Is My Pain Sciatica or Something Else?

Sciatica--pain along the large sciatic nerve that runs from the lower back down the back of each leg--is a relatively common form of low back pain and leg pain. However, the term sciatica is often misused, and patients may try to self-diagnose and self-treat the wrong cause of their sciatica or they may not actually have sciatica.

This newsletter busts some of the common myths about sciatica and gives an overview of its symptoms, causes and treatment options.

Sciatica is a set of symptoms, not a cause of pain

The term sciatica literally means that a patient has leg pain from compression on the sciatic nerve. The diagnosis is what is causing the compression (such as a disc herniation in the low back). Sciatica is used to describe pain in the lower back, in the rear, down the back of the leg, and maybe even into the foot, usually only on one side of the body. It could also be accompanied by numbness, tingling and burning/prickling. Severity of sciatic pain can range from infrequent and irritating to severe and debilitating, experienced as a shooting pain or a constant pain, usually most painful in the leg, which gets worse when sitting. See Sciatica and the sciatic nerve for more on sciatic symptoms and nerve anatomy.

There are many conditions that feel like sciatica, but are treated differently

Sciatica is often referred to as any type of leg pain, but in fact there are many causes of leg pain that are not classified as sciatica and need to be treated differently. Sciatica occurs when the sciatic nerve is irritated or compressed by a problem in the low back, thus sending pain from the sciatic nerve down to the buttock and sometimes down the back of the leg. However, many other problems can also cause pain down the leg, including:

• Joint problems, such as arthritis, can also refer pain from the joints into the leg, but this is not sciatica and the treatment is different. For arthritis, the focus is on conservative treatments that preserve motion and reduce pain long term and usually include prescribing anti-inflammatory drugs (such as COX-2 inhibitors) to reduce joint inflammation. Read also COX-2 inhibitors: Celebrex and Bextra information.

• Leg pain can also be caused by piriformis syndrome, where the piriformis muscle irritates the sciatic nerve. This condition is more common in women than in men. See also Piriformis syndrome--another irritation to the sciatic nerve.

• Another cause of leg pain that can feel like sciatic pain is sacroiliac joint dysfunction. The sacroiliac joint is at the very base of the spine, and too much motion or too little motion in this joint can cause pain that radiates down the leg like sciatica. This condition is also more common in women than in men. See also: What is sacroiliac joint dysfunction?

Sciatica is difficult, and potentially dangerous, to self-diagnose

Given the multitude of conditions that can cause sciatic pain, it is imperative to meet with a doctor for the appropriate diagnosis. Although rare, sciatica can be caused by a tumor or infection, or may be accompanied by progressive weakness in the legs or bladder/bowel incontinence, all of which need to be treated right away. Most cases aren't serious but still require medical intervention for a correct diagnosis and the right set of treatment options. Common causes of sciatica include a lumbar herniated disc, lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis. For more on these and other possible causes of sciatica, see What you need to know about sciatica and The truth about sciatica.

Treatments are specific to the individual and the cause of their sciatic pain

Getting a correct diagnosis for the cause of the pain is important because this determines the appropriate treatments.

• Short term relief often takes the form of 1-2 days of rest, ice/heat therapy and pain medications to reduce inflammation and pain, such as NSAIDs or prescription oral steroids. See Sciatica first aid for a more thorough discussion of these short term treatments. For a severe episode of pain, epidural steroids may be injected directly into the painful area around the sciatic nerve to decrease inflammation. While the relief tends to be temporary (may be only a few weeks), injections can usually provide enough pain relief to allow a patient to make progress with an exercise program. See Epidural steroid injections for more information.

• Mid-term treatments may include some combination of manipulation (e.g. by a chiropractor, osteopath or appropriately trained physical therapist), physical therapy and exercise. Surgery may make sense if symptoms don't improve after 6-12 weeks of non-surgical treatment and if a patient's pain and ability to do regular activities are at an unacceptable level. A microdiscectomy may be considered if the sciatic pain is caused by a disc herniation. A lumbar laminectomy (open decompression) may be advised for sciatica pain that waxes and wanes over many years due to lumbar spinal stenosis. You can find more about these procedures and their success rates in What you need to know about sciatica.

Exercise is usually better for healing sciatic pain than rest

Beyond the first few days after the onset of sciatic pain, it's almost always best to avoid bed rest in favor of gentle exercise. Inactivity weakens the back muscles and spinal structures, which can lead to back strain and injury and thus additional pain. Moderate exercise is typically recommended for long term relief of most sciatic pain--and is especially critical for ongoing spinal disc health. Again, the specific underlying cause of the sciatic pain is key to developing the most appropriate and safe exercise regimen. See Sciatica exercises for stretching and strengthening exercises for the most common causes of sciatica.

Final thoughts

Although sciatica can be very painful and debilitating, it rarely results in permanent damage. Most sciatica pain episodes result from inflammation and will get better within two weeks to a few months. For longer or more intense episodes of sciatic pain, the good news is that there are numerous treatment options available depending on the specific cause. If your back and/or leg pain doesn't seem to fit the description for sciatica, check out Common causes of back pain to see what else may be going on. Regardless of the cause, it's important to see a spine specialist to get a proper diagnosis and to arm yourself with reliable and understandable information, such as on Spine-health.com, for your path to rehabilitation and recovery.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President
Spine-health.com

Editor's Notes:

• Readers responded in overwhelming numbers to the newsletter survey in late February! Thank you for your feedback.

• Clarification from the February newsletter, which incorrectly stated that Wellbutrin and Zoloft have the same active ingredients. The correct brand names should have been Wellbutrin and Zyban.

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com.The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.