If you’ve been feeling pain in your lower back or numbness in your legs, your friends might be throwing the words “sciatic nerve pain” or “sciatica” at you and telling you it’s time to hit the doctor’s office. Any time the nerves come up, we get, well, nervous! But is a little pain in your rear end actually sciatic nerve pain? And even if it is, do you really need to visit a doctor? Maybe. Then again, maybe not. The truth is, most of us suffer from low back pain at some point—we’re a nation of people who spend long days sitting in uncomfortable office chairs that offer little lumbar support and plenty of problems for the back. A 2015 study published in the Annals of Internal Medicine estimates that more than half of the average person’s waking hours are spent sitting between computer work, commuting, and TV watching. In turn, all that time on our collective tuchases is linked to everything from an increased risk of heart disease to an increased incidence of lower back pain. But for an estimated 10 percent of us, low back pain isn’t just low back pain. It’s a problem with the sciatic nerve, the biggest nerve in the whole body, which travels directly through our middles, down the spine into our rear ends and then down our legs. So how do you know when it’s just regular old aches and pains or when it’s something more? Let’s go nerve deep, shall we?
Sciatic Nerve Pain or Sciatica?
The terms sciatic nerve pain and sciatica don’t just sound similar, they’re the exact same thing. The former tends to be used by physicians, while the latter is the word we tend to throw around when we’re sounding off with our friends, but at the end of the day, you can use them interchangeably. No matter what you call it, sciatica is rooted in the sciatic nerve, one of 43 pairs of nerves in the human body, and the body’s biggest. It’s formed when the L4-S3 nerve roots merge together after exiting the spine, says Neel Anand, professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, California. “Once [the sciatic nerve] exits the spine, it travels through the buttock and along the back side of the leg where it then divides into three branches,” Anand explains. “These nerve branches provide our lower extremities with their strength and sensation.” If you’re scratching an itch on your thigh, the nerves will tell your brain you’re getting relief, for example, or it can help the body respond to some sweet, sweet deep tissue massage. But in instances of sciatica, the sensation in the lower extremities is uncomfortable or downright painful. The sciatic nerve typically causes pain when there’s nerve compression, meaning something is pressing on the sciatic nerve itself, irritating it and causing it to signal to the brain that you’re in pain. The leading cause of nerve compression is a herniated disc in the low back. That means that one of the spinal discs (or intervertebral fibrocartilage) located between the spinal vertebrae has pushed out, bulging between the vertebrae and putting pressure on the spinal nerves. In other cases, sciatica can be ascribed to arthritis, pregnancy, or other mechanical irritants. “Sometimes the nerve itself can be irritated more distally in the pelvis,” says Daniel Resnick, MD, a neurosurgeon at the University of Wisconsin, School of Medicine & Public Health and the president of the North American Spine Society (NASS). Sciatica isn’t a disease so much as a side effect of whatever condition causes it, be it a bulging disc or arthritis, which can result in sciatic nerve pain symptoms. Speaking of symptoms, sciatic nerve pain typically involves sharp, searing, electric-like or shooting pains that lead from the buttocks down the leg. The pain can occur when sitting or standing, and especially when spending a prolonged time in either position. Sciatic nerve pain sufferers may also feel numbness, tingling, and muscle weakness, and the symptoms can occur anywhere along the pathway of the sciatic nerve. Typically the pain will radiate from the spine, through the butt, down one leg or the other, and all the way down below the knee. Sometimes the pain can be felt into the foot, although just how extensive the reach is varies from person to person. Speaking of…
Who’s going to get sciatic nerve pain?
Sciatica can crop up in the elderly, and the vision of a grandpa or grandma standing up only to yelp, “My sciatica!” is fairly common. It’s also a bit of a misunderstanding. Sciatic nerve pain isn’t unique to the geriatric population. “Though it is frequently believed that sciatica is a side-effect of aging, it can actually occur in people of all ages,” Anand says. “People in their twenties can experience it and in fact, the peak age at which sciatica as a result of disc herniation usually occurs is in the forties to fifties.” Although men are three times more likely than women to suffer from sciatica, pregnancy is a common cause of low back pain in women, and at least 1 percent of those who have low back pain during pregnancy will encounter sciatic nerve pain during the nine months they spend carrying a baby. That said, sciatica is not technically a pregnancy-related condition, either, according to Anita Somani, MD, an OB-GYN with OhioHealth in Columbus, Ohio, so while it can happen, it’s not a given for moms-to-be. The weight of the uterus and the fetus pressing on the nerve can be to blame, but often pregnant women who suffer from sciatic nerve pain have other issues that are causing the problem. “It can happen with a weak back, herniated disc, bone spurs, or spinal stenosis,” Somani says. “Anything that pinches the sciatic nerve can cause this condition.” If the problem is the uterus and fetus bearing down on that nerve, the good news is that the pain can go away temporarily or permanently when the baby changes position and should be gone for good after delivery. Not pregnant, but still feeling the pain? Other risk factors for sciatica are a mix of genetics and lifestyle. In fact, Resnick shares that “bad luck” is actually on his list of reasons someone might be struggling with shooting pains down their rear end, but he also tacks on lack of exercise, aging, and even smoking. Yes, smoking. Although researchers haven’t been able to pinpoint the exact reasons why smoking and sciatica might be linked, a number of studies have determined that smoking is a “modest risk factor for lumbar radicular pain and clinically verified sciatica.” According to a 2016 study published in the American Journal of Medicine, however, quitting smoking will reduce your risk, although it won’t eliminate it entirely. As for lack of exercise, it stands to reason that excess weight puts stress on the discs of the lower back, which in turn can cause disc herniation, which—you guessed it—paves the way for sciatic nerve pain. While keeping your core tight and weight in line with medical guidelines isn’t a guaranteed fix, it will reduce your risk.
