Sciatica is nerve pain that travels down the legs. It has a misleading name because the sciatic nerve is not the cause of the pain at all. Sciatic pain is due to irritation of a spinal nerve root in the lumbar area,

Pain can range from mild to severe and is often described as sharp, aching, or shooting from the low back, through the buttocks, and to the back of the thigh. Sciatica is usually caused by a pinched nerve and, as a result, typically only affects the side of the body where that occurs.

It is a relatively common condition that, while bothersome, is not of great concern in most cases. Conservative treatments typically offer relief. In some situations, however, sciatic pain is an early sign of a serious nerve or spine problem that may require intervention.

Symptoms of Sciatica

Sciatica typically affects adults, and rarely affects children or teenagers. It causes symptoms on one side of the body in the area that corresponds to the affected nerve root.

The symptoms may come and go, and they can vary depending on whether you are sitting, standing, or lying down. Sometimes, coughing, laughing or sneezing can exacerbate the pain.

Initially, sciatica pain may be mild, but it may become more intense over time.

Common symptoms of sciatica pain can include:

  • Pain, burning, or a shock-like sensation in the buttocks, hip, and/or legSudden shooting pain that travels down the leg

Sometimes sciatica is associated with other symptoms, including:

  • Tingling or discomfort in the toesLow back painNumbness or tingling in the buttocks, hip, and/or legWeakness in the hip, and/or legBowel or bladder incontinenceSexual dysfunction

Saddle Anesthesia

Saddle anesthesia describes numbness of the area around the anus and inner thighs. Unlike sciatica, it usually affects both sides of the body, although it doesn’t have to be symmetrical.

Generally, weakness and bowel, bladder, or sexual problems are signs of more extensive nerve or spine involvement that could have long-term effects if left untreated.

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This video has been medically reviewed by Cara Beth Lee, MD.

Saddle anesthesia can be accompanied by weakness and/or bowel or bladder problems and is usually a sign of a more serious health problem.

Causes

Sciatica is caused by irritation or impingement (pinched nerve) of one or more lumbar nerve roots. Spinal nerves are arranged as right and left pairs, and physical pressure tends to affect one side.

Impairment of a spinal nerve is described as radiculopathy, and this condition can cause sensory changes such as pain, numbness, and loss of sensation. It can also cause motor changes, including weakness and muscle atrophy (shrinking of the muscle).

There are several conditions that cause sciatica, including:

  • Lumbar herniated disc: Rubbery material from the center of discs (cartilage) in your lower spinal bones can bulge out and irritate or compress spinal nerve roots.
  • Spondylolisthesis: Vertebra can slip out of place relative to each other—this can cause impingement of the lumbar nerve roots. This can occur due to trauma but is more frequently associated with degenerative changes (wear and tear).
  • Central canal stenosis: A form of spinal stenosis, this is when the spinal canal—the opening through which the spinal cord and lumbar nerve roots pass—becomes narrowed, causing compression of the nerve roots. This can occur due to trauma, arthritis, or inflammatory disease, but is typically the result of degenerative changes (wear and tear). Repetitive movements, such as construction work and heavy lifting can trigger inflammation as well.
  • Foraminal stenosis: This is the second of the two general types of spinal stenosis. The intervertebral foramina are small openings on each side of a vertebral bone. All spinal nerves pass through these holes as they exit the spine.
  • Osteophyte (bone spur): A bony outgrowth, often caused by osteoarthritis, can develop and narrow the canal space available for the spinal cord or may pinch spinal nerves.
  • Pregnancy or weight changes: Redistribution of your body weight can put physical pressure on spinal nerve roots. This often resolves after pregnancy or weight loss.
  • Piriformis syndrome: The piriformis muscle in the buttock can spasm, entrapping a nerve.
  • Cancer: Several types of cancer can metastasize (spread) to the spine or pelvis, causing pressure on the lumbar nerve roots. Prostate cancer, anal cancer, lung cancer, and breast cancer are examples of cancers that have a tendency to metastasize to the lower spine.
  • Infections: A severe pelvic infection or abscess may involve the lower spine, causing pressure on spinal nerve roots.

Diagnosis

Generally, your healthcare provider will be able to identify sciatica based on your symptoms and physical examination.

Your spinal nerve roots should not be affected by activities such as sitting in an uncomfortable position or carrying a large wallet in your back pocket. You may experience some aches and pains due to these factors, but this is due to local pressure on the muscle—not nerve involvement—and your symptoms should resolve within a few hours.

Additional testing is often necessary to determine the cause of your symptoms.

Medical History and Physical Examination

Your healthcare provider is likely to ask you a number of questions, such as whether your symptoms fluctuate, whether you experience weakness or diminished muscle control, and whether you have bowel or bladder issues.

Your physical examination will include an assessment of your muscle strength, reflexes, and sensation (to light touch, pinprick, vibration, temperature, and position sense). These tests help identify which nerves are involved.

Diagnostic Tests

There are a number of diagnostic tests that your healthcare provider might use to help pinpoint the cause of your sciatica.

Tests you might need include:

  • Spine or pelvic imaging: Spine or pelvic X-ray, computerized tomography (CT), or magnetic resonance imaging (MRI) can visualize the area in and around your lumbar spine and/or spinal nerve roots. This can help in the diagnosis of bone issues, tumors, and infections.
  • Nerve studies: Electromyography (EMG) and nerve conduction studies (NCV) can be used to assess the function of your lumbar nerve roots and the nerves of your leg. This helps your medical team know if there is any serious damage.

Treatment

Treatment for sciatica can vary depending on the extent of your symptoms and their cause.

Sometimes devices such as supportive pads, heating pads, ice packs, or external back braces may be helpful. These may be combined with oral (by mouth) or injected medication and/or physical therapy. Sometimes surgery is needed to relieve compression on the lumbar nerve roots.

Devices

Your healthcare provider may recommend a supportive pad or back brace, especially if your sciatica symptoms are affected by your physical position.

Heating pads can help with sciatic pain that is associated with muscle spasm. And ice packs can help reduce the pain that is related to inflammation.

Medication

Medications used for the management of sciatica include over-the-counter pain medications and anti-inflammatories. If your sciatica pain is severe, your healthcare provider may recommend a prescription version of one of these medications.

Steroid injections can reduce inflammation, while local anesthetic injections can provide pain relief that lasts for weeks or months.

Physical Therapy

Physical therapy is very individualized. Your physical therapist will assess your pain and motor function, and will work with you on supervised exercises. Your physical therapist may also show you how to do exercises at home.

Surgery

Surgery is not always necessary to treat sciatica. However, if you have a tumor, you may need to have it surgically removed. After a traumatic injury, surgery may be necessary.

If you have sciatica, you should speak to your doctor to see if you have any physical therapy restrictions.

A herniated disc can be treated with a discectomy, a procedure that relieves disc impingement on the spinal cord or the nerve root.

A Word From Verywell

Sciatica is a common problem. It can wax and wane over time, but it is often persistent if not treated. Usually, conservative measures such as medication and physical therapy can help relieve the symptoms.

You can also learn preventative strategies to keep it from recurring. This may include things like maintaining a healthy posture while you work or incorporating regular exercise into your life.