Ask the Expert: What is Sciatica? 

If you’ve ever experienced long-term lower back and hip pain that radiates down your leg, there’s a chance it’s not a run-of-the-mill back ache. It might be Sciatica.  

“People often use the term sciatica to describe pain that shoots down the leg” said WVU Medicine Pain Management Specialist Dan Nguyen, MD.   

Sciatica is a symptom rather than a disease itself. It can cause pain, numbness, tingling, or weakness along the affected nerve pathway. Symptoms can range from mild and short-lived to severe and persistent. Most people improve with conservative treatment and time. 

The pain, numbness, and weakness that comes with sciatica can range from moderate and temporary to severe and chronic. 

“While sciatica can be extremely painful and interfere with everyday activities, most cases do not require surgery,” Dr. Nguyen said. “The first goal is to control symptoms while allowing the body to recover and helping patients safely return to normal activity and reclaim their quality of life.” 

What Causes Sciatica? 

Sciatica happens when a nerve root in the lower spine becomes irritated or compressed. According to Dr. Nguyen, sometimes a specific condition is the culprit and sometimes there isn’t one clear cause. 

"The most common causes are a herniated disk or age-related changes in the spine, including bone spurs and narrowing around the nerve roots," he said.  

Other conditions that may cause sciatic nerve pain include: 

• Degenerative disk disease.
• Spinal stenosis.
• Osteoarthritis.
• Pregnancy.
• Tumors or cysts. 

“Not everyone who has these conditions will experience sciatic nerve pain,” Dr. Nguyen said. “There are risk factors like age, excess body weight, prolonged sitting and occupations or activities that involve repetitive lifting or twisting. However, these factors do not necessarily cause sciatica in any individual person.” 

What Does Sciatica Feel Like? 

The tell-tale symptom of sciatica is pain that radiates from the lower back or buttock down the leg, typically on one side. The pain may extend below the knee and into the foot. 

“Patients may describe the pain as burning, sharp, shooting or like an electric shock,” Dr. Nguyen said. “Some people also experience tingling, numbness or weakness in the affected leg or foot.” 

Symptoms can become worse with prolonged sitting and may also increase with movements that raise pressure around the affected nerve, including coughing or sneezing. 

"It is important to remember that not every pain that travels into the leg is sciatica," Dr. Nguyen said. "Problems involving muscles, joints, the sacroiliac joint or other structures in the lower back and hip can produce similar symptoms." 

How is Sciatica Treated? 

Depending on the individual patient, treatment may include: 

• Over-the-counter pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), when appropriate and safe for the patient.
• Heat or cold therapy for temporary symptom relief.
• Physical therapy and individualized exercises.
• Activity modification.
• Prescription medications in selected cases.
• Epidural steroid injections for some patients with persistent radicular pain.

Surgery when there is significant or progressive nerve dysfunction or when symptoms remain disabling despite appropriate nonsurgical treatment 

"Physical therapy can play an important role in recovery," Dr. Ngueyn said. "Rather than prescribing one particular stretch or exercise for everyone with sciatica, a physical therapist can assess the patient's symptoms and develop an individualized program. 

Exercises that may be incorporated into rehabilitation can include mobility work, strengthening and exercises designed to improve function and reduce strain on the lower back. 

"Exercises can improve mobility, strength and tolerance for activity,” Dr. Nguyen said. “The right program depends on what is causing the symptoms and how the individual responds to movement.” 

When Is Surgery Needed? 

Surgery is not usually the first treatment for sciatica.  

"Most people improve without an operation," Dr. Ngueyn said. "Surgery may be considered when a structural problem, such as a herniated disk or spinal stenosis, is causing persistent nerve compression and symptoms remain severe or disabling despite nonsurgical treatment." 

Surgery may be recommended more urgently when there is significant or progressive weakness or signs of serious nerve compression, such as loss of bladder or bowel control or significant numbness around the groin buttocks or inner thighs.