Sciatica is a condition that causes pain in the lower back that spreads down into the buttock, hip, and leg. Sometimes the leg pain can happen without any back pain. Sciatica happens when a spinal nerve is irritated or has pressure put on it as it comes out of the spinal canal in the lower back. This most often happens when a bulge or rupture of a nearby spinal disk presses on the nerve. Sciatica can also be caused by a narrowing of the spinal canal (spinal stenosis) or spasm of the muscle in the buttocks that the sciatic nerve passes through (piriformis muscle). Sciatica may also be called lumbar radiculopathy.
Sciatica may start after a sudden twisting or bending force, such as in a car accident. Or it can happen after a simple awkward movement. In either case, muscle spasm often also happens. Muscle spasm makes the pain worse.
A healthcare provider makes a diagnosis of sciatica from your symptoms and a physical exam. Unless you had an injury from a car accident or fall, you usually won’t have X-rays taken at this time. This is because the nerves and disks in your back can’t be seen on an X-ray. If the provider sees signs of a compressed nerve, you will need to schedule an MRI scan. Nerve conductions studies and electromyography are nerve tests that can also help find the cause of nerve pain. Signs of a compressed nerve include loss of strength in a leg.
Most sciatica gets better with medicine, exercise, and physical therapy. If your symptoms continue after medical treatment, you may need surgery or injections to your lower back, depending on how severe your symptoms are.
Follow these tips when caring for yourself at home:
- As soon as possible, start sitting up or walking. This will help you prevent problems that come from staying in bed for long periods.
- When in bed, try to find a position that is comfortable. A firm mattress is best. Try lying flat on your back with pillows under your knees. You can also try lying on your side with your knees bent up toward your chest and a pillow between your knees.
- Don't sit for long periods. This puts more stress on your lower back than standing or walking.
- Use heat from a hot shower, hot bath, or heating pad to help ease pain. Massage can also help. You can also try using an ice pack. You can make your own ice pack by putting ice cubes in a plastic bag. Wrap the bag in a thin towel. Try both heat and cold to see which works best. Use the method that feels best for 20 minutes several times a day.
- You may use acetaminophen or ibuprofen to ease pain, unless another pain medicine was prescribed. Note: If you have chronic liver or kidney disease, talk with your healthcare provider before taking these medicines. Also talk with your provider if you’ve had a stomach ulcer or gastrointestinal bleeding.
- Use safe lifting methods. Don’t lift anything heavier than 15 pounds until all of the pain is gone.
Follow up with your healthcare provider, or as advised. You may need physical therapy or more tests.
If X-rays were taken, a radiologist will look at them. You will be told of any new findings that may affect your care.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
- Pain gets worse even after taking prescribed medicine
- Weakness or numbness in 1 or both legs or hips
- Numbness in your groin or genital area
- You can’t control your bowel or bladder
- Fever (100.4 F or 38 C)
- Redness or swelling over your back or spine
StayWell last reviewed this educational content on 9/1/2019