What Is Sciatica, and How Is It Treated?

Back pain is very common. Nearly 80% of people will have some form of back pain at least once in their lives. Sciatica is a specific kind of back pain that starts in the lower back and travels down the leg. It’s caused by a specific type of nerve damage. Read on to find out more about what sciatica is, how to know you have it, and what you can do about it.   

What causes sciatica?

Sciatica is a specific kind of back and leg pain caused by compression or irritation of the sciatic nerve. The sciatic nerve is the largest nerve in your body, and it comes from the lower end of your spinal cord, in the small of your back. As the nerve travels down the leg, it splits into the tibial and common peroneal nerves, which provide feeling and movement to the lower leg.

Sciatica can have many different causes. This is because anything that compresses your sciatic nerve as it exits the lower spine or courses down into your leg can cause sciatica. Some common causes include:

• Traumatic injury to the lower spine or pelvis can directly injure the sciatic nerve. A fracture can cause bone fragments, which may compress the nerve. 

• Herniation of the discs between the vertebrae in the lower spine can compress the sciatic nerve.

• Spinal stenosis, or narrowing of the space around the spinal nerves in the lower spine, can compress the sciatic nerve as it exits the spine. 

• Arthritis in the spine can cause sciatic nerve inflammation.

• Pregnancy can cause sciatica if the enlarging uterus compresses the sciatic nerve.

Less common causes include:

• Tumor growth near the lower spine or the sciatic nerve

• Infection in or near the spinal cord and spinal nerves

• Piriformis syndrome or compression of the sciatic nerve by the piriformis muscle, a muscle in your lower spine  

However, often it’s impossible to know the exact cause.

How is sciatica different from other back pain?

There are many different kinds of back pain, but sciatica is very specific. Because the sciatic nerve starts in the lower back and runs down the back of the leg, compression of the sciatic nerve leads to pain, numbness, tingling, or weakness in the lower back, buttocks, thigh, calf, or foot. These symptoms usually occur only on one side of your body.

Here are some other causes of back pain, along with some typical symptoms: 

• Musculoskeletal pain. This is often due to the straining or “pulling” of a muscle. A muscle strain may feel like sharp pain in your upper or lower back and may be worse with walking, bending, twisting, or changing position.

• Spinal stenosis. This happens when the spinal canal narrows. This narrowing can happen in your upper or lower back. When it happens in the lower back, common symptoms include back pain and shooting pains, numbness, or weakness in both legs. Spinal stenosis can lead to sciatica if the narrowing occurs near the origin of the sciatic nerve.

• Disc herniation. This refers to the displacement or bulging of a disc of padding between your vertebrae. When a disc bulges, it can compress the nerves exiting at that part of the spine. Depending on the location, this can cause pain, numbness, and tingling in your neck, back, arms, or legs. When this happens at the level of the sciatic nerve, it can cause symptoms of sciatica. Sometimes, depending on the size of the bulge, you may not notice any symptoms at all. 

• Trauma. Injury to the bones of the back can cause them to break. This is known as a vertebral compression fracture. These fractures can cause sudden and severe pain, usually in the middle of your back, that may worsen with standing or walking. Unless the injury occurred in your lower back and affected the sciatic nerve, the pain from a compression fracture would be unlikely to cause shooting pain, numbness, or weakness in your leg.

• Cancer. Different types of cancers can spread to the bones of the back or the spinal cord and cause back pain. Hematologic cancers, like multiple myeloma, can also damage the bones and increase the risk of vertebral compression fractures. Similar to trauma, unless the tumor put pressure on the sciatic nerve or caused a fracture that compressed the sciatic nerve, cancer-related back pain would not likely give you pain that traveled into your leg. 

Who is at risk of having sciatica?

Because back pain is common and there are many causes for sciatica, many people may experience it at some point in life. 

Certain risk factors may make sciatica more likely for some people. These common risk factors include:

• Middle age

• Having overweight or obesity

• Smoking

• Having a previous back injury or arthritis of the spine

• Frequent back straining, such as from a physically demanding job

• Psychological stress or depression

• Pregnancy

How can I know if my back pain is from sciatica?

It can be difficult to tell the difference between different kinds of back pain. As we’ve mentioned, the pain of sciatica tends to be very specific, although symptoms can come and go over days to weeks.

Symptoms of sciatica may get better with heat, rest, stretching, and over-the-counter pain medications like Tylenol or Motrin. If you’ve had the pain for 6 weeks and it doesn’t seem to be getting better, then you may need medical care to help determine the diagnosis. Your healthcare provider may do something called a straight leg raise test to see if your pain is sciatica. This is a simple test where you lie on your back and your healthcare provider raises your leg up while keeping it straight. This movement strains the sciatic nerve and can cause pain if the nerve is already irritated from compression or inflammation.   

Sometimes, even with the straight leg test, it can be hard to know if your symptoms are from sciatica. In this case, your healthcare provider may recommend that you get imaging, like an X-ray, CT scan, or MRI, to look at the bones and nerve roots of the spine. In some cases, these tests can determine whether sciatica is causing your symptoms or if there’s a different reason for your back pain. 

What is the treatment for sciatica?

The first step for treating sciatica involves some simple but effective home remedies: 

• Heat or ice packs may help.

• Over-the-counter pain medications, like Tylenol and Motrin, can ease pain and inflammation. 

• Lidocaine patches can help some people.

• Keep moving as much as possible, as too much time in bed can make things worse. 

• Avoid prolonged sitting or standing.

• Stretching, light exercise, and maintaining good posture can help ease pain and prevent future episodes of sciatica. 

If your symptoms do not get better with these treatments, then you have options. 

Other treatments for sciatica can include: 

• Prescription medications, like muscle relaxants, pain medications, steroid pills, or nerve pain medications

• Physical therapy

• Massage

• Spinal steroid injections

• Spine surgery

For most people (nearly 90%), sciatica gets better with non-surgical treatments and time. If your pain doesn’t get better within 6 weeks, you may need to make a medical appointment to check for other causes of back pain.  

The bottom line

Back pain is very common. Sciatica is a specific kind of back pain that’s caused by compression of the sciatic nerve from arthritis, disc herniation, injury, pregnancy, or tissue inflammation. Sciatica can be quite uncomfortable, but it’s usually only temporary. Most people get better with non-surgical treatment and time.

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Written by:

Kelly Elterman, MD

Kelly Elterman, MD, is a board-certified anesthesiologist by the American Board of Anesthesiologyand has been practicing clinically since she finished her residency training in 2013. Along with her training, she has over 10 years experience in anesthesiology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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