam

When you visit Dr. Moore, he will discuss your symptoms in detail. You’ll be asked about:

The exact nature of your pain: Where it starts, where it travels, what it feels like.
When symptoms started: How they have progressed.
What makes your symptoms better or worse: Specific activities or positions.
Other medical conditions: Past injuries or surgeries.

During the physical examination, Dr. Moore will:

Observe your posture and gait: How you stand and walk.
Test your range of motion: In your lower back and legs.
Perform neurological tests: This includes checking your reflexes, muscle strength, and sensation in your legs and feet. This helps identify which specific nerve root might be affected.
Specialized tests: Like the Straight Leg Raise (SLR) test, where you lie on your back and Dr. Moore lifts your leg. If this reproduces your sciatic pain, it’s often a strong indicator of nerve root compression in the lumbar spine.

Imaging Studies: X-rays and MRI

Imaging tests help visualize the structures of your spine and confirm the diagnosis.

X-rays

What they show: X-rays primarily show bone structures. They can reveal:
Bone spurs: Extra bone growth that can narrow the spinal canal.
Spinal alignment issues: Like spondylolisthesis.
Loss of disc height: Indicating disc degeneration.
Fractures or tumors: Though less common causes of sciatica.
Limitations: X-rays do not show soft tissues like discs, nerves, or muscles. So, while they can rule out certain issues or suggest others, they don’t directly show nerve compression from a herniated disc.

MRI (Magnetic Resonance Imaging)

The gold standard: MRI is often considered the most informative imaging test for sciatica.
What it shows: Unlike X-rays, MRI provides detailed images of both bone and soft tissues. It can clearly visualize:
Herniated discs: Showing how much material is bulging and if it’s pressing on a nerve.
Spinal stenosis: Clearly defining where the narrowing is occurring.
Tumors or infections: If present.
Inflammation: Around nerve roots.
How it works: MRI uses a powerful magnetic field and radio waves to create detailed cross-sectional images of your spine. It does not use ionizing radiation.
Necessity: An MRI is not always needed immediately for typical sciatica that is improving. However, it is usually ordered if conservative treatments aren’t working, if symptoms are severe or worsening, or if red flags are present.

Other Possible Tests

In some cases, other tests might be considered:

CT scan (Computed Tomography): Offers detailed bone images, similar to X-rays but with more detail, and can also provide some soft tissue information if an MRI is contraindicated.
Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests measure the electrical activity of nerves and muscles. They can help determine the extent of nerve damage and rule out other conditions that might mimic sciatica, such as peripheral neuropathy.

Dr. Moore will decide which tests are most appropriate based on your specific situation to ensure an accurate diagnosis.

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Treatment Paths: From Conservative to Surgical

Metric	Description	Typical Values/Range	Notes
Prevalence	Percentage of adults affected by sciatica at some point	5% – 10%	Varies by age and activity level
Common Causes	Underlying reasons for sciatic nerve pain	Herniated disc, spinal stenosis, piriformis syndrome	Herniated disc is most common
Pain Location	Typical path of sciatic nerve pain	Lower back → buttock → back of thigh → calf → foot	Follows sciatic nerve distribution
Symptoms	Common symptoms experienced	Pain, numbness, tingling, muscle weakness	Symptoms vary in intensity
Duration	Typical length of acute sciatica episodes	4 to 6 weeks	Chronic cases may last longer
Treatment Options	Common approaches to relieve symptoms	Physical therapy, pain medication, stretching, surgery (rare)	Most cases improve with conservative care
Effectiveness of Stretching	Impact of targeted stretches on pain relief	Moderate to high	Helps reduce nerve compression and improve mobility
When to See a Doctor	Signs indicating need for medical evaluation	Severe pain, weakness, loss of bladder/bowel control	Urgent care may be required

The good news is that most people with sciatica improve with conservative, non-surgical treatments. Think of it as trying to fix a leaky faucet – you try tightening it first before calling in a plumber for a major repair.

Conservative Care (Non-Surgical Options)

Initial treatment almost always focuses on conservative approaches to manage pain, reduce inflammation, and encourage healing. These typically include:

Rest and Activity Modification

Short period of rest: Lying down for a day or two can help alleviate acute pain. However, prolonged bed rest is generally not recommended as it can lead to deconditioning.
Avoid aggravating activities: Identify and temporarily stop activities that worsen your pain, such as heavy lifting, prolonged sitting, or twisting.
Stay active: Gentle movement, such as walking, is often beneficial as it helps maintain mobility and blood flow.

