Sciatica Causes and Treatment Options

by Anita Vijapura, M.D.

Sciatica Causes and Treatment Options

Sciatic pain is pain that you have as a result of irritation, inflammation, pinching, or compression of a nerve coming from your lower back. The sciatic nerve itself is the longest nerve in your body. It travels from your lower back all the way down through the hips, buttocks, and into the lower legs with branches going into your feet and toes.

True injury to the sciatic nerve is rare. We use the term sciatica more commonly to refer to the irritation, inflammation, or compression to any nerve in your lower back that causes pain or symptoms down your legs. Forty percent of people in the United States will experience sciatica at some point in their lives.

Pain in your lower back, hips, down the buttocks, or down the legs are the symptoms we typically hear. You may have numbness or weakness anywhere along the path of the nerve or some tingling pins and needles sensations. In rare but serious situations, you may experience loss of bowel or bladder control.

Sciatica itself can be caused by many conditions. Most commonly, we see a herniated or slipped disc in a patient’s back, which may be from a strain injury or natural wear and tear from changes that occur as we age. As a result of the herniated or slipped disc, the disc pushes forward and can compress the nerve as it leaves the spine. Even just narrowing of the nerve’s passageway by the slipped disc can put pressure on the spinal cord and surrounding nerves leading to pain in the neck and lower back, a condition called spinal stenosis.

Arthritis in your spine can also narrow the nerve’s passageway with bone spurs jutting out into that space. You can also develop sciatica from a tumor causing compression of the nerve or as a result of injury to the nerve or spine.

So, how do we treat sciatica?

In most cases, time and self-care treatments do the trick. These treatments include ice, heat, over-the-counter medications, and gentle stretching. Occasionally, if a little more help is needed, prescription medications can be taken. Anti-inflammatory, muscle relaxant, and nerve pain medications are often used.

Formal physical therapy evaluation and treatment is often beneficial to help loosen and maintain flexibility of the affected joints of your hip and lower back. Physical therapy also strengthens the core that stabilizes your spine. We use spinal injections to help with inflammation and swelling around those nerves. A typical injection we do is the epidural steroid injection. The steroid is a potent anti-inflammatory medication, and when injected around the nerve, it will help with inflammation, swelling, and pain. In certain cases, if injections aren’t working, we can try spinal cord stimulation, which delivers a mild electrical pulse to the nerves to interfere with the pain signals that are being sent to your brain.

In other cases, surgery may be the best option. If there’s true compression of the nerve, you will need a decompression or a relief of that pressure to make the nerve truly feel better.

Lastly, here are some tips to help reduce your risk of developing sciatica.

  • Maintain a good posture when sitting, standing, lifting objects, and sleeping. Good posture will help take pressure off of your spine.
  • Exercise regularly. Maintaining the flexibility in your joints and strengthening your core and muscles that surround your spine is incredibly important.
  • Maintain a healthy weight. Extra weight is associated with pain and inflammation which may make you more likely to develop sciatica, and of course, extra weight can impact the structures in your spine.
  • If your pain is unbearable, your mobility is limited, or you’re having bowel/bladder control issues, please go see your doctor to see if there are more serious causes or treatment options that could benefit you.

Frequently asked questions

My sciatic nerve pain has reduced, but my back still hurts. Is sciatica causing this pain?

It could be sciatica.

It could be something we call centralization. The pain is centralizing more to the spinal column, rib cage, neck, and skull. If you’re no longer having leg symptoms, the nerve could still be irritated. It could also be a handful of other things, so it is important to be properly evaluated to make sure there isn’t another problem causing your pain.

Can a certain chair cause sciatica?

If your posture is poor while you’re sitting in any chair, then yes, that can increase your risk of developing sciatica.

Unfortunately, there isn’t an easy fix if you already have sciatica and will be sitting in the car or on a plane for an extended period of time. One of the best things to help with sciatica pain is strengthening the muscles surrounding your spine, and that’s not a switch that can just be turned on. It takes time and work to develop that strength. But you have to start somewhere!

Try to always maintain good posture, and if you need a postural trainer (a device that helps you learn the habits of good posture), seek one out.

Are there exercises I can do to help relieve sciatica pain?

Absolutely. There are a wide variety of exercises.

It’s important to do gentle stretching, and physical therapy is one of the best things you can add to your regimen to help reduce sciatica pain. Our amazing physical therapy staff can provide you with numerous exercises and stretching routines.

Are there any sports or activities that cause sciatica?

No, there is no singular sport or activity that you need to avoid.

As long as you exercise regularly, maintain a proper weight, and maintain a proper posture during any activity, your risk of developing sciatica decreases.

Do massages help with sciatica pain?

Massages can help with the pain.

Sometimes, you have stiffening or spasm of the muscles. A massage can help ease that tension out. Those tense muscles can impact your physical therapy treatment, so loosening them out can help you really get the full effect of the physical therapy treatment.