Is Your Leg Pain Sciatica — or Something Else?

6 problems that cause sciatica and 3 that mimic it

When pain radiating down your leg makes walking, sitting or standing up a challenge, you may have sciatica.

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Or you may have a problem that mimics sciatica.

Many different problems cause pain and weakness or numbness in the hip, leg and ankle, says Santhosh Thomas, DO, MBA, Medical Director of the Center for Spine Health.

6 common causes of sciatica

The following conditions can put pressure on your sciatic nerve:

  1. Herniated disk. “When a disk (often described as the shock absorber) between the bones of the lower spine bulges inward or outward, it can press on one of the nerves making up the sciatic nerve,” says Dr. Thomas.

    This is one of the most common causes of sciatica and occurs more often in younger patients. However, herniated disks are not a concern unless they compress a nerve and cause symptoms.

  2. Lumbar spinal stenosis. A collapsing disc and/or buckling of ligaments that support the spine can narrow the canal through which the nerves pass.

    “Degenerative changes in the spine sometimes cause bony outgrowths that can irritate or compress the nerve(s),” he explains.

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  3. Spondylolisthesis. Here, the spinal vertebrae slip out of alignment. Degenerative disk disease, previous spine injuries, prior spine surgery and physical stress to the spine are common causes.

    “Young gymnasts, divers and other athletes who hyperextend their backs are at risk of spondylolisthesis,” notes Dr. Thomas. “Lifting weights also stresses the spine, as does obesity because extra weight pulls on the spine.”

  4. Trauma. Car accidents, falls and sports injuries that cause tissue damage can compress the sciatic nerve.
  5. Piriformis syndrome. About 15 to 25 percent of sciatica patients have this syndrome. Injury, stress or tightness in the buttock’s piriformis muscle compress the sciatic nerve, causing symptoms. “Piriformis syndrome is a similar, but different, problem that is treated differently,” he notes.
  6. Spinal tumors. These can compress one of the nerves exiting the spine or the sciatic nerve, producing pain in the thigh, hip and groin. “But spinal tumors aren’t that common and rarely cause symptoms below the knee,” says Dr. Thomas.

3 problems mistaken for sciatica

These conditions create leg and foot pain and may be mistaken for sciatica. But they are not caused by sciatic nerve compression: 

  1. Peripheral vascular disease. Narrowing of the leg’s blood vessels restricts blood flow and may cause pain and muscle cramps.

    As with sciatica, vascular disease can make walking distances difficult.

  2. Peripheral neuropathy. “Diabetes, alcoholism and other medical conditions can damage small nerves in the extremities,” says Dr. Thomas.

    Like sciatica, peripheral neuropathy can cause burning, jabbing pain, tingling and numbness in the lower leg and foot.

  3. Peroneal neuropathy. Injury to the common peroneal nerve, which runs below the knee on the outside of the leg, may cause the weakness and foot drop sometimes seen with sciatica.

    “When we see this, we have to determine whether it comes from a peripheral or a spinal nerve,” notes Dr. Thomas.

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How to find out if leg pain is sciatica

If you’re unsure about whether your leg pain is sciatica, talk to your doctor.

He or she will review your health history and do a physical exam. Imaging studies, and in some cases, electromyography (EMG) can help to pinpoint the source of your pain.

Conservative care, including physical therapy, is the first step in treatment. If that doesn’t help, doctors will consider spinal injections.

Dr. Thomas explains that surgery is rarely considered unless bowel or bladder problems develop, pain worsens or weakness becomes prominent.​

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