Medications

Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation.
Muscle relaxants: May be prescribed for muscle spasms.
Oral corticosteroids: A short course may be used to reduce acute inflammation around the nerve.
Neuropathic pain medications: For chronic or severe nerve pain, gabapentin or pregabalin may be considered.

Physical Therapy

Core strengthening: Exercises to strengthen the muscles that support your spine (abdominal and back muscles) help stabilize your spine and reduce stress on discs and nerves.
Stretching: To improve flexibility in the lower back, hips, and hamstrings, which can reduce pressure on the sciatic nerve.
Proper posture and body mechanics: Learning how to sit, stand, lift, and move safely to prevent re-injury.
Manual therapy: Techniques like massage, mobilization, or manipulation may be used by a physical therapist.

Injections

Epidural steroid injections: A corticosteroid and a local anesthetic mixture is injected into the epidural space (the area surrounding the spinal cord and nerve roots). This can significantly reduce inflammation and pain, providing a “window of opportunity” for physical therapy to be more effective. These are often performed under X-ray guidance for accuracy.
Nerve block injections: Similar to epidural injections, targeting specific nerves.

Lifestyle Modifications

Ergonomics: Adjust your workstation, chair, and car seat to support good posture.
Weight management: Excess weight can put additional strain on your spine.
Smoking cessation: Smoking can impair disc health and healing.

Surgical Intervention

Surgery is generally considered when conservative treatments have failed to provide relief after a significant period (typically 6-12 weeks), or if there are serious neurological deficits like significant muscle weakness, foot drop, or bowel/bladder dysfunction (red flags). The goal of surgery is to decompress (relieve pressure on) the irritated nerve root.

Dr. Moore offers a range of advanced surgical options, always prioritizing techniques that offer the best outcomes with the least invasiveness.

Minimally Invasive Spine Surgery (MISS) Techniques

Faster recovery: Smaller incisions, less muscle disruption, less blood loss, and often shorter hospital stays compared to traditional open surgery.
Reduced post-operative pain: Leads to an easier recovery.

Types of Surgical Procedures for Sciatica:

Microdiscectomy: This is the most common surgery for a herniated disc causing sciatica.
Procedure: A small incision is made, and a microscopic camera and specialized instruments are used to carefully remove the portion of the disc that is pressing on the nerve.
Benefits: Highly effective in relieving leg pain from a herniated disc, with a high success rate.
Laminectomy/Laminotomy: Used to treat spinal stenosis.
Procedure: A small part of the lamina (the bone forming the back of the spinal canal) is removed (Laminotomy) or a larger part (Laminectomy) to create more space for the spinal cord and nerves.
Decompression: Relieves pressure on the compressed nerve roots.
ProneTransPsoas (PTP): A specialized minimally invasive technique, often used for lumbar fusion or disc issues.
Approach: The patient is positioned on their stomach (prone), and the surgeon approaches the spine through the psoas muscle from the side, allowing for a less disruptive approach to the disc space for fusion or disc excision. This helps avoid major back muscles and bone removal.
Benefits: Very effective for certain types of disc problems and fusions, with improved patient recovery and reduced complications.
Ultrasonic Decompressions:
Technology: Dr. Moore utilizes advanced ultrasonic technology to precisely remove bone or disc material.
Benefits: This very precise method helps protect delicate nerve tissues by differentiating between hard and soft tissues, leading to safer and more effective decompression while minimizing collateral damage.
Spinal Fusion: Primarily used for conditions causing instability, severe spondylolisthesis, or persistent pain from disc degeneration that has not responded to other treatments.
Procedure: Two or more vertebrae are permanently joined together using bone graft and instrumentation (screws, rods) to stop motion and reduce pain.
Indications: Can be performed for various spinal levels, including cervical, thoracic, and lumbar.
Artificial Disc Replacement (ADR): An alternative to fusion for specific patients, usually in the cervical and lumbar spine, particularly for single-level disc disease.
Procedure: The damaged disc is removed and replaced with a prosthetic disc designed to preserve motion.
Benefits: Maintains more natural spinal movement compared to fusion, potentially reducing stress on adjacent discs.
Scoliosis Correction: For cases of adult degenerative scoliosis that are causing nerve compression and pain, Dr. Moore offers advanced surgical techniques to correct the spinal curvature and decompress the nerves.
Trauma Follow-Up and Corrective Surgery: For patients who have sustained spinal injuries, Dr. Moore provides comprehensive follow-up care and, when necessary, surgical correction to stabilize the spine and address nerve damage.

