The sciatic nerve branches off
nerve roots at the lower end of the spinal cord – it’s
two branches run from the lower back through the each side of
the pelvis, buttocks, back of leg to the foot. The sciatic nerve
is the longest nerve in the body and its diameter is the diameter
of a finger
Sciatica is a term for pain that radiates along the sciatic nerve,
anywhere from the lower back, buttocks, down the back of the leg,
to the foot. There may also be weakness, numbness, tingling, particularly
in the leg and/or foot. The location of the pain and/or numbness
varies according to the location that the sciatic nerve or nerve
root is affected. The pain can range from burning to aching and
can vary in intensity. The pain may be intermittent or constant. Sciatica
usually occurs on only one side of the body. Prolonged
sitting or standing, sneezing, coughing or lifting aggravates sciatica.
Sciatic pain may be acute but often develops gradually
Causes of Sciatica:
Sciatica is caused by inflammation or compression of the sciatic
nerve or nerve roots in the lower spine. It may also be caused by
damage to nerve roots. Sciatica is not a disease in itself and its
causes are various.
*Compression of a nerve is often referred to as a "pinched
nerve." A "pinched nerve" in the lower spine causes
The most common cause of sciatica is a herniated
disc in the lumbar spine (lower back) that puts pressure on
the sciatic nerve or a nerve root. A herniated disc can occur suddenly
and cause acute pain or it may develop gradually.
Spinal stenosis is a narrowing of the spaces in the spinal column
that causes compression of the spinal cord or nerve roots. It
can cause sciatica if it occurs in the lower back.
In advanced osteoarthritis
of the spine,
bits of cartilage may break off and float around inside the spinal
joints. This causes irritation and inflammation and if it occurs
in the lower back may put pressure on the sciatic nerve.
Spondylolisthesis – when one vertebra slips over another
– occurs most often in the lower back – where the misaligned
vertebrae may place pressure on the sciatic nerve.
A less common cause of sciatica is Piriformis syndrome, a disorder
in which a muscle located in the buttocks (the piriformis muscle)
contracts and irritates the sciatic nerve. In this case, the pain
starts in the buttocks and radiates down the leg. Piriformis syndrome
is generally treated with stretching exercises, massage, and anti-inflammatory
Something as simple as muscle strain
can cause inflammation, which may put pressure on the sciatic nerve.
*Always consult a physician to diagnose the
cause of sciatica and rule out any serious conditions that may require
Treatment consists of treating the pain and the condition that
is causing it. Anti-inflammatory medication, analgesics, and usually
some form of physical therapy are prescribed.
Medications: Non-prescription NSAIDs (anti-inflammatory
drugs) such as aspirin and ibuprofen treat both pain and inflammation.
Analgesics such as Tylenol treat pain but not inflammation, but
may be preferred by some people. In cases of severe acute sciatica,
physicians may prescribe codeine preparations and/or muscle relaxants.
An injection of corticosteroids, a powerful anti-inflammatory,
into the spinal fluid around the affected area delivers a high dose
of medication to the spinal nerves.
Exercise: A couple of days of bed rest may be
necessary with acute, severe sciatic nerve pain. Bed rest will not
speed up recovery, and it can actually hinder it. Not using the
muscles causing them to weaken very quickly. Muscles – back
and ab muscles - are what supports and protects the joints of the
spine. Exercise also increases circulation and promotes healing.
*Depending upon the cause of sciatic pain,
certain exercises may have to be avoided. Always consult a doctor
as to the safely of exercises for your particular condition.
Stretching exercises are usually recommended to relieve sciatica.
Stretching exercises loosen tight muscles and increase spaces between
the vertebrae, allowing more room for the spinal nerves. Stretching
muscles in the back and buttocks and even the hamstrings (muscles
in the back of the thigh) can relieve sciatica. See
*A physical therapist can create an individualized
exercise program for a patient’s particular condition. Depending
upon the cause of sciatic pain, certain exercises may have to be
Severe Acute Sciatica: Though bed rest does not
speed up recovery, in the case of acute sciatica lying down on a
firm surface often relieves the pain. Applying ice for the first
couple of days of acute sciatica may also help.
Treating Muscles Spasms: Muscles may spasm in
a reaction to sciatica, intensifying the pain. Sciatica may also
be caused by muscle spasms that irritate the spinal nerves. Massage
therapy may be helpful. Stretching exercises also loosen up
tight muscles. Heat also relaxes tense muscles. Moist heat may be
more effective. See hydrotherapy.
Support/ Posture: Sitting on soft surfaces aggravates
sciatica - adequate support is necessary to prevent slouching, which
places excessive stress on the lower back. A chair that tilts back
slightly shifts your weight onto the backrest of the chair to take
stress off the lower back. Support is necessary while lying down
too. A saggy mattress causes the lower back to sink into the mattress
and can irritate the spinal joints and aggravate sciatica. Any increase
or decrease in the normal curve of the lower back increases stress
on the spine and aggravates sciatica. See Posture.
Avoid heavy lifting, which places extreme stress on the lower back.
Use proper body mechanics. See lifting techniques.
Avoid prolonged sitting or standing, which can
aggravate sciatica. (Your lower back supports the majority of the
Other Pain Treatments: The use of Heat and Cold
are often used to relieve pain. See
Back Pain Treatment and Complementary
Treatments for more pain relief information.
Surgery: If conservative treatments do not bring
adequate pain relief, surgery becomes a consideration. If there
is progressive weakness or difficulty in walking (possible progressive
nerve damage) surgery is may be necessary. Immediate surgery is
required if there is or loss of bladder or bowel function.
Sciatica Prevention with Exercises:
*If you currently have sciatica, consult a physician who can diagnose
the cause and recommend appropriate exercises.
Keeping the back muscles strong and flexible reduces the risk
of a herniated disc, the most common cause of sciatica. Low impact
aerobics increase circulation and promote healing. Walking, swimming,
and riding a stationary bike are good low-impact aerobic exercises.
Strengthening the muscles that support the spine (back and abdominal
muscles) help maintain proper posture, which takes stress off
the spinal joints. Strengthening exercises may cause the muscles
to tighten up so stretching exercises are important. Stretching
exercises that increase the spaces between the vertebrae and create
more room for the discs may relieve pressure on nerves. Exercise
can help prevent or slow down age-related degenerative changes
in the spine and can help prevent sciatica from recurring.