Sciatica

Brief Overview: Sciatica refers to pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips, buttocks, and down each leg. It is a symptom of an underlying condition (such as a herniated disc or spinal stenosis). The pain may be sharp, burning, or electric-like and usually affects one side of the body.

Prevalence: According to UpToDate, “Lumbosacral radiculopathy is one of the most common problems seen in neurologic consultation. Although data are limited, the estimated lifetime prevalence is approximately 3 to 5 percent for adults, with equal rates among males and females.”

Etiology:

Herniated or bulging lumbar disc pressing on a nerve root (most common cause).
Spinal stenosis (narrowing of the spinal canal).
Degenerative disc disease.
Spondylolisthesis (vertebra slips forward, compressing nerve).
Muscle spasm or piriformis syndrome (rare).

Risk Factors:

Age (degenerative changes).
Obesity (increased spinal load).
Occupations with heavy lifting, twisting, or long sitting.
Sedentary lifestyle/deconditioning
Diabetes (can increase risk of nerve damage).
Previous back injuries.
Tobacco use

Commonly Associated Conditions:

Lumbar disc herniation.
Spinal stenosis.
Degenerative disc disease.
Chronic low back pain.

Common Medications:

NSAIDs, Tylenol
Systemic glucocorticoids
Epidural glucocorticoids

Common Labs, Imaging, and Tests:

MRI, CT
CT myelography
Nerve conduction studies, EMG
Cerebrospinal fluid analysis may be indicated

Common Symptoms:

Pain radiating from low back into buttock, thigh, calf, or foot.
Pain often worsens with sitting, coughing, or sneezing.
Tingling, numbness, or “pins and needles” in leg or foot.
Muscle weakness in the affected leg.
Usually one-sided symptoms (though rarely both sides).

Common Treatments:

Medications (see above)
Activity modification
Physical therapy

Physical Findings:

Positive straight leg raise test (pain radiates down leg when raised).
Weakness in leg or foot (e.g., foot drop).
Altered reflexes in knee or ankle.
Sensory changes along sciatic nerve distribution.
Limited lumbar spine flexibility due to pain.

Potential Complications and Contraindications:

Chronic pain and reduced mobility.
Permanent nerve damage if untreated severe compression.
Progressive weakness or paralysis.
Bowel or bladder dysfunction (medical emergency—cauda equina syndrome).
Medication risks: GI bleeding (NSAIDs), sedation (muscle relaxants, neuropathics), dependence (opioids).
Surgical risks: infection, scarring, persistent pain.

General Health and Lifestyle Guidance:

Maintain healthy weight to reduce spine stress.
Stay active: walking, swimming, yoga, and stretching exercises. Ask your healthcare provider what exercises are recommended for you.
Use proper lifting techniques (bend at knees, not waist).
Avoid prolonged sitting; take breaks to stretch.
Stop smoking (improves disc and nerve health).
Supportive sleep positions (side with pillow between knees).

Suggested Questions to Ask Patients:

Where does your pain start and where does it travel?
When did your symptoms begin, and what makes them better or worse?
Do you have any numbness, tingling, or weakness in your legs or feet?
How does the pain affect your daily activities and sleep?
Have you noticed changes in bowel or bladder function?
What treatments or medications have you tried so far?
Do you have a history of back injuries or spine problems?

Suggested Talking Points:

Sciatica is a common condition caused by irritation or compression of the sciatic nerve. It’s usually treatable without surgery.
Most people improve with time, physical therapy, and medications.
It’s important to stay active—bed rest can actually slow recovery.
Let us know immediately if you have sudden weakness, difficulty walking, or changes in bowel or bladder function. Ask your healthcare provider for any warning symptoms to be aware or and advice on when you should seek urgent/emergency care.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.