Dr. Moore will discuss all appropriate surgical and non-surgical options with you, explaining the risks and benefits of each, to help you make an informed decision tailored to your specific situation and health goals.

Frequently Asked Questions About Sciatica

Here are answers to some common questions about sciatica:

Can sciatica go away on its own?

Yes, in many cases, sciatica symptoms improve and resolve on their own within a few weeks with conservative care, such as rest, activity modification, and over-the-counter pain relievers. However, if symptoms persist or worsen, medical evaluation is important.

Is walking good for sciatica?

For most types of sciatica, gentle walking is beneficial. It helps improve circulation, strengthens core muscles, and can reduce stiffness. However, if walking aggravates your pain, it’s best to limit it and consult with your doctor or physical therapist.

What’s the best sleeping position for sciatica?

Many people find relief by sleeping on their side with a pillow between their knees to keep the spine aligned, or on their back with a pillow under their knees. Experiment to find what provides the most comfort for you.

How long does sciatica last?

Acute sciatica can last for a few days to a few weeks. If symptoms persist beyond 6 weeks, it’s often considered chronic sciatica. The duration depends on the underlying cause and how well it responds to treatment.

Can stretching make sciatica worse?

Yes, certain stretches can worsen sciatica depending on the cause. For example, aggressive hamstring stretches might exacerbate symptoms if you have a disc herniation. It’s best to consult a physical therapist for guidance on appropriate stretches.

What’s the difference between sciatica and piriformis syndrome?

True sciatica originates from nerve root compression in the lumbar spine (e.g., from a herniated disc). Piriformis syndrome is when the piriformis muscle in the buttock irritates or compresses the sciatic nerve. Both cause similar leg pain, but the source of the compression is different.

Seek Expert Care

If you are experiencing symptoms of sciatica, especially if they are severe, persistent, or include any of the red-flag symptoms, it is crucial to seek evaluation from a qualified clinician. An accurate diagnosis is the first step toward effective treatment and lasting relief.

Dr. Jeffrey A. Moore is a fellowship-trained Orthopedic Spine Surgeon in Oklahoma City, serving the OKC metro including Norman, Edmond, and Yukon. He is dedicated to providing compassionate, evidence-based care, from conservative management to advanced minimally invasive surgical techniques.

Take the first step toward understanding and alleviating your sciatic pain. Call us today at (405) 645-5475 to schedule an appointment, or book online at JeffreyMooreSpine.com. We also offer a FREE MRI review/2nd opinion service to help you understand your diagnostic imaging and discuss potential treatment paths.

CALL (405) 645-5475

FAQs

What is sciatica?

Sciatica is a condition characterized by pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. It typically affects only one side of the body.

What causes sciatica?

Sciatica is most commonly caused by a herniated disk, bone spur on the spine, or narrowing of the spine (spinal stenosis) that compresses part of the nerve. This compression leads to inflammation, pain, and often some numbness in the affected leg.

What are the common symptoms of sciatica?

Symptoms include sharp, shooting pain that radiates from the lower back down the leg, numbness or tingling in the leg or foot, muscle weakness, and sometimes difficulty moving the leg or foot.

How is sciatica diagnosed?

Diagnosis typically involves a physical exam and review of symptoms. Imaging tests such as X-rays, MRI, or CT scans may be used to identify the cause of nerve compression.

What treatments are available for sciatica?

Treatment options include physical therapy, pain medications, anti-inflammatory drugs, steroid injections, and in severe cases, surgery. Lifestyle changes such as exercise and proper posture can also help alleviate symptoms.

Can sciatica resolve on its own?

Yes, many cases of sciatica improve with self-care measures and time. Most people recover within a few weeks to months without surgery.

When should I see a doctor for sciatica?

You should seek medical attention if you experience severe pain, weakness, numbness, or loss of bladder or bowel control, as these may indicate a more serious condition requiring immediate treatment.

Are there ways to prevent sciatica?

Preventive measures include maintaining good posture, regular exercise to strengthen back and core muscles, avoiding prolonged sitting, and using proper techniques when lifting heavy objects.