5 Ways To Tell If You Have Sciatica
Pain that radiates down the back of your leg, numbness or tingling that extends down to your foot, a quick jolt each time you cough or sneeze—sounds like sciatic nervepain, right?
Well, maybe. For one thing, "sciatica" is actually a symptom, not a condition. It's leg pain (anywhere from the lower hip and butt region, all the way down to your toes) resulting from a pinched nerve—most likely because of a herniated or slipped disc. Contrary to popular belief, actual back pain doesn't usually come along with sciatica—or it's a minor part of the overall problem. "If a patient has 80% leg pain and minimal back pain, it really turns on our radar for sciatica," says Eric Mayer, MD, sports and spine specialist at Cleveland Clinic's Center for Spine Health.
How do you know for sure that shooting pain is nerve-related and not coming from somewhere else—like your muscles? Here are tips on getting to the root of your agony, once and for all.
1. You feel weak in your knees.
Well, actually just one knee—and it runs throughout the entire leg. The sciatic nerve—the one that gets pinched and causes sciatica—is the largest single nerve in the entire body, running from the lower spine all the way down to the foot. When that nerve is pinched, its function is disrupted, resulting in all kinds of unwanted sensations, such as pain, weakness, and tingling. And while pain is pretty common (and oftentimes hard to diagnose), pain and weakness in a single leg acts like a red flag for doctors. "Patients often drive to the emergency room for pain, but it's really the weakness that's concerning—if you see that you're getting weak, you should seek care," says Mayer.
2. You're a walker, not a runner.
If you're not training for your next marathon or logging hours on the treadmill, there's a good chance your leg pain is sciatica caused by a herniated disc, not the less-common piriformis syndrome, which mainly affects athletes. The funny thing is that piriformis syndrome presents itself almost exactly like sciatica: pain, tingling, numbness starting in the buttocks and extending down the leg. But instead of a slipped disc causing the issues, your piriformis muscle (found in the butt near the top of your hip joint) is pressing on that touchy nerve.
3. You can't summon your pain
Telling a doctor you have "pain" is kind of like going to Ben & Jerry's and ordering "ice cream"—specificity is key. Sometimes the pain you think is sciatica isn't actually nerve-induced pain at all, but rather, something muscular. So how do you find out? Use your thumb, suggests Jacob Teitelbaum, MD, author of Real Cause, Real Cure. "Push around on the muscles in your lower back and see if you can find spots that affect your pain," says Teitelbaum. If you can trigger pain by a push—not a gentle push, you want to exert at least 5 to 10 pounds of pressure—your pain is most likely muscular and the result of a shortened, tightened muscle. "When a muscle gets stuck in the shortened position, it gets thicker and doesn't get the blood or nutrients that it needs," says Teitelbaum. And when you press on those tightened muscles—especially on the small, tender knot in the center—it can send pain throughout the body.
4. There's one test you just can't pass.
It's the main test docs use to diagnose sciatica caused by a slipped disc, and it starts with you lying down with your feet stretched out. The examiner then raises your straight leg between 30 and 70 degrees. Pain from this test—the kind that radiates down your entire leg, below your knee, and possibly even down to your toes—indicates sciatica. This is because when you stretch the affected leg, you're also stretching the entire sciatic nerve, and if the nerve root is pinched, you'll feel it through the stretching movement.
5. You've gotta go a whole lot more.
We're not talking about getting up a few extra times each night, but rather, totally losing control of your bowel and bladder movements. When paired with the typical sciatica pain, doctors treat this as a "surgical emergency," according to Alan Hilibrand, MD, spokesperson for the American Academy of Orthopaedic Surgeons. It's extremely rare, but if the spinal column is putting that much pressure on the nerve, it can lead to permanent damage to bowel and bladder function, so be sure to see a doctor immediately.
But here's the good news: Most of the time—like 80% of the time, according to Hilibrand—sciatica will clear up on its own (exactly how is another story—docs can't agree on whether the disc moves itself back in place or if the nerve simply stops being bothered by it). "The majority of people who have an acute event of sciatica will gradually improve or resolve in about 90 days," says Mayer. During that time, it's best to make the sciatica manageable through pain medication, anti-inflammatories, or physical therapy; your doctor may even suggest an epidural steroid if over-the-counter meds aren't doing the trick. But if symptoms persist past the 3-month mark, surgery may be your best option.
11 Effective Solutions for Sciatica Pain
Sciatica is leg pain caused by a pinched nerve in the lower back. Although the pangs begin in nerve roots located on either side of the lower spine, they then course through the sciatic nerve, which runs the length of each leg from the buttock down to the foot. The leg agony, called radiculopathy, "is often worse than the back pain," says William A. Abdu, MD, medical director of the Spine Center at Dartmouth-Hitchcock Medical Center. Usually felt in one leg, the sensation "can be intolerable," says Birgit Ruppert, a physical therapist at the Spine Center. "Some people liken it to the nerve pain you experience if you have a toothache."
The most common cause of sciatica is a herniated disk: When a disk develops a tear or crack and bulges into the spinal canal, it can pinch the sciatic nerve. Usually, symptoms clear up within about six weeks, but for some people, the pain can last far longer.
Sixty percent of people with sciatica who didn't get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. "Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area," says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. "It also reduces inflammation, creating an environment that promotes the body's natural healing mechanisms."
"You can get relief as soon as the first session, though it takes about 12 sessions to see improvement," says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.
A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga's effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers "move and function better so they don't fall into a posture that aggravates the sciatica," says James W. Carson, PhD, a psychologist at the Comprehensive Pain Center at Oregon Health & Science University.
Trigger Point Massage
Don't expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. "When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg," says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don't see progress by the fourth visit, "they need to try another form of therapy," he says.
Pain Relievers and Muscle Relaxants
Taking a nonsteroidal anti-inflammatory drug, either OTC (like ibuprofen) or Rx, can ease the distress. Because painful muscle spasms may also accompany a disk herniation, doctors sometimes prescribe muscle relaxants or pain-reducing tricyclic antidepressants. (Just don't make any of these 13 common mistakes you're making with your pain meds!)A caveat: "These won't help with the pain caused by pressure on the sciatic nerve," says A. Nick Shamie, MD, a spokesperson for the American Academy of Orthopaedic Surgeons.
Epidural Steroid Injections
People whose pain doesn't lessen within about a month and who aren't helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. "The hope is to reduce inflammation within that nerve branch," explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.
Exercise and Physical Therapy
Moving is usually the last thing people dogged by sciatica want to do, but it's important to be physically active. "Lying in bed makes it more likely that the pain will last longer," says Ruppert. "Exercise increases blood flow to the disk and the nerve, helping to get rid of the chemicals causing the inflammation." Take 15- to 20-minute walks. If that hurts too much, give swimming or water aerobics a try; there's not as much pressure on the back when you're in the water, says Ruppert. It may also be worth seeing a physical therapist, who can prescribe stretching exercises to restore flexibility to the back or moves that strengthen core muscles, helping to stabilize the spine and reduce the likelihood of a similar injury.
After 4 to 6 weeks of unremitting symptoms, patients may qualify for surgery. The Spine Patient Outcomes Research Trial found that those who had surgery for a herniated disk had greater decreases in pain and disability 3 months afterward than patients who did not. The benefits lasted up to 4 years.