Brief overview
- Symptoms: tingling, electric shock-like or pulling pain, numbness, paralysis
- Treatment: Depends on cause and severity; treatment options include medications, surgery, physical therapy, heat treatments, massages
- Causes: Herniated disc, vertebral body injuries, articular rheumatism, inflammations, abscesses, bruises, tumors, infections
- Prognosis: With timely, proper treatment, the chances are good that the symptoms will heal completely.
What is sciatic pain?
The sciatic nerve (sciatic nerve) is the thickest nerve in the human body. It runs down the back of the thigh and branches off at the level of the knee into its two lower leg branches, the peroneal nerve (nervus peronaeus) and the tibial nerve (nervus tibialis). It supplies the muscles in the leg. With its sensory parts, it reports sensations from the lower extremities to the central nervous system.
Sciatica: What are the symptoms?
Sciatic pain and the accompanying symptoms sometimes occur gradually, sometimes quite suddenly. Doctors refer to typical sciatic pain as neuropathic pain – meaning that it is not due to a structural injury in the leg or buttocks, but to the nerve itself.
More descriptively, many patients express themselves: For example, sciatica symptoms feel “like an electric shock” or “ants tingling in the leg.” In addition, numbness or paralysis symptoms occur in some cases.
It is also characteristic that the pain radiates. This is referred to as radicular pain (pain originating from the nerve root). This distinguishes sciatica from lumbago, for example. The trigger here is often an unfortunate twisting or lifting that leads to a sudden, severe back pain. However, this does not move into the leg.
In the case of sciatic pain, it also depends on exactly which nerve fibers are injured:
- If mainly the fibers of the fifth nerve root of the lumbar spine (L5) are affected, the pain runs from the buttocks to the back outer thigh to the outer knee to the front outer lower leg. Sometimes it continues into the ankle.
If the sciatica is pinched due to a herniated disc, the pain is often aggravated by coughing, sneezing or pressing (during bowel movements) as well as during some movements. Less frequently, urination and defecation are also disturbed. If inflammation is the cause of sciatica, the pain often increases at night.
How is sciatica treated?
How sciatic pain is best treated depends on the cause, severity and duration of the symptoms. However, the first priority in sciatica treatment – especially for new onset pain – is to relieve it as quickly as possible.
The aim is to prevent the pain from becoming chronic and forming a so-called pain memory. Doctors understand this to mean that the central nervous system uses “learning effects” to report pain later, even when there is no longer any cause for it.
Sometimes the body manages to heal itself or the affected nerve on its own. The pain often subsides after a few days to six weeks.
In the case of acute complaints, it often helps to elevate the legs. You can achieve this by lying on your back and resting your lower legs on a chair or a thick pillow. Ideally, the hip and knee joints should be bent at about a right angle (90 degrees).
If the pain does not improve or is very severe from the beginning, there are basically three treatment approaches: Medication, other conservative therapies (physical therapy et cetera), and surgery.
Medication for sciatica treatment
Sciatic pain can be relieved with painkillers. In most cases, the treating physician follows the World Health Organization (WHO) pain therapy step scheme. This scheme consists of the three stages:
- Non-opioid painkillers such as paracetamol, ibuprofen or diclofenac.
- Weak opioid painkillers (such as tramadol) in combination with non-opioids.
- Strong opioid pain relievers (such as morphine, buprenorphine, or fentanyl) in combination with non-opioids
First, an attempt is made to relieve sciatic pain with pain medications (analgesics) that have as few side effects as possible. If these do not have sufficient effect, the doctor additionally prescribes weak opioids. Strong opioids are used only for the most severe pain that is difficult to treat. Often, a combination of different painkillers (co-analgesics) is also helpful.
Opioids are very effective pain relievers. However, they have potentially life-threatening side effects and are addictive if taken long-term. For this reason, it is absolutely recommended that they be used only cautiously and under medical supervision.
Other conservative sciatica treatment
In addition to medications, there are other conservative (non-surgical) treatment options for sciatic pain. Targeted physical therapy is often helpful in relieving sciatic pain and improving prognosis. Depending on the method, tight muscles can be loosened or the spine stabilized and strengthened. Many people with chronic pain also adopt unfavorable restrained and incorrect postures, which can be corrected with the help of physiotherapy.
For example, movement therapy (physiotherapy, back school), heat treatments or massages are used. The therapist selects the appropriate treatment for your individual pain patterns and causes.
Another approach to support sciatica pain treatment is behavioral therapy. It helps sufferers cope better with the discomfort. It also helps ensure that patients do not take it easy and move less out of fear of sciatic pain. This would jeopardize the long-term success of the treatment. The behavioral therapy approach therefore plays an important role in modern sciatica treatment.
