Sciatic Nerve Pain

Sciatic nerve pain is a burning and stabbing pain that can be felt in the back, buttock, hip, back of the leg, and foot on one side of the body. It is also known as sciatica or lumbar radiculopathy.

The sciatic nerve is the body's longest nerve. It originates in your lower back and runs behind your legs. Compression or irritation of the nerve root in the lumbar spine or the nerve anywhere along its path can cause sciatic nerve pain and other symptoms in the lower body.

This may be due to a herniated disc (slipped disc) or spondylolisthesis (slipped vertebra), among other causes.

This article will detail the typical symptoms, common causes, and evidence-based treatments associated with sciatic nerve pain.

What Does Sciatica Pain Feel Like?

The hallmark symptom of sciatic nerve pain is pain that travels (radiates) from the low back down one side of the body. It might be described as aching, stabbing, shooting, sharp, shock-like, or burning pain.

The symptoms of sciatica can vary greatly from person to person. Depending on the degree of sciatic nerve compression, the location and intensity of these symptoms can differ.

Some of the most common complaints are:

• Low-back pain that travels into the buttock and back of one thigh
• Radiating pain from your buttock to your foot and toes in one leg
• Numbness or pins-and-needles sensations in the lower leg
• Sudden or progressive weakness in one of your legs
  

In some individuals, sitting or standing too long irritates their condition. Others experience the most symptoms while trying to rest at night. Some people with sciatica complain of pain when straining or holding their breath.

Coughing or sneezing can also trigger sciatica pain. It is often worse when flexing the lower spine forward, twisting, or bending.

Sciatic Nerve Pain Location

Sciatic nerve pain and associated symptoms are typically felt on only one side of the body. Only one spinal nerve root or nerve is usually affected.

The pain radiates along the path of the sciatic nerve on that one side to the following:

• Lower back
• Buttock
• Hip
• Back of thigh
• Below the knee
• Foot
• Toes

A couple of significant indicators of sciatica are that the leg pain is worse than the back pain, and the leg pain is felt below the knee.

What Causes the Sciatic Nerve to Flare Up?

Several different issues can cause sciatica to develop. A herniated disc in the low back commonly compresses the sciatic nerve and leads to symptoms.

The most common underlying causes of sciatica pain are:

• Herniated disc in the lumbar spine: The intervertebral (between vertebrae) disc is composed of rubbery cartilage, which can bulge out and impinge on the spinal nerve roots.
• Lumbar spinal stenosis: Spinal stenosis is a narrowing of the spinal canal, which can compress the spinal cord and spinal nerve roots. This is a cause common in older people.
• Spondylolisthesis: A vertebra has slid forward or backward out of alignment.
• Muscular spasm or inflammation in the pelvis or lumbar region, including piriformis syndrome (spasm of the piriformis muscle in the buttock)
• A mass: This may appear on or near the spine.
• Pregnancy: Weight gain and shifting of where weight is carried can lead to pressure on the spinal nerve roots.

While anyone can get sciatic nerve pain, the condition is most prevalent in men between 30 and 50 years old.

How to Treat Sciatic Nerve Pain

In most instances, sciatica is a self-resolving condition that improves gradually with conservative interventions. Your healthcare provider may recommend one of several treatments meant to help alleviate your symptoms. These commonly include: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen), Aleve (naproxen), or aspirin
• Heating or icing the affected area
• Keeping moving and avoiding bed rest
• Gentle aerobic exercise, like walking, to help alleviate the pain
• Stretching exercises targeting the low back, hip, and buttock muscles
• Physical therapy, which will be individualized to address your specific underlying cause and needs
• Spinal injection with corticosteroids

In 80% to 90% of cases, sciatic symptoms diminish after a few weeks without the need for surgery. In rare instances, however, a surgical procedure may be necessary to treat your nerve pain. This typically involves undergoing a laminectomy or a discectomy procedure.

This surgery usually reduces sciatica symptoms, particularly in the leg. That said, one systematic review found that most people never experience a full resolution of their pain or disability after the operation. 

Are There Tests to Diagnose the Cause of Sciatic Nerve Pain?

Several different tests are typically used to diagnose sciatic nerve pain. Among the most common are:

• A physical exam: This is usually the first step in diagnosing the problem. During this evaluation, your healthcare provider may have you perform different movements or ask you to manipulate your leg in various ways. This helps identify which nerve roots are involved.
• X-ray: Since this type of imaging displays the body’s bones, it can be useful for diagnosing sciatica-causing arthritis or bone spurs (bony growths) in the spine.
• Magnetic resonance imaging (MRI): An MRI displays the body’s soft tissue structures and helps identify problems with a spinal disc or muscle.
• Electromyography (EMG): EMG is often used to assess how the sciatic nerve functions. During this test, a fine needle is inserted into a muscle, and the electrical activity in the area is evaluated. This can help the provider identify the origins of your sciatic nerve pain.

Sciatica pain may be classified in four types, as follows:

• Neurogenic sciatica has its origins in compression of a nerve or spinal nerve root.
• Referred sciatica means that the pain is being produced due to a muscle or joint problem and the pain is instead felt in the area served by the sciatic nerve.
• Alternating sciatica means that the pain is felt first on one side of the body and then on the other. Arthritis of the sacroiliac (SI) joint that connects the spine pelvis may produce this type.
• Bilateral sciatica means pain is felt in both legs and the buttocks. This is uncommon. It may occur when more than one herniated disc is present or there is more extensive disc degeneration.

When to See a Healthcare Provider

Any new or worsening pain in the back, leg, or foot should be evaluated by a trusted healthcare provider. This is especially true if you have progressive numbness, tingling, or weakness in any of these areas.

In addition, the following symptoms should be immediately evaluated for cauda equina syndrome:

• Urinary or fecal incontinence
• Urinary retention
• Sexual dysfunction
• Sensory disturbances in the saddle region (anus, genitals, buttocks)

Summary

Several issues can cause sciatic nerve pain, most commonly a herniated spinal disc. The condition can lead to pain, numbness, and tingling that originates in the low back and shoots down the back of one leg.

Sciatica usually resolves over the course of several weeks and is treated with medication, stretching, physical therapy, and aerobic exercise. In rare instances, a laminectomy or discectomy surgery may be needed to alleviate the pain.