Back pain is the most common complaint among aging populations, and the lower back is one of the most injury-prone areas of the body. This has, in part, to do with our lumbar spine’s propensity for injury due to poor load-bearing, prolonged sedentary living, and the spine’s own slow wear-and-tear. It’s no wonder then that one of the most common complaints is sciatic nerve pain, caused by radiculopathy (a pinched nerve) among many forms of chronic pain. But what is sciatic nerve pain? Why is it so common? If it starts in the back, why is it felt in the legs? And how is it treated? Here, we’ll explore a few handy facts and myths surrounding sciatica.
What Causes Sciatic Nerve Pain?
The human body is both resilient and fragile in different ways. We possess tendons, muscles, and bones that allow us to support many times our own weight. But when it comes to pain and injury, it’s all about the weakest link. While the upper spine is protected by a myriad of structural supports, from a sturdy ribcage to a set of strong load-bearing muscles, the lower spine has much less support, mostly in the form of core musculature.
As a result, it usually endures the most strain due to poor posture both when resting and during activity (whether work or leisure). When the strain becomes too much, many things can happen. Herniated discs are the most common issue, wherein the spongey sacs that absorb impact and pressure between our bony vertebrae become herniated or ruptured. The resulting swelling and leakage places pressure on the many nerve roots surrounding our spine. The sciatic nerve – which attaches to the lumbar region – is one of the largest major nerves affected by this pressure.
Because it is situated close to the most injured discs in the human spine, the sciatic nerve is often impinged by a herniated or ruptured disc. As a result, sciatica can be serious, but it can also be relatively minor. While more serious than a simple strain, the body is quite adept at identifying sources of inflammation and pain and resolving them. Sometimes, however, that process goes awry. Therefore, it’s important to do your best to help your body before resorting to invasive interventions.
Bed Rest Is Not the Answer
Contrary to what you might think, just taking it easy isn’t really the best long-term strategy for lower back pain and sciatic nerve pain in particular. While this is highly context-based – and it’s definitely important to call your doctor, regardless of what kind of pain you might be experiencing – sciatica, in general, is best served by modest amounts of non-weighted exercise.
Lying on your back regularly is critical for spine health, but you should limit the amount of time you spend in bed each day. Getting good sleep can help your discs swell with water and promote repairs. But past a certain point (after an 8-hour sleep, for example), this swelling can exacerbate your sciatic nerve pain. Standing up helps slowly drain your discs and reduce swelling.
Lying on your back all day can also slow down healing and keep you from benefiting from a myriad of pain-relieving exercises and activities. If, however, you’re still in considerable pain, don’t try to force movement. Instead, take over-the-counter analgesics and anti-inflammatory drugs and ask your doctor for an all-clear.
Sitting Increases Pain and Discomfort
If bed rest isn’t the answer, you might be tempted to try and get some work in – but if that work means sitting at a desk, you should consider arranging for some alternative seating arrangements (like a standing desk). Sitting can worsen the pain, as it places a greater amount of strain on the lumbar region than lying down or even walking/standing.
That being said, too much standing or walking can induce a wave of pain as well. Seeking help with sleeping positions, pillow placements, stretching advice, and basic exercises for the core (like the plank and the bird dog) can help counteract some of the pain by relegating more and more strain and load the muscles surrounding the spine rather than the spine itself.
Core exercises that cause excessive spinal flexion (like sit-ups and certain crunches) should be avoided in favor of exercises that promote spinal stability. A healthy spine is more complex than simply doing more stretches, more exercises, and fewer sitting. A pain management and spine specialist can help you identify the best way forward for reducing and even overcoming sciatic nerve pain.
Stress Can Make It Worse
Yes, physical stress can make the pain worse (when too much stress is present), but we’re talking about mental stress, more specifically. Emotional and mental stress ties directly into physical stress, exacerbating symptoms and even inducing hyperalgesia because of depressive symptoms and excess stress. So if you’re going through a hard time emotionally as a result of your injury or pain, consider not only taking care of yourself physically but making your mental well-being a priority as well.
Not All Lower Back and Leg Pain Are Due to Sciatica
The sciatic nerve runs through the back and leg, which means that sciatic nerve pain can also occur in the:
- Lower back
- And between the toes
Pain through the quad muscle or hamstrings can also indicate sciatic nerve impingement, and you may not necessarily feel much pain in your lower back.
Invasive Sciatic Nerve Pain Treatment Is Rarely Needed
Sciatica is a condition that does resolve itself with appropriate help. Going to a doctor and a physical therapist and determining the proper course of action to help the body along and reduce pain without resorting to prescription painkillers can be highly effective – it just takes some time. However, when the pain isn’t subsiding, more invasive measures may be called for. For example, temporary nerve blocks, prescription medication, and corticosteroid injections to reduce the swelling of the disc can take a lot of pain and pressure off.
How to Recognize the Emergency Warning Symptoms
There are extreme cases when ignoring the pain and waiting for it to subside is not the right move. Not only should you always see your doctor if you suspect you’ve been injured or are struggling with sciatica, but there are certain warning signs and symptoms that require medical attention and emergency care. These include (but is not limited to):
- High-grade fevers.
- Sudden and rapid weight loss or nausea.
- Loss of bowel control or bladder control.
- Instantaneous increase in sharp pain and discomfort.
As mentioned previously, sciatica can range from mild to very severe, but it’s important always to see a professional if you are in pain.