No matter the cause, if you’re suffering from any of the symptoms of sciatica, there’s typically good news on the horizon. Most cases of sciatic nerve pain will go away within three months, if not sooner. Ninety percent of the time, Resnick says, it will actually go away without any treatment at all. If you’re aching and want to stick to at-home treatments, over-the-counter anti-inflammatories are typically recommended, along with heat and ice therapy, which can soothe your aching back, butt, and legs. Resting can help too, so if you want to curl up in bed for a day with Netflix, feel free to pamper yourself…for awhile. Just but be careful not to overdo your rest and relaxation period. “Research now shows that prolonged inactivity or bedrest can actually end up making your symptoms worse, so keep moving,” Anand warns. That said, if there are certain activities you’ve been pursuing, like a specific workout, make the pain worse, it’s wise to lay off and modify your lifestyle for awhile. Try to reduce the need to carry heavy objects, even if that means something as simple as cleaning out a bulky purse and downsizing for a while. When it comes to working out, it’s important to keep on moving, but Anand suggests sticking to gentle stretching exercises that avoid twisting, jerking, and bouncing, as you’ll want to move without exacerbating your symptoms. If you’re a yoga fan or interested in giving it a go, child’s pose and downward dog are both recommended to help stretch out the low back and ease sciatic nerve pain. Provided you’re open about your symptoms, a yoga teacher can help with developing a workout that can stretch your muscles and provide relief without worsening the sciatica. If sitting makes your nerve pain flare up, but work requires you spend a lot of time seated, practice good posture. Sit up straight rather than leaning over toward your work. Don’t cross your legs. Position your feet flat on the floor, and keep your hips and knees bent at 45 degree angles. If you can, grab an office chair that provides lumbar support, and look for one that has wheels. When you’ve got to move around your desk, taking advantage of the wheels to move your body as a single unit can help you avoid twisting and turning. Also, be careful about how you move from sitting to standing. As often as possible, take standing breaks to avoid remaining in one static position for too long. Do not bend at the waist to stand up, as this can make the pain worse. Instead, slide forward on your seat, then use your legs to push yourself into a standing position. And don’t underestimate the power of positive thinking. “Though it is impossible to completely eliminate your sciatica risk, understanding that a painful episode is likely short lived can go a long way to putting your mind at ease when one decides to strike,” Anand notes. If you’re still hurting after a few months, a trip to the doctor can help you get to the root of the problem. Your healthcare provider may call for x-rays or an MRI to see what’s going on internally. “Doctors often require some type of imaging examination to get to the bottom of sciatica symptoms that haven’t resolved on their own by the three-month mark,” Anand explains. “The purpose for these exams is to connect the symptoms the patient is experiencing with something on the imaging exam that helps us identify why.” Unfortunately, even with imaging, it isn’t always possible for doctors to identify what’s causing sciatica symptoms. Idiopathic sciatica—or sciatica with no known cause—can be frustrating for sufferers who just want an answer about the origins of their pain. But even idiopathic sciatica tends to go away with conservative treatments, Anand says. If doctors do decide a patient needs something beyond over-the-counter anti-inflammatories for pain management, most wind up prescribing steroid treatments, injecting the medicine right into the area of pain, or prescribing steroid pills. In rare cases, surgery may be required, but the surgeons will be working to fix the cause of the sciatica rather than looking to simply cure the sciatic nerve pain. If surgery is required, the solution to the sciatica winds up being a secondary benefit, while the primary focus is addressing the overarching issue that’s causing the sciatica and any other symptoms.
Preventing Sciatic Nerve Pain
Maybe you’ve been through a bout of sciatic nerve pain and never want to experience it again. Or maybe you’ve read all about it and are thinking, “Thanks, but no thanks.” While the cases of “bad luck” that cause sciatica can’t be avoided, there is increasing evidence that a focus on overall better health can prevent you from experiencing a flare up. Case in point: Undoing the bad habits that come with sitting all day or standing for long periods of time. “Exercise regularly to help keep your spine strong, maintain good posture while you’re in a seated position, and use good body mechanics if you stand for long periods or do a lot of heavy lifting for work,” Anand says. Looking to lengthen and strengthen? Try these yoga poses for core strength and consider incorporating resistance bands or kettlebells into your current fitness routine.