By Korin Miller
When you’re just minding your own business and trying to live your life, you probably don’t expect pain to suddenly slam into the lower half of your body. But that’s what can happen with the painful condition sciatica. “It can seemingly come out of nowhere … leaving you stunned,” Neel Anand, M.D., professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, tells SELF.
Unless you happen to be reading up on sciatica when it first affects you, you might be completely mystified by what’s happening. Although sciatica sucks overall, one of the few good things about this condition is that it usually presents in a distinctive enough way that it’s clear what you’re dealing with—as long as you know the major sign to look for.
The location of your sciatic nerve, which branches off each side of your spine and runs down each leg, is what dictates sciatica’s painful hallmark symptom.
Your sciatic nerve has a few important jobs, such as commanding the muscles in the back of your knees and lower legs, according to the U.S. National Library of Medicine. Your sciatic nerve also supplies sensation to the backs of your thighs, part of your lower legs, and soles of your feet.
If anything compresses your sciatic nerve, it can’t follow through on these duties, which is when symptoms arise. Culprits can include a herniated disc (when one of the plush cushions between your spinal bones bulges in a way it shouldn’t), a spinal bone spur (a prickly growth that can develop on the edge of a bone), or a narrowing of the spaces in your spine (spinal stenosis), according to the Mayo Clinic says. When something like this happens, it can cause inflammation and pain that will typically chart a unique path down your body.
The easiest way to distinguish sciatica from other types of pain is that it usually causes discomfort extending from your lower back, through your butt, and down the back of your thigh and calf, according to the Mayo Clinic. It’s theoretically possible to feel pain pretty much anywhere along the nerve depending on which part is compressed, Mike Murray, M.D., an associate of Orthopaedic Surgery at Penn Medicine, tells SELF, but that’s how it most commonly appears.
Although sciatica pain typically runs from your lower back down one leg, the pain itself can present in any manner of ways.
Sciatica can cause everything from a pretty livable ache to a sharp, burning sensation to intense pain that makes it hard to live your life as usual, according to the Mayo Clinic.
Or maybe your sciatica will make your leg feel like someone’s poking it with a cattle prod, delivering electric jolts each time. Perhaps it will instead make your leg feel numb, tingly, or weak. “I’ve heard every description over the years,” Santhosh Thomas, D.O., a spine specialist at Cleveland Clinic, M.D., tells SELF.
Sciatica can go away on its own, but it’s really a good idea to see your doctor if you’ve been in pain for more than a week.
Other signs you need medical help: The pain, muscle weakness, or numbness in your lower back or leg are severe enough that they’re impeding your life, or you’re having bladder and bowel problems. Those all mean you need to see someone ASAP, even if it hasn’t been a week, Ferhan Asghar, M.D., an assistant professor in the Department of Orthopaedic Surgery at UC Health, tells SELF. This kind of acute presentation could indicate permanent sciatica-induced nerve damage, according to the Mayo Clinic.
Once you get to your doctor, they’ll likely do a physical exam to check your muscle strength and reflexes, including tests like having you walk on your toes or heels, stand up from a squat, and lift your legs one at a time while lying on your back. Sciatica pain usually intensifies when you perform these types of actions, the Mayo Clinic explains.
Your doctor may also have you undergo tests such as an X-ray, MRI, or CT scan to see if something like a herniated disc or bone spur might be causing your sciatica, or have you do an electromyography to see how well your nerves are functioning, the Mayo Clinic says.
Whatever you do, don’t put off your doctor’s appointment because you’re scared that having sciatica means you’ll definitely need surgery. “Some people will have severe, debilitating symptoms and won’t see a doctor because they worry that they’ll have to have an operation,” Dr. Asghar says. “But that’s often not the case.”
Treatment for sciatica usually starts with measures you can take on your own, like resting, using over-the-counter pain relievers, applying ice or heat packs, and stretching.
If your first step is to reach for pain medications like nonsteroidal anti-inflammatory drugs, great, go for it. They might be helpful, according to the Mayo Clinic, as might resting for around a day after you first experience the pain.
It may also feel nice to apply a cold pack (through a towel so you don’t hurt your skin) for up to 20 minutes multiple times a day to target inflammation. After you’ve done that for two to three days, then you can try applying something warm, like a heating pad, to see if that soothes your pain any further. You can also experiment with switching between applying heat and cold, the Mayo Clinic says, along with stretching gently (ask your doctor for specific stretches you can try for sciatica).
Hopefully, that’s enough to get you back to normal. Most cases of sciatica do respond to these kinds of treatments. Otherwise, your doctor can walk you through your options, including stronger drugs like prescription anti-inflammatories and muscle relaxants, along with steroid injections to do away with excessive inflammation, according to the Mayo Clinic. They may also recommend physical therapy to prevent the pain from rearing its head again in the future.
If all that fails, sometimes surgery is necessary, Dr. Murray says. That’s especially true if you’re also having pain that’s getting worse, weakness, or loss of bowel or bladder control, the Mayo Clinic notes. The surgery will aim to fix whatever’s compressing your sciatic nerve and causing your unpleasant symptoms. Once that’s out of the equation, you should be much closer to putting sciatica firmly in your past.