Sciatica - Numbness, Ache, and Weakness in the Leg

What is Sciatica?

The sciatic nerve is a long and substantial nerve—the body's largest nerve—with several nerve roots originating from the lower back.

When any part of the sciatic nerve is irritated or pinched, symptoms arise that fall under the collective name "sciatica". 

Pain in the Leg

It is common to experience pain that radiates from the back down into one leg, sometimes along the entire length of the sciatic nerve, from the back to the toes. Because it involves a nerve, other typical problems can also occur, such as tingling, numbness, and weakness.

Why Do You Get Sciatica?

Sciatica is a symptom that, in turn, can have several different causes—but the most common cause of sciatica is a herniated disc in the lower back. A lumbar disc herniation means that a disc between the vertebrae of the spine in the lower back bulges out and puts pressure on the sciatic nerve, or that disc fluid leaks out and causes inflammation. The pain can spread along the entire nerve pathway, which usually gives rise to symptoms along the back of one leg and sometimes down into the foot and toes. In addition to pain that radiates down the leg, sciatica can also cause discomfort such as numbness, aching, loss of sensation, and muscle weakness.

"False sciatica" involves symptoms that are similar to nerve root sciatica but involve muscles and joints.

Several Possible Causes

There are a number of possible causes of sciatica; that is, there are several different ways in which the sciatic nerve can become pinched or be exposed to inflammatory processes. These need to be identified and preferably treated as soon as possible for the symptoms to be effectively relieved. In addition to a herniated disc, the spinal vertebrae can also slip out of their normal position and press against the sciatic nerve. A narrowing in the spinal canal through which the sciatic nerve runs can also occur. The sciatic nerve can also be directly damaged in the event of trauma, such as a fall.

Muscles and Joints

Sometimes muscle tension and joint problems can cause sciatica-like symptoms, known as false sciatica. False sciatica does not involve the sciatic nerve itself but is caused by problems originating in the muscles and joints.

Sciatica is a Symptom of a Problem in the Lower Back

Symptoms can include:

• Pain radiating down the leg: The pain often starts in the lower back or buttock and radiates down the back of the thigh, calf, and sometimes all the way out into the foot or toes. Most often, only one leg is affected.
• Different types of pain: The pain can be sharp, aching, shooting, stabbing, or throbbing.
• Worsening pain: The pain can increase with coughing, sneezing, straining, sitting, or bending forward.
• Numbness, tingling, and loss of sensation: Because a nerve is affected, some people may also experience tingling, numbness, or reduced sensation in parts of the leg and foot.
• Muscle weakness: In more severe cases, it can lead to weakness in certain muscles in the leg, which can make it difficult to, for example, walk on your toes or heel.
• Reduced reflexes: The reflexes in the leg can also be affected.

True and False Sciatica - What's the Difference?

True sciatica (nerve root sciatica): is a set of typical symptoms that originate from the nerve roots of the sciatic nerve in the lower back and are due to the nerve being subjected to some form of pressure or irritation. This type is caused by one of the nerve roots that form the sciatic nerve being directly irritated or pinched, most often due to a herniated disc in the lower back. A herniated disc means that one of the shock-absorbing discs between the vertebrae bulges out and presses on the nerve root, or that disc fluid leaks out and causes inflammation.

False sciatica (ischialgia): involves symptoms similar to those that arise from pressure on the sciatic nerve, but which are caused by something else. This can be muscle tension or problems in the joints in the gluteal region or pelvis, for example in the piriformis muscle (piriformis syndrome). The pain is then "referred," which means it comes from a different location but is felt along the path of the sciatic nerve. Regardless of the cause, there is help available to reduce discomfort and pain.

Causes of Sciatica

The most common cause of true sciatica (nerve root sciatica) is a herniated disc in the lower back. Other causes may include:

• Spinal stenosis: A narrowing of the spinal canal that can put pressure on the nerve roots.
• Spondylolisthesis: When one vertebra slips forward over another.
• Degenerative changes: Age-related changes in the spine that can affect the nerve roots.
• Piriformis syndrome: When the piriformis muscle in the buttock presses on the sciatic nerve.
• Pregnancy: Increased weight and changes in posture can put pressure on the sciatic nerve.
• Trauma or injury: A direct injury to the nerve.

How Long Does Sciatica Last?

Sciatica often goes away on its own. Most people recover after a few months; in some cases without treatment. However, since sciatica can have several different causes, both the need for care, treatment, and the time required for recovery depend on what is causing the symptom.

Recovery time depends on the cause Treatment should be directed at the underlying reason for the irritation of the sciatic nerve; most often a herniated disc. An operation that fixes the disc herniation therefore also helps with sciatica.

When Should I Seek Medical Care?

