Commonly known as a “pinched nerve,” sciatica nerve pain is a form of radiculopathy that can cause several potential spinal conditions. Here’s what you need to know.
Lower back pain is one of the most common long-term or chronic pain experienced by modern-day adults worldwide. As many as 4 in 10 Americans alone complain of sciatica nerve pain at some point in their lives, and for many, this pain can be recurring. Yet despite being so commonplace, sciatica nerve pain is also often misunderstood. There are myths and misconceptions around how it occurs, why it occurs, and how to treat it – causing many to go on with more pain, or more extended recovery periods, than necessary.
The good news about sciatica is that treatment is usually conservative, as with many other forms of lower back pain. You need only assist your body as it heals itself and feel the pain slowly go away. But that doesn’t mean it’ll always be like that. Preventative measures, healthy lifestyle choices and self-care can go a long way towards avoiding future pain episodes, managing pain in the long term, and winning back some much-needed quality of life in cases of chronic pain. Let’s explore how sciatica occurs, address a few common myths, and find out how to treat it together.
What Is Sciatica?
Sciatica is a condition caused by a compressed, pinched, or squeezed sciatic nerve towards the lower end of the spine. Sciatica itself is not a medical diagnosis. Instead, it is a term used to describe painful symptoms caused by an irritated or pinched nerve root. When a person experiences sciatica with origins in the spine, it isn’t that the whole nerve is being pinched. Rather, one or several nerve roots are being pinched, with symptoms depending on the specific root affected, as well as the severity of the condition.
To understand this better, picture the human spine. Each bone in the spine, or vertebrae, is labeled based on the different regions of the spine. The sacral and lumbar are the two lowest regions, from the tailbone to the last vertebrae beneath your ribs. The specific bones with sciatic nerve roots attached to them include:
The sciatic nerve is one of the longest nerves in the human body, originating near the spine around the hip level and radiating down the leg into the foot. Any or all of which could compress on these roots and cause pain, tingling, weakness, and several other strange or unpleasant sensations throughout the regions of the body innervated by the sciatic nerve. That is why there is a wide range of symptoms associated with sciatica, most of which are related to some unilateral (one-sided) pain, tingling, or weakness in the buttock, thigh, calf, or foot.
Understanding Sciatica Nerve Pain
Sciatic pain is most often caused by a form of radiculopathy, called lumbar radiculopathy. Radiculopathy is a pinched nerve. This, in turn, is caused by several different potential spinal conditions, including:
- Spinal stenosis: Spinal stenosis is the narrowing of the spinal canal, where the spinal cord is. This can lead to sciatica-like symptoms, including weakness and pain.
- Herniated disc: Herniated discs can occur due to injury, osteoarthritis, degenerative disc disease (DDD), or other causes. It can also lead to sciatica pain as the affected disc will press on the surrounding nerve roots.
- Bone spurs: Bone spurs can occur anywhere along the body, including the spine. These protruding bone growths can press on the surrounding nerves and induce pain.
All of these terms together can become very confusing. So, what chronic pain condition do you actually have:
- Herniated disc?
- Lumbar radiculopathy?
- Degenerative disc disease (DDD)?
In some cases, you can have all four at the same time. These terms are just different ways of explaining what’s going on in your body and why you’re feeling pain in one leg. It does not mean that you have four completely different, disconnected diagnoses. Your doctor can help explain exactly how they found out how each of these conditions plays a role in your case and how their treatment plan aims to address them all. Speaking of which…
How Is Sciatica Identified?
Sciatica is most reliably identified through the use of imaging technology. Medical tech has come a long way since the first implementation of the x-ray, but in many cases, x-rays still serve as the basis for diagnosing disease and determining damage. That being said, x-rays have a crucial weakness: they have a more challenging time imaging soft tissue because the rays themselves quickly pass through it. This is why x-rays are so essential in determining bone fractures and dental conditions.
For inflammation, pinched nerves, and other similar cases, a doctor may use x-rays in combination with other imaging tests to get a closer look at the surrounding area, including an MRI (magnetic resonance imaging) scan and computed tomography. Doctors can also use non-imaging tests to eliminate other potential causes for your leg pain and narrow the causes down to sciatica. They may do this because imaging tests can be expensive, and if sciatica can be ruled out through simpler testing, they can save you and your practice a lot of time and money. These tests include the slump test and the straight leg raise test.
Sciatica Nerve Pain Treatment Options
Treating sciatica conservatively (rest, cooling, compression) is usually the best, but complications and emergencies can still arise. Nerve pain can be dangerous, and while many people with sciatica might experience mild discomfort or pain in one leg for a few days, then have it subside on its own, many others can be faced with pain lasting weeks or months.
When sciatic pain becomes chronic, or when symptoms result in loss of bladder control, severe weakness, and extreme pain, it becomes crucial to see a medical professional as soon as possible. Doctors may have to remove a portion of the bone or disc, putting pressure on the nerve, to avoid paralysis and other complications in severe cases. In more mild cases, minimally-invasive procedures such as a corticosteroid injection or nerve block can help provide immediate relief during the condition’s worst days.
In the long-term, sciatica is treated and prevented through lifestyle adjustments and physical therapy to reduce pressure on the spine and surrounding nerves and strengthen the supporting muscles in the area. Pain management may also warrant the use of specific medication, from over-the-counter painkillers to anticonvulsants, muscle relaxants, opioid painkillers, and even antidepressants. Exact prescriptions and treatments always vary on a case-by-case basis.