Misconceptions About Sciatica Pain
The term sciatica is often used incorrectly to explain leg pain, low back pain and other sciatica symptoms.
It’s a condition so widespread that many people think they can self-treat it or just follow another person’s advice for how to relieve the pain.
However, as this article will explain, there are many myths and misconceptions about sciatica, and patients are well-served to fully understand what can cause sciatica, warning signs that it may be a dangerous condition, and the full range of treatment options, including sciatica exercises.
Sciatica is a relatively common form of leg pain that is often misunderstood by patients. There are frequent misconceptions about what the term sciatica means, why sciatica occurs and how to find relief from the low back pain and leg pain.
The Truth: Sciatica is a Symptom, Not a Diagnosis
Contrary to what many patients believe, sciatica is actually a set of symptoms rather than a diagnosis for what is causing the pain.
Especially for more severe cases, the cause of the low back pain and leg pain needs to be correctly addressed in order to relieve discomfort.
Sciatica means that a patient’s sciatic nerve is being compressed by another spinal structure, usually causing pain in the low back, on one side of the rear and/or down the back of the leg. Sciatic nerve irritation usually occurs at the L5 or S1 level of the spine.
The clinical diagnosis (and the focus for treatment) would be whatever problem is actually causing the nerve compression and the sciatic pain.
The most common low back problems that cause sciatica are:
- Lumbar disc herniation – where the inner core of a spinal disc in the low back extrudes and places pressure on a nerve root; also called a pinched nerve, slipped disc, bulging disc or protruding disc
- Lumbar degenerative disc disease – when weakened discs in the low back allow excess motion in the spine and cause irritation of the nerve roots
- Isthmic spondylolisthesis – where one vertebral body slips over another and pinches a nerve root
- Lumbar spinal stenosis – in which a narrowing of the spinal canal in the low back pinches nerve roots, sometimes as the result of a bone spur
- Lumbar subluxation – a term describing an altered position of the vertebra in the low back and the functional loss that results
- Other causes – Although less common than those listed above, there are several other conditions that can cause sciatica and require medical attention. For example, patients who have a spinal tumor or infection should seek help immediately.
Truth: The Sciatica Experience Can Be Different for Each Patient
Sciatica pain can run from the low back, down the back of each leg and sometimes into the feet and toes. Other sensations associated with sciatica may include tingling and/or a burning or prickly feeling, usually only on one side of the body.
Patients typically feel different types of sciatic pain depending on the location of the nerve compression.
The severity and duration of pain from sciatica also vary among patients. Some find sciatica pain severe and debilitating, while others experience it as irritating and intermittent.
Many patients recover from an episode of sciatica within a few weeks, but there is no hard and fast rule.
Depending on the particular cause of the patient’s sciatica, the leg pain or low back pain could worsen over time and/or take much longer to be relieved.
Truth: Serious Problems and Damage Can Occur (Though Rare)
Pain from sciatica results from damage to the patient’s nerve tissue.
In the vast majority of cases, the nerve damage is not permanent.
However, the following signs indicate that there may be a more serious problem that requires immediate medical attention:
- Patients who feel weakness or numbness may require surgery, and any patient experiencing these symptoms should seek professional attention.
- Patients who experience bowel or bladder incontinence (inability to control the bowel or bladder) and/or increasing weakness or loss of sensation in the legs should see a doctor immediately.
Truth: The Sciatic Nerve Runs From The Low Back To The Toes
The sciatic nerve is located in front of the piriformis muscle (deep in the rear), including the lowest two nerves that exit from the lower spine (L4 and L5) and the first three sacral nerves (S1, S2 and S3).
Each of the nerves has two branches, one on each side of the spine. The root of each nerve exits the spine between two vertebra in the low back, travels down the back of each leg, and branches out to the leg and into each foot. The sciatic nerve is the largest single nerve in the human body.
Sciatic pain that radiates along this nerve can be excruciating and debilitating for many patients.