Most cases of sciatica are harmless and go away on their own. However, it is important to seek medical care if:

• The pain is persistent or gets worse despite self-care.
• You experience increasing numbness, loss of sensation, or muscle weakness in the leg/foot.
• You experience pain in both legs.
• You have sudden pain after an accident or trauma.
• You have difficulty controlling your bladder or bowels (urinary or fecal incontinence). This is a serious symptom (cauda equina syndrome) that requires emergency medical care!
• You experience loss of sensation in the groin and around the anus (saddle anesthesia). This also requires emergency medical care!

Understanding what sciatica is and which symptoms you should be aware of can help you manage the discomfort in the best way.

Treatment and Relief

The treatment of sciatica depends on the underlying cause. In many cases, the symptoms go away on their own with time. Here are some common tips:

• Movement and activity: Keeping the body in motion is often good, but avoid movements that worsen the pain. Adapt the activity to what feels good. Light walks can be helpful.
• Pain relief: Over-the-counter pain relievers and anti-inflammatory drugs can provide relief.
• Physical therapy: A physical therapist can give you customized exercises to strengthen your back and relieve pressure on the nerve.
• Chiropractor/Naprapath: These professionals can help diagnose and treat problems in the back and pelvis that can cause sciatica.
• Rest: In the acute phase, rest may be necessary, but prolonged stillness can worsen the condition.
• Positioning: Finding positions that relieve the nerve can be comfortable, for example, lying on your back with your legs bent and elevated.
• Heat/cold: Some people experience relief from applying heat or cold to the painful area.
• Manual therapy or massage can be experienced as a relief.

What You Can Do Yourself for Sciatica Pain

The typical pain that radiates down the leg is most often due to a problem along the spine that also involves the nerve roots of the sciatic nerve. Pain and discomfort can be worsened by immobility, and healing can take longer. It is important to stay mobile. The discomfort can often be reduced, for example, through short walks several times a day. Sitting, as well as certain movements like bending forward, should be avoided. It can feel good to rest on a firm surface in a supine position, with the hip and knee bent at a 90° angle. Heat can offer help in the acute stage.

Physical therapy: treatment can reduce pain By seeking care, you can get help with pain that radiates down the leg. For more information, contact a doctor. True sciatica means pain originating in the sciatic nerve. However, there are other reasons for sciatica-like pain. Both muscles and joints can cause pain in the spine and down a leg; something that goes by the name "false sciatica." But regardless of whether it is true or false sciatica, treatment from a physical therapist can reduce the discomfort.

Exercises according to an individually adapted program

• MDT (McKenzie assessment and exercises)
• Treatment such as manipulation, mobilization, and massage

Common Questions and Answers About Sciatica

How do you know if you have sciatica?

Sciatica is a painful condition that is felt in one leg; as a radiating pain from an aching back. Sciatica is caused by the sciatic nerve being exposed to something that irritates it. This can be pressure, a pinch, or an inflammation. The origin of the symptom of sciatica is located in the lower back, at the roots of the long sciatic nerve.

How do you get rid of sciatica pain?

Heat and rest can relieve the pain in the acute phase. Lie on the floor with your legs on a chair, with your knees bent at a 90° angle. The pain can be relieved with over-the-counter painkillers or anti-inflammatory drugs. Sciatica is a symptom (pain that radiates down the leg) that disappears when the sciatic nerve is relieved and the cause of the problem subsides.

What are the best exercises for sciatica?

All measures for sciatica need to be performed with consideration for what is causing the symptom. For most painful conditions in the back, the advice is usually to try to maintain mobility through physical activity and light everyday exercise. However, exercises should always be adapted to the individual and their ability.

Can sciatica go away on its own?

Sciatica goes away on its own in most cases. However, it can take different amounts of time depending on what is causing the symptom. The most common cause is a herniated disc in the lower back. Sometimes, care and treatment are needed to relieve the discomfort.

How long does it take for sciatica to go away?

The symptom of sciatica signals that a problem involving the sciatic nerve has occurred, usually localized to the lower back. Since the nerve roots of the sciatic nerve are in the lower part of the spine, the discomfort arises in connection with another back problem, usually a herniated disc. Sciatica subsides when the underlying cause heals. This can take different amounts of time depending on what caused the sciatica symptoms.

Do you have a herniated disc with sciatica?

A herniated disc means that a disc—the shock-absorbing cartilage disc that lies between the vertebrae of the spine—has slipped out of place or broken. It causes back pain, but sometimes also pain down a leg. This is because the disc or its contents irritate or press on the sciatic nerve. Sciatica is most often a symptom of a herniated disc. In some cases, surgery is required for the pain in the nerve to go away.

Do you have back pain with sciatica?

Lumbago-sciatica means lumbago—but that the sciatic nerve is also involved. The nerve or a nerve root has become pinched or is irritated. The pain in the back then radiates down one leg. Most of the time, the condition goes away without treatment. If your symptoms last longer than a couple of months without decreasing, it is important to find out what is causing it. In some cases, you should seek care immediately.