Sciatica Causes, Symptoms, Prevention, and Treatment Options

Running from the spinal cord in the lower back all the way to the toes is the body’s largest and longest nerve, the sciatic nerve. This nerve connects the spinal cord with the buttocks, the hamstring muscles at the back of the thighs, and other muscles in the legs, enabling movement and feeling to the lower extremities. If the sciatic nerve becomes irritated or compressed, symptoms of radiating pain, numbness, tingling, or weakness can manifest along the nerve. Sciatica causes can include degenerative disc disease, spinal stenosis, and a variety of other degenerative spine conditions.

The Sciatic Nerve

The sciatic nerve is derived from a combination of five nerve roots—the fourth and fifth lumbar and the first three sacral nerve roots—and branches off from each side of the base of the spinal cord. Each of these nerve roots branches out between two vertebral segments and is named for the vertebra above it. For example, the nerve root which exists between the fourth and fifth lumbar segment (L4 and L5) is named the L4 nerve root. This collection of five nerve roots group together on the front of the piriformis muscle (a small muscle in the buttocks that rotates the leg outwards) to become one—the sciatic nerve. It then runs down the back of each leg, branching out to provide sensory functions to specific areas in the leg and foot. As previously noted, if the sciatic nerve is compressed or its nerve roots are damaged, radiating pain can occur along the nerve. Where the radicular pain travels depends on the location of the compression.

Sciatic pain generally radiates down one side of the body in the buttocks, the back of the thigh, and/or the calf. The pain can vary from a dull ache to sharp shooting pain. Often the pain starts slowly, but can increase in intensity. Additionally, it can cause a pins-and-needles feeling down the calf and in the sole of the foot. Along with nerve pain, numbness or weakness can occur in the lower extremities, creating difficulty in sitting and standing. Coughing, sneezing, laughing, or even walking can aggravate the symptoms of sciatica.

The Different Sciatica Causes

One of the many possible sciatica causes is a herniated disc. The spine is made up of numerous vertebrae and intervertebral discs which lie between adjacent vertebrae. The discs are made up of a strong outer wall called the annulus fibrosus, which surrounds a spongy, jellylike substance called the nucleus pulposus. The discs act as shock absorbers to cushion the vertebrae and prevent wear and tear on the spine. When the discs are healthy, they allow the back and neck to move in a fluid manner. However, if a disc herniates or ruptures, the annulus fibrosus can tear and the nucleus pulposus can leak into the spinal column. The leaking nucleus pulposus can put pressure on a sciatic nerve root and may cause pain or weakness in the affected extremity.

In addition to herniated discs, there are other spinal conditions that can cause sciatica, including:

Degenerative disc disease – Degeneration of the intervertebral discs is common as a person ages because, over time, the discs break down, lose water content, and dry out. Dried discs can bulge or herniate and may pinch the spinal cord or the sciatic nerve roots, which can lead to sudden pain or pain that gradually worsens over a period of time, among other symptoms.

Spondylolisthesis –This condition occurs if a vertebra slips forward over another vertebra. The subsequent dislocation can cause neural compression and can result in sciatica. Among adults, the most common cause of spondylolisthesis is degenerative disc disease. Symptoms of spondylolisthesis can include tight hamstring muscles, tenderness near the slipped vertebra, and nerve damage.

Piriformis syndrome – The sciatic nerve runs underneath the piriformis muscle, a small muscle located within the hip and buttocks region. If the piriformis muscle becomes tight or spasms, it can put pressure on the sciatic nerve and cause radiating symptoms down the leg. Other symptoms of this syndrome can include weakness, stiffness, and restricted movement. Athletes and people who sit for extended periods of time are prone to piriformis syndrome.

Spinal stenosis – Typically related to aging, spinal stenosis is a narrowing of the spinal canal that can result from a herniated disc, bone spurs, or osteoarthritis. Spinal conditions such as these can narrow one or more nerve canals in the spine, which can create compression forces on spinal nerve roots. Spinal stenosis can cause a dull ache or a sharp pain in the back or neck, or one that radiates to other regions of the body. The pain can be aggravated by motion such as twisting, standing, bending, or walking.

Less common sciatica causes can include inflammation from a muscle strain, trauma to the spine or injured nerve roots, a spinal or sciatic nerve tumor, or a lower back infection. Additionally, other conditions can lead to sciatic nerve problems such as a person’s occupation, age, medical conditions including diabetes or pregnancy, weight issues, and lack of exercise.

Sciatica Prevention and Treatment Options

Fortunately, there are a number of ways to help a person prevent sciatic nerve injury and sciatica. Preventative measures typically involve taking care of the body by practicing healthy habits, such as:

Exercising regularly. Strengthening and stretching exercises like yoga, low-impact aerobics such as swimming or walking, and exercise ball stretches can reduce stress on the abdomen and lower back muscles, which are essential to proper posture and spine alignment. Exercise will also help improve strength, flexibility, and range of motion.

Choosing seating with lower back support and keeping knees and hips level when sitting. Also avoid sitting cross-legged as that can put pressure on the sciatic nerve. If standing for long periods, lift one leg onto a footrest to relieve pressure on the spine’s lumbar region.

Sleeping on a mattress and foundation which offers support.

Using proper lifting techniques. Maintaining a healthy body weight.

For patients already experiencing symptoms of sciatica, there are a number of treatment options available, including conservative and alternative therapies. Consult with a doctor before starting any treatment plan.

The doctor may recommend conservative treatments such as hot and cold pack therapy, non-prescription medicines (ibuprofen, acetaminophen, and aspirin), and physical therapy exercises. Most patients generally respond to nonsurgical measures within a few weeks or months. If a patient is experiencing severe or debilitating pain, the doctor can recommend steroid injections and prescription medications to be used in conjunction with nonsurgical therapy.

Alternative treatment methods can also help relieve sciatica pain, including massage therapy. With gentle manipulation or deep pressure application, massage can increase blood circulation and relax tight muscles, which may relieve the sciatic nerve of pressure and help reduce inflammation.

Another alternative pain management option is acupuncture, a treatment that involves inserting thin needles into a patient’s skin near the area of pain. Needles typically remain in place for 15 to 30 minutes. This ancient practice centers on the philosophy of achieving comfort by opening the body’s flow of energy.

For those patients who don’t respond to conservative treatments such as anti-inflammatory medication, exercise, acupuncture, or steroid injections, more targeted surgical treatments may be necessary. A lumbar laminectomy can relieve pressure from the sciatic nerve by removing a portion of a lamina bone to create additional space for an intervertebral disc that is pinching the sciatic nerve. There are also minimally invasive endoscopic techniques that are alternatives to open spine surgery, including percutaneous endoscopic discectomy and endoscopic foraminotomy. These procedures involve the use of a laser to shrink and remove the affected disc material, and remove foraminal bone material, respectively. Consult with a health care provider or spine specialist to learn more about sciatica causes, symptoms, and available treatment options.