There's not always a simple fix for this complex type of pain.
by Featured Provider Arpan Patel on Tuesday, April 12, 2022
Pain can be a bit of a mystery. Where it originates, where it presents and when it comes can give you mixed signals.
Sciatica pain is much easier to pinpoint. It runs along the sciatic nerve from your lower back down your legs. But often, what feels like sciatica, is not coming from the sciatic nerve at all.
“Sciatica is a very general word and a lot of people use it very differently,” says Arpan Patel, MD, a pain management physician at The Iowa Clinic’s West Des Moines Campus. “The misconception is that sciatica always originates from the sciatic nerve. That’s not always true.”
Sciatica pain comes from many places.
It is true that sciatica involves some sort of low back or buttocks pain that radiates into the leg. But the source of that pain can be elsewhere than the sciatic nerve.
“It’s really just nerve pain,” Dr. Patel says. “It can happen at the level of the spine, the buttocks or the upper thigh. In any of those three situations, the pain follows a similar pattern down the leg.”
Other potential causes are compression from arthritis, nerve entrapment in your upper thigh or contractions of the piriformis muscle, which is in your buttocks above the sciatic nerve.
“The most common cause of sciatica is actually from a disk herniation in the lumbar spine, usually at the L5,” Dr. Patel says. “We call that radicular pain because it happens at the level of the spinal cord and radiates down the spinal nerve root to your legs.”
There’s treatment beyond at-home sciatica stretches.
The first thing you’ll find when searching for answers to the pain, numbness, tingling and muscle weakness of sciatica is a lengthy list of stretches and exercises. That can deceive you into thinking your sciatica can be quickly cured on your own.
Stretching and strengthening exercises are an important part of sciatica pain treatment. Depending on the severity and duration of your pain, you may need much more to find lasting relief.
Physical therapy is the foundation.
That’s true regardless of where your sciatica — or sciatica-like — pain stems from. A physical therapist can show you the ropes and help you perform sciatica stretches and exercises properly.
“Initially, regimented physical therapy is always good. It helps you understand the sciatica exercises you need to do and what kind of rigor you need to use,” Dr. Patel says. “Lumbar flexion and extension exercises are helpful. And there are a number of ways to stretch and release the piriformis muscle.”
After you finish your work with a physical therapist, you can confidently perform your routine on your own. And you should. Even if they don’t fully cure your pain, sciatica exercises are important as you pursue other aspects of pain management.
Sciatica pain medication may be in the mix.
Serious sciatica pain is debilitating. Over-the-counter options like ibuprofen or naproxen often can’t cut it. For severe pain, you may receive prescription painkillers, muscle relaxants or even fast-acting steroids to reduce swelling and inflammation in the nerves.
“Sciatica-like pain is typically nerve pain. In that situation, nerve pain medication is also a good idea,” Dr. Patel says.
These medications can help manage pain in the short-term when others fail or offer relief until you’re ready for other treatments.
Epidurals are long-term answers.
An epidural into the space near your spine and pinpointed to the source of your sciatica provides more lasting relief.
“An epidural should last at least three months. And every time you come back for a repeat injection, you should be better off than you were before because you’re making progress even when it’s gradually improving pain,” Dr. Patel says. “An epidural is not a curative procedure, but it helps your body heal on its own.”
For some, an epidural offers mixed results or lacks the effectiveness you seek. But epidurals are versatile treatments and can be given in several ways. Just because one didn’t work for you in the past doesn’t mean you won’t benefit from a repeat injection.
“Most people don’t realize that not all epidurals are created equal. There are a lot of different ways to do the injection,” Dr. Patel says. “You can go through the tailbone or in the middle or off to the side of the spine. You can use a catheter to administer medication. It can be very targeted to where it needs to go.”
Spinal cord stimulation is an emerging treatment.
Spinal cord stimulation is a relatively new sort of treatment that improves with every year, Dr. Patel says. It’s typically reserved for the most severe and chronic cases of sciatica pain that don’t respond to all the other more conservative treatments.
A pain doctor places two wires into the same space where an epidural might go. Instead of a steroid or medication, electricity is sent to the source of pain. The electrical stimulation blocks the pain signals from the leg before they go up to your brain.
“That is going to be the most advanced treatment for sciatica, especially if you’ve already had surgery or want an alternative to surgery,” Dr. Patel says.
Self-care can help keep sciatic pain away.
Most cases of sciatica heal on their own over time. And the treatments help manage or relieve the pain until your body’s healing process is complete. There are still other things you can do to manage flare-ups and minimize the chances of recurring sciatica pain.
Cardio is always encouraged — whether that’s going for a walk or a jog. For strength training, Dr. Patel discourages squats, cleans or other overhead lifts and recommends machine-based exercises over free weights.
“With free weights, you’re using a lot of collateral muscles. While that’s great for building muscles, it’s not great if you’re trying to recover,” he says. “Machines help control your range of motion and reduce the stress on your back.”
If your sciatica pain returns, don’t hesitate to visit a doctor.
“When you’re not able to do what you need to do on a daily basis, that’s when sciatica warrants a visit, whether that’s with your primary care provider or at our Spine Center,” Dr. Patel says. “Sciatica is not a diagnosis, but a pattern of pain. And it’s our job to find out what’s causing it to get you the right treatment that provides relief.”