Surgical sciatica treatment
Surgery is rarely necessary for sciatic pain. This is the case, for example, when a herniated disc causes serious symptoms (such as disturbances in defecation, paralysis or severe pain that is difficult to treat).
Sometimes sciatica is the result of a narrowing of the spinal canal in the lumbar region (lumbar spinal stenosis). In this case, too, surgery may be appropriate.
Today, doctors usually perform such operations in a minimally invasive way. In other words, the surgeon does not make a large incision in order to have a direct view of the area to be operated on. Instead, he makes several small incisions through which he inserts fine optical and surgical instruments into the body.
Sciatica: examination and diagnosis
An injured or pinched sciatica is often very painful. However, the discomfort usually goes away on its own within days to weeks. If the pain persists or recurs, a visit to the doctor is advisable.
In general, if back pain is accompanied by numbness or paralysis in the leg and/or disturbances in bowel and bladder emptying, please see a doctor!
The doctor will first ask you in detail about your medical history (anamnesis). He may ask the following questions:
- How long have you had the pain?
- How would you describe the pain (e.g., as shooting in or electrifying)?
- Where exactly is the pain? Do they radiate?
- What gives you relief?
- What is your occupation?
- Is your daily life affected by the sciatic pain?
During the following clinical examination, your doctor will first look at your back and legs. He looks for any misalignments and checks the mobility of the joints, the strength of the muscles and your reflexes. He also tests whether the feeling in your legs has changed. To do this, he strokes the skin, for example, and then has you show the place where he touched you.
With the so-called Lasègue test, your doctor checks whether the nerve roots of the lower spinal cord are irritated. To do this, you lie on your back and the doctor lifts your extended leg. If the sciatic nerve is pinched or otherwise irritated, you will experience pain in your back even halfway up your leg.
In the search for the cause of the symptoms, the doctor will perform further examinations if necessary, for example a magnetic resonance imaging (MRI or magnetic resonance tomography) or computer tomography (CT). Such imaging procedures are particularly important if paralysis or sensory disturbances are present.
If sciatic nerve inflammation is suspected, the doctor will draw your blood to determine inflammation levels and identify any pathogens (such as Borrelia). An analysis of cerebrospinal fluid (CSF) may be needed. To do this, the doctor will insert a needle through the skin of the lower back and gently advance it into the spinal canal next to the spinal cord to take a small sample of cerebrospinal fluid – this is called a spinal tap.
Lumboischialgia
Lumboischialgia manifests itself similarly to “classic” sciatic pain (ischialgia): For example, sufferers report pulling pain, tingling and numbness in the leg. Muscle weakness is also possible.
In contrast to sciatica, in lumboischalgia not only the sciatic nerve is irritated, but also the nerves leaving the spinal cord at the level of the lumbar spine. Accordingly, the pain emanates less from the buttocks than from the lower back.
Learn more about symptoms, diagnosis and treatment in the article Lumboischialgia!
Causes and risk factors
The main cause of sciatica is a herniated disc or its precursor, the bulging disc. Sometimes other diseases are behind it, if they press on nerve roots and fibers of the sciatica. These include, for example:
- Vertebral body injuries
- Tumors
- Articular rheumatism
- Pus collections (abscesses)
- Bruises (hematomas)
Another possible cause of sciatic irritation is infectious diseases, such as Lyme disease. The bacterial pathogens of this infection (borrelia) are transmitted by ticks. Herpes viruses in shingles (herpes zoster) also sometimes cause sciatica problems.
Sciatica in pregnancy
Back pain is quite common during pregnancy. However, it is rarely due to the sciatic nerve. Instead, the pain is usually due to pregnancy-related factors, such as the growing weight of the abdomen and the hormonally induced loosening of ligament structures.
However, this does not mean that sciatica-like symptoms during pregnancy are to be taken lightly. Since a herniated disc and other serious causes are also possible, a visit to the doctor is definitely advisable for affected women.
If the doctor does indeed diagnose ischialgia, he or she will usually prescribe treatment with physiotherapy. For the good of the unborn child, painkillers are not used during pregnancy, or only to a limited extent.
You can read everything important about sciatica in expectant mothers in the article Sciatica in pregnancy.
Course of the disease and prognosis
It is important to strengthen the back and abdominal muscles with regular exercises and sports. A strong muscle corset relieves and stabilizes the spine. It is also helpful to learn back-friendly behavior (for example, when working at a desk or lifting heavy loads). This alleviates existing complaints in the long term and prevents new sciatica problems.
In addition, social and psychological factors influence the course and prognosis of back complaints, including sciatic pain. For example, loneliness, depressive mood and stress have a negative influence on the complaints. They also contribute in part to back pain becoming chronic and to the reduced effectiveness of pain medication.
This means that an intact social life, the support of relatives and friends, good conditions at work, a trusting relationship with the treating physician, and a positive underlying mood are helpful for the positive course of sciatic pain.
