Is Your Leg Pain Sciatica or Something Else?

Sciatica. You’ve heard other people talk about this weird leg pain — and now, joy, you’ve got mystery leg pain of your own. Is it sciatica? Spine expert Santhosh Thomas, DO, MBA explains what it is, how to tell if you have it — and how to get relief.

What is sciatica?

Sciatica is leg pain caused by a pinched nerve. And not just any nerve: Sciatica affects the sciatic nerve, the longest, widest nerve in your body. (In other words, it’s important — and when it’s hurting, it’s hard to miss.)

Nerves come out from your spine and sacrum (your tailbone) and supply strength, sensation and contribute to reflexes that are checked in the doctor’s office. These small nerves exit the spine and form the sciatic nerve, which branches out from each side of your tailbone. They come together, then split again into two large segments that run through your backside and down each leg. They bring movement and sensation to your hips, buttocks and legs.

Sciatica rears its ugly head when something compresses the nerve. That pinch results in pain (and sometimes weakness) up and down the leg, usually just on one side.

“People describe it in all sorts of ways — burning, tingling, numbness, radiating pain or electric shock sensations,” Dr. Thomas says. “Those sensations can come right out of the blue.”

The pain can be severe and might even make it hard to walk or stand.

Causes of sciatica

A variety of problems can put the squeeze on your sciatic nerve. Some of the more common culprits include:

• Herniated (slipped) discs between the vertebrae pressing on the sciatic nerve.
• Spinal stenosis, or narrowing of the spinal canal.
• Spondylolisthesis, when one of the vertebrae slips out of place.
• Piriformis syndrome, which occurs when the piriformis muscle deep in the derriere becomes tight or starts having spasms.
• Pregnancy, which can put pressure on the sciatic nerve — especially during the third trimester.

Sciatica symptoms — or something else?

Sciatica isn’t the only reason for pain in the legs, of course. Other conditions can mimic sciatica:

• Vascular disease: Narrowing of the blood vessels in the legs can cause pain and cramps and might make it hard to walk.
• Peripheral neuropathy: Small nerves in the legs can become damaged, causing burning, pain, tingling or numbness in the foot or lower leg. This type of nerve damage is often related to diabetes, alcohol use disorder or other medical conditions.
• Peroneal neuropathy: An injury to the peroneal nerve below the knee can cause weakness and make it hard to lift the foot.

How can you tell if you’re dealing with sciatica or something else? Sciatica tends to affect the length of the leg, not just the foot. And most often, that pain radiates downward from top to bottom, Dr. Thomas says.

Another clue: Sciatica usually strikes just one side. “If you have pain in both legs, it is less likely a disc herniation, but more likely due to degenerative changes like spinal stenosis,” he says.

Sciatica treatment

If you suspect you have sciatica, should you drop everything and run (er, limp) to the doctor’s office? It’s usually not an emergency, Dr. Thomas says. But it’s a good idea to get a physical exam to find out what’s going on.

If you have weakness in the leg, or bowel and bladder problems, get checked out soon, he adds. Those symptoms could indicate a more serious problem that could lead to permanent nerve damage if you don’t get prompt treatment. 

Sciatica usually goes away in time and without serious complications — though it might take a few weeks or months, Dr. Thomas says. While you wait (impatiently), there are several ways to manage the pain:

1. Oral medications: Anti-inflammatories, prescription pain medications, steroids and muscle relaxants can all be used to relieve pain and improve mobility in people with sciatica. “The right medicine depends on your symptoms,” Dr. Thomas says.
2. Physical therapy: Stretching exercises and other physical therapy maneuvers can ease pressure on the pinched sciatic nerve.
3. Spinal injections: Injecting anti-inflammatory medications and anesthetics into the spine can calm swelling and help you move more easily.
4. Surgery: When people don’t respond to other treatments or have serious problems like loss of bladder control, surgery might be necessary to repair the spine problems. But that’s a worst-case scenario, says Dr. Thomas. “We can treat nearly 90% of people without surgery.”

Now sciatica isn’t such a mystery. It’s still no fun, but at least you know what you’re dealing with — and relief is in sight.