Sciatica Can Be a Pain In the Rear

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If you’re like 40 percent of the population, you’ve probably felt, at least once or twice, pain shoot down your lower back. And on to your buttocks, down the back of a leg, all the way to the sole of your foot. 

If so, you know sciatica pain — or perhaps another condition that mimics the discomfort.

Medically speaking, says Jeffrey Hoskins, MD, sciatica pain is associated with the sciatic nerve, the largest nerve in the body. The pain results from irritation of the nerve roots in the lower back that converge to form the sciatic nerve, which runs the course described above.

Sciatica pain is felt in the legs, adds David Propst, DO. “Sometimes the pain is in the top of the legs, sometimes in the bottom of the legs.”

Sciatica pain can be accompanied by weakness, numbness, or tingling. 

What Causes Sciatica Pain?

For younger, more active people, sciatica pain is most likely activity-related.  That is, says Dr. Hoskins, “trauma to the spine from lifting a heavy object, causing something to bulge out or herniate, putting pressure on the nerve root.” The condition most commonly is caused by a herniated, or ruptured, disc. The gel-like center of the ruptured disc presses on nerve roots.

For older people, arthritis or bone spurs in the spine are typically the culprit. Sciatica pain becomes more common with age.

A related condition, piriformis syndrome, occurs when the piriformis muscle in the buttocks spasms and tightens around and irritates the sciatic nerve. “Some people are born with an anatomic variance that predisposes them to this syndrome,” Dr. Hoskins explains. Physical therapy is usually the prescribed treatment.

Another condition that mimics sciatica pain is sacroiliitis. This is an inflammation of one or both sacroiliac joints, where the lower spine and pelvis connect. This is usually treated with physical therapy and sometimes steroids injected into the joint.

Arthritis in the lower spine may also mimic upper sciatica pain, without hitting a nerve. 

And women in pregnancy and childbirth commonly experience sciatica-like pain caused by relaxed ligaments in the pelvis, Dr. Hoskins said. This pain can linger a few days after delivery.

Dr. Propst describes the symptoms and treatment options for sciatica pain.

Click play to watch the video or read video transcript.

How To Prevent Sciatica Pain

People with sciatica-type pain generally have family members with similar problems, says Dr. Propst. “It's not uncommon for somebody to come into the clinic complaining of low back or leg symptoms saying, ‘My mother had this. My father had this. My uncle has this.’”

Regardless of family history, Dr. Hoskins recommends the following for reducing your chance of experiencing sciatica or sciatica-like pain:

  • Maintain an ideal body weight
  • Maintain a strong core of abdominal muscles. This will protect the lower back from stress.
  • Maintain flexibility. This lessens stress on the lower back.

“We’ve also learned that nicotine reduces blood flow to the vertebral column, which irritates the nerves and increases nerve pain,” adds Dr. Propst. “So you can reduce your chances of lower back or sciatica pain by not smoking.”

“Overall, 80 percent of people with sciatica pain find these conservative treatments provide relief.”

How To Treat Sciatica Pain

Sciatica small

Common forms of treatment, Dr. Hoskins says, include:

  • Physical therapy and exercise. As recommended by your doctor
  • Steroid injections
  • Surgery. The most common procedure — without other significant spine issues — is discectomy. This involves a small incision to remove herniated disc material that causes pain when it presses on a nerve root. Most patients return home the day of surgery. “Most people with sciatica never get to the point of needing surgery,” Dr. Hoskins said.

“It’s a frequent and common condition, and oftentimes symptoms will recur,” Dr. Hoskins said. And sometimes sciatica goes away on its own. 

Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may be recommended, as well as gentle heat or cold applied to painful muscles.

If you have profound weakness in your legs, Dr. Propst suggests you see a spinal surgeon right away for an MRI. “Weakness is a sign there's permanent nerve damage occurring.”

How Effective Is Treatment?

At least 50 percent of people improve with physical therapy and anti-inflammatory drugs, says Dr. Propst. Patients who don’t improve with physical therapy and anti-inflammatories may see improvement with an epidural cortisone shot.

“Overall, 80 percent of people with sciatica pain find these conservative treatments provide relief,” he says. “Only 10 to 20 percent need surgical intervention.”

Lifelong chronic pain like sciatica can cause severe depression and affect quality of life, says Dr. Propst. “But with the proper treatment, sciatica pain is usually curable. That’s why it’s important to get to a specialist that deals with leg pain.”

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