Truth: Sciatica Leg Pain is Caused by a Problem in the Low Back
Patients often feel leg pain from sciatica, which leads them to believe that there is something wrong with their legs.
However, because the sciatic nerve extends through the low back, legs and feet, a problem causing nerve compression in the low back can cause low back pain and feelings of pain through the legs, feet and sometimes the toes.
Truth: The Causes of Sciatica Are Not Genetic
As explained above, sciatica is the result of a problem in the low back that can develop from aging or from a spinal injury. These conditions are not passed on genetically, as patients may mistakenly believe.
There is no truth to the idea that sciatica is handed down from generation to generation.
Truth: Piriformis Syndrome Feels Like Sciatica – But It Isn’t The Same
Piriformis syndrome is a condition that is often confused with sciatica. When the piriformis muscle becomes tight, it can irritate the sciatic nerve. This causes sciatica-like pain, tingling and numbness that often run from the low back to the rear, down the leg and into the foot.
Although the discomfort from piriformis syndrome feels similar to sciatica, the two have different causes. With piriformis problems, the pain is not caused by a compressed nerve root where it exits the spine as occurs with true sciatica.
Correctly identifying the cause of the pain is important because the treatments for each type of pain tend to be very different.
Truth: Pain From Arthritis and Joint Problems Is Not True Sciatica
The pain from arthritis or other joint problems is actually more common than sciatica, and they are often confused.
In reality, sciatica and arthritis are classified as different types of pain. Radicular pain like sciatica is caused by a pinched nerve.
In contrast, referred leg pain from arthritis is dull, achy and often moves around and varies in intensity.
Although the leg pain from arthritis may feel similar, it is not truly sciatica. Distinguishing the correct problem is important because the treatments for each type of pain often differ.
Myths About Sciatica Options
Patients who have sciatica are best served by a treatment plan that is individualized based on the patient’s symptoms, diagnosis and response to various treatments.
The process of finding relief from low back pain and leg pain associated with sciatica can often require some trial and error. Some patients may find certain treatments more effective than others.
Truth: The Causes of Sciatica Must Be Treated on an Individualized Basis
Because of the many conditions that can compress nerve roots and cause sciatica, one patient’s treatment options may be very different than those of another.
A combination of treatment options is often the most effective course, and many patients will try some combination of the following treatment options:
- Physical therapy and chiropractic treatments can help relieve pressure on the sciatic nerve.
- Alternating heat therapy and ice massage therapy can help to relieve acute pain from sciatica.
- Anti-inflammatory medications like non-steroidal anti-inflammatory drugs (NSAIDs, i.e. ibuprofen, naproxen or COX-2 inhibitors) or oral steroids may be used to help relieve inflammation.
- Epidural steroid injections can reduce inflammation around the nerve root and the associated low back pain.
- To help control the low back pain and leg pain while undergoing other nonsurgical treatments, patients may take pain medications.
- Surgery may also be considered as a treatment option, usually (but not always) following a course of conservative treatments.
It is important to note that what works for one patient may not work for another, even if they have the same back problems.
For example, a patient who has sciatica from a herniated disc may not find relief from conservative treatments and then will choose to undergo lumbar surgery.
Another patient with sciatica from a similar type of herniated disc may find sufficient low back pain and leg pain relief through conservative treatments, including physical therapy, chiropractic, heat and ice therapy, injections and/or medications.
Truth: Sciatica Can Last For Much Longer, Depending On The Cause
Many cases of sciatica go away within a few weeks using conservative treatment methods. However, this is not the case for all patients. For some, sciatica can last much longer, even for several months.
After back problems are diagnosed, the duration and intensity of treatment will need to be adjusted on a patient-by-patient basis.
Truth: Surgery May Be The Best Treatment Option For Some Patients
Patients should avoid having surgery too soon or too late. Although many patients hope to avoid surgery, for some, surgery might be the best (and quickest) option for pain relief.
If the conservative (non-surgical) treatments (such as exercise and physical therapy, chiropractic, injections, etc.) have not helped, the patient’s