Sciatica Symptoms

For some people, sciatica pain can be severe and debilitating. For others, the sciatica symptoms might be infrequent and irritating, but have the potential to get worse.

Usually, sciatica only affects one side of the lower body and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg.

Common Sciatica Symptoms

Low back pain may be present along with the leg pain, but typically the leg pain is markedly more severe than the low back pain.

Some combination of the following symptoms is common:

  • Lower back pain, if experienced at all, is not as severe as leg pain
  • Constant pain in only one side of the buttock or leg, but rarely both the right and left sides
  • Pain that originates in the low back or buttock and continues along the path of the sciatic nerve - down the back of the thigh and into the lower leg and foot
  • Pain that feels better when patients lie down or are walking, but worsens when standing or sitting
  • Pain that is typically described as sharp or searing, rather than dull
  • Some experience a "pins-and-needles" sensation, numbness or weakness, or a prickling sensation down the leg
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  • Weakness or numbness when moving the leg or foot
  • Severe or shooting pain in one leg that may make it difficult to stand up or walk
  • Depending on where the sciatic nerve is affected, the pain and other symptoms may also include foot pain or pain in the toes.

Sciatica Symptoms for Each Nerve Root

There are two nerve roots that exit the lumbar spine (L4 and L5) and three that exit the sacral segment (S1, S2 and S3).

All five nerves bundle together to form the sciatic nerve, and then branch out again within the leg to deliver motor and sensory functions to specific destinations in the leg and foot.

Sciatica symptoms vary based on where the compressed nerve root is located. For example:

  • L4 nerve root sciatica symptoms usually affect the thigh. Patients may feel weakness in straightening the leg, and may have a diminished knee-jerk reflex.
  • L5 nerve root sciatica symptoms may extend to the big toe and ankle (called foot drop). Patients may feel pain or numbness on top of the foot, particularly on the "web" of skin between the big toe and second toe.
  • S1 nerve root sciatica affects the outer part of the foot, which may radiate to the little toe or toes. Patients may experience weakness when raising the heel off the ground or trying to stand on tiptoes. The ankle-jerk reflex may also be reduced.

Since more than one nerve root may be compressed, patients may experience a combination of the above symptoms.

Sciatica Symptoms That Require Immediate Attention

Rarely, sciatica symptoms that worsen quickly may require immediate surgery. The following symptoms indicate a need for immediate medical care:

  • Symptoms that continue to get worse rather than improve, which may indicate possible nerve damage, especially if the progressive symptoms are neurological (such as weakness).
  • Symptoms that occur in both legs (called bilateral sciatica) and cause either bladder or bowel incontinence or dysfunction, which may indicate cauda equina syndrome. Cauda equina syndrome is an acute compression of one or several nerve roots that occurs relatively rarely (in approximately 2% of herniated lumbar disc cases).1

Patients should seek immediate medical attention if they experience any of the above symptoms.

References

  1. Winters ME, Kluetz P, Zilberstein J, "Back Pain Emergencies," Medical Clinics of North America, 2006:90:505–23.
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