Sciatica Explained: Your Complete Guide


Download PDF

What Exactly is Happening in Your Body?

Your sciatic nerve is the longest and thickest nerve in your body - about as wide as your thumb in some places. When this nerve gets irritated or compressed, it sends pain signals along its entire pathway. Sciatica isn't actually a diagnosis itself, but rather a symptom of an underlying problem affecting this important nerve. Let's explore what this means for you in practical terms.

Sciatic nerve path

Detailed Symptoms: What You Might Experience

Pain Characteristics:

Sciatica pain points
  • A sharp, electric shock-like sensation
  • Pain that's typically worse in the leg than in the back
  • Discomfort that follows a predictable path (buttock to thigh to calf)
  • Pain levels that fluctuate based on position and activity

What makes the pain worse?

  • Sitting for long periods (especially on soft couches)
  • Sudden movements like coughing or sneezing
  • Bending forward or twisting of the back
  • Extended periods of standing
  • Carrying heavy objects

Underlying Causes: What's Irritating Your Sciatic Nerve?

Lumbar Herniated Disc

1. Lumbar Herniated Disc (Most Common):

The jelly-like center of a spinal disc leaks out. This material presses directly on nerve roots causing irritation.

Degenerative Disc Disease

2. Degenerative Disc Disease:

Natural aging causes discs to lose hydration, resulting in reduced disc height and more friction. This can cause spurs to develop, impinging on the nerves.

Spinal Stenosis

3. Spinal Stenosis:

Narrowing of the spinal canal. This is particularly problematic when bending backward and is more common in the elderly.

Piriformis Syndrome

4. Piriformis Syndrome:

The sciatic nerve runs directly beneath the piriformis muscle. When this muscle spasms, it causes irritation and pain running down the nerve.

Spondylolisthesis

5. Spondylolisthesis:

One vertebra slips forward over another, creating instability and nerve compression. This may develop gradually or after injury.

Diagnosis: What to Expect at the Doctor's

Doctor examining patient

Your healthcare provider will likely:

1. Take a Detailed History

Your doctor will ask about your symptoms, their onset, and what makes them better or worse.

2. Perform Physical Examination

  • Straight leg raise test
  • Muscle strength assessment
  • Reflex testing
  • Sensory evaluation

3. Order Imaging (If Needed)

  • X-rays: To check bone alignment and look for bone spurs.
  • MRI: The best imaging for soft tissue details, especially useful for disc issues.
  • CT scan: An alternative if MRI is not possible or contraindicated.
  • EMG (Electromyography): For suspected nerve damage and to differentiate between nerve root and peripheral nerve issues.

Comprehensive Treatment Approaches

Physical therapy for back pain

First-Line Conservative Treatments:

  • Activity Modification: Learning movement patterns that reduce irritation on the sciatic nerve.
  • Targeted Physical Therapy: Typically 2-3 sessions per week initially, focusing on strengthening and stretching.
  • Medication Management:
    • NSAIDs (ibuprofen, naproxen) for inflammation.
    • Muscle relaxants for spasms.
    • Neuropathic agents (gabapentin) for nerve pain.
    • Short-term oral steroids for severe cases to reduce inflammation.
  • Home Remedies:
    • Ice packs (acute phase) to reduce swelling and pain.
    • Heating pads (chronic stiffness) to relax muscles and improve blood flow.
    • Lumbar support cushions for better posture while sitting.
Spinal injection

Interventional Options:

  • Epidural Steroid Injections: Delivers anti-inflammatory medicine directly to the affected area around the nerve roots.
  • Nerve Root Blocks: More targeted injections that focus on a specific nerve root causing pain.
  • Radiofrequency Ablation: For chronic cases, especially if pain is due to facet joint arthritis; uses heat to deactivate nerve fibers.

Practical Self-Care Strategies

Movement Tips:

  • Walk short distances frequently to keep the spine mobile.
  • Avoid both prolonged sitting and standing; alternate positions often.
  • Sleep in the fetal position with a pillow between your knees to align your spine.
  • Use your legs (not your back) when lifting objects to protect your spine.

Workplace Adjustments:

  • Set your computer monitor at eye level to prevent neck strain.
  • Use a footrest if needed to maintain proper posture.
  • Take micro-breaks every 30 minutes to stand up and take short walks.
  • Consider a sit-stand workstation to vary your posture throughout the day.

Helpful Exercises:

  • Gentle knee-to-chest stretches to decompress the lower back.
  • Pelvic tilts to mobilize the lower back and strengthen core muscles.
  • Piriformis stretches (seated figure-4) to release tension in the piriformis muscle.
  • Core stabilization exercises to support the spine and prevent future episodes.

When to Seek Immediate Care

Contact your doctor right away or go to the ER immediately if you notice:

  • Sudden severe weakness in your leg or foot.
  • Numbness in the "saddle area" (groin and inner thighs).
  • Loss of bladder or bowel control.
  • Pain that keeps worsening despite rest and conservative measures.

Prevention: Keeping Your Back Healthy

  • Maintain strong core muscles through regular exercise.
  • Practice proper posture, especially when sitting or lifting.
  • Stay active with low-impact exercises like swimming or walking.
  • Use lumbar support when driving or sitting for extended periods.
  • Manage stress, as tension can worsen muscle tightness and pain.

Living Well With Sciatica

While sciatica can be incredibly painful, remember:

  • It's rarely permanently damaging.
  • Most cases resolve with time and proper care.
  • You have multiple treatment options available.
  • Small daily adjustments can make a big difference in managing your symptoms.