If you’ve been looking for information on sciatica over the past few weeks, you aren’t the only one. The painful nerve condition has been searched for more this fall than at any other time in Google’s history.
“Sciatic occurs when the sciatic nerve — the largest nerve in the body that begins in the lower back — is irritated,” said Dr. Jennifer Caudle, associate professor at Rowan University.
In most cases, it isn’t the problem of the sciatic nerve but of the structures that contribute to the formation of the nerve, said Dr. Brian Cole, an orthopedic surgeon at Englewood Spine Associates. “The sciatic nerve is a large peripheral nerve that runs down the back of the legs,” said Cole. “Historically, because the symptoms traverse the pathway of the sciatic nerve, it was called sciatica.”
According to information from the American Academy of Orthopedic Surgeons (AAOS), sciatica is most likely to develop between 30 and 50. Almost 40% of all adults will experience sciatica, according to the Cleveland Clinic, although the condition rarely happens in those under the age of 20 unless it’s related to an injury.
Here, experts explain the risk factors, symptoms, and treatment options for this condition.
What are the signs of sciatica?
Pain that spreads from the lower back and then down one leg is one telltale sign that indicates you may be dealing with sciatica, not a different type of back pain, according to the Hospital for Special Surgery in New York City.
“The symptom of sciatica is typically pain down the back of the legs [usually one leg], which may be associated with numbness and tingling,” said Cole. The HSS reports the radiating pain can also start in the buttocks and be described as aching, dull, shooting, or burning.
The symptoms can worsen when lifting, bending, coughing, laughing, sneezing, or sitting down, according to Penn Medicine. In the most severe cases, symptoms can include muscle weakness, along with fecal or urinary incontinence.
What causes sciatica?
“The sciatic nerve can be irritated for several reasons, including a herniated disk,” explained Caudle. Also referred to as a slipped, ruptured, or bulging disk, it can be brought on by wear-and-tear on the lower spine brought on by age, as well as osteoarthritis. Other common causes include spinal stenosis or bone spurs, she said. Spinal stenosis is when the area inside the backbone is too narrow and puts pressure on the nerves that connect to the spine and the spinal cord.
Sciatica can occur in episodes throughout life, noted Cole. “As we age, the probability of sciatica shifts from herniated discs in the younger ages to spinal stenosis in the older ages,” he said.
Additional body weight (whether caused by pregnancy or obesity), Type 2 diabetes, tobacco use, and lack of physical activity, as well as experiencing a prior bone or muscle injury, are also contributing risk factors.
How can sciatica be treated?
To start, if you are experiencing sciatica symptoms, consult your doctor as soon as possible, particularly if you are experiencing extreme numbness or tingling, problems urinating or moving your bowels, or pain that travels below the knee.
If your pain is in the mild to moderate range, there is some good news. “For some people, sciatica will resolve on its own,” says Caudle. The AAOS says an ample amount of time and rest usually encourages the condition to continue to heal.
In the meantime, to ease the pain, Cole explained early treatment focuses on alleviating the problems of compression and inflammation. “We do this through initiating physical therapy, along with prescribing anti-inflammatory medications,” he said. “These can be highly effective in eradicating the symptoms.”
Applying ice packs, followed by heat, like a warm compress or heating pad, to the affected area can also offer relief, noted Caudle. Recommendations from Cleveland Clinic include using cold packs for around 20 minutes at a time throughout the day during the first 48 to 72 hours, then switching to heat beginning around day three.
While the typical workout routine is likely to be put on hold for a few weeks — along with lifting heavy items and twisting your back — and it’s crucial to rest, that does not mean completely eliminating regular movement. Since motion helps reduce inflammation, remaining in bed during the day can cause pain in other areas of the body, according to the AAOS. If your doctor hasn’t prescribed physical therapy, Caudle recommends gentle stretching exercises.
Alternative therapies, including acupuncture, chiropractic care, and massage therapy, can relieve pain. Additionally, Caudle suggests osteopathic manipulative medicine (OMM), a manual therapy that an osteopathic physician can perform.
If the pain isn’t subsiding and mobility is not improving after six weeks, Cole says healthcare providers may need to investigate further through imaging tests of the spine, including an MRI or X-rays. “Some people may elect for spinal injections, which is another route of administration of anti-inflammatory medication in a higher proportion to a specific area.”
According to the AAOS, up to 90% of people with sciatica feel better over time without having an operation. Surgery — including a laminectomy or laminotomy, in which part or all of the vertebral bone is removed surgically to relieve pressure on the nerve — would be the last resort.
“Surgery may be required when conservative care has failed, or there is a neurologic deficit such as weakness, atrophy of muscles or bower or bladder compromise,” said Cole.