Sciatica is characterized by pain in one leg, usually radiating through the buttock and sometimes felt down into the foot. Sciatica is caused by the compression of the sciatic nerve, the largest nerve in the body. The duration of sciatica is determined by the cause, precisely the nature, and severity of the condition causing the compression. For example, spinal trauma may cause acute sciatica for some weeks until swelling has gone down enough for the pain to subside. On the other hand, some cases of sciatica are recurring over months and years due to a repetitive injury or a chronic cause.
Not all sciatica is causally related to the spine. Many cases are caused by other musculoskeletal conditions, such as muscle spasms, piriformis syndrome, and inflammation in the region near the nerve. In addition, because it is such a large nerve, there may be multiple compression points – although most of the time, the compression occurs near the root or the buttocks. Identifying why you are experiencing sciatica is key to determining how long it will take for the pain to subside.
Acute vs. Chronic Sciatica
The critical difference between an acute and chronic condition is time. Acute pain subsides as the source for the pain heals. Think of a mild burn or a cut on your finger. Chronic pain continues for weeks and months. Chronic pain is usually diagnosed after four months, or sixteen weeks, of recurring or constant pain.
The same metric applies to sciatic pain. Most cases include flare-ups and pain episodes lasting about four to six weeks. However, an estimated 20 to 30 percent of patients with sciatica continue experiencing sciatic pain for one to two years. The reason sciatica can persist depends on several factors. Sometimes, especially when pain is neurogenic, damage to the nerve can cause long-term pain.
Thus, even when the nerve heals, it may heal improperly and may continue to send errant pain signals to the brain. In other cases, the cause of the pain itself may be chronic and recurring. For example, damage to the discs between the vertebrae can lead to swelling, pressing on the nearby nerve roots. In addition, frequent physical stress can cause the swelling to return or cause a previously slipped disc to reoccur.
Diagnosing Sciatica
Sciatica is usually diagnosed through a physical exam and/or an imaging test. The characteristics of the condition – pain shooting down one leg, often starting in the buttocks or radiating through the leg – are enough to indicate sciatica. However, a diagnosis is still needed before any formal treatment can begin. And because sciatica is usually just a symptom of a different condition, the diagnosis is essential for determining where the pain is coming from and what might be causing it.
MRI or CT scans are usually used to identify sciatica. In these tests, a doctor will use different machines to look through the soft tissue in the back and buttocks to find signs of compression on the nerve, swelling, disc problems, or spinal issues. Both an MRI machine and CT scanners resemble a large tube or a frame. MRI machines utilize magnetic fields to stimulate the protons in our body and generate 3D imagery, while a CT scan uses x-rays and computer programs.
A physical examination can include the straight leg test (moving the leg through a range of motion while the patient is lying on their back to determine pain levels). The doctor will also ask about your medical history and family history to narrow down potential causes, ranging from a previous injury to signs of degenerative disc disease. Conditions that may cause sciatica or sciatic pain include:
Risk factors associated with sciatica include:
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- Obesity
- Smoking
- Manual labor
- Physical deconditioning
- Age (DDD is more common in older adults)
- Height (taller individuals are more prone to spine issues)
- Mental health (depression can exacerbate pain signals and lower the pain threshold)
These diagnostic tests will help doctors narrow down the causal condition and identify an effective treatment plan.
Sciatica vs. Similar Conditions
Pain in one leg is not always caused by sciatica. Instead, joint inflammation, from arthritis to bursitis, an injury to the ligaments in your joints (knee, hip, or ankle), and ankylosing spondylitis can cause one-sided leg pain. Other causes include deep vein thrombosis, gout, muscle cramps, peripheral neuropathy (often caused by diabetes), stress fractures, and more.
Treating Chronic Sciatica at Home
Sciatic pain can be treated partially at home. However, depending on the cause and severity of your sciatica, home remedies can often be enough to deal with the pain until it subsides. Effective home remedies include (but is not limited to):
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- Massage therapy: A good massage can release endorphins, promote blood flow in the lower back, release muscle tension, and give you both temporary natural pain relief, and actively help your body heal faster.
- Exercise and physical therapy: A simple exercise plan matched to your condition can help relieve pain by releasing endorphins, reducing stress on the back through increasing strength, and reducing the likelihood of recurring pain. That does not mean you should just hit the gym or start jogging, though. Instead, approach a pain professional about setting up a personalized home training plan.
- Hot and cold therapy: Both heat and ice can help relieve pain and improve healing, depending on the context. Ice is better for acute injuries, including a sudden flare-up. Meanwhile, heat can help reduce chronic sciatica and is more appropriate when the pain will not let up.
- Over-the-counter pain relievers: Anti-inflammatories and acetaminophen (paracetamol) may help reduce pain. Topical medication can help as well, including heat gels, camphor, or topical painkillers.
- Ergonomic interventions: While there is little evidence that posture alone can prevent back pain, posture may be essential to further pain once a pain condition has presented itself. You may want to relearn how to sit, stand, walk, bend over, and twist without exacerbating your sciatica or causing a flare-up.
Medical Treatments and Long-Term Pain Management
Sciatica treatments range from physical therapy to selective pain management interventions, such as nerve blocks and corticosteroid injections, to surgeries in cases of a severe spinal condition, where part of the bone or surrounding would have to be removed to reduce pain and prevent dangerous complications.
Treatment plans vary from patient to patient, even when the symptoms appear similar on the outside. If you have been experiencing one-sided leg pain or lower back pain for a while now, consider going to a professional. Bed rest and ibuprofen might not be enough to treat your underlying condition or address the source of the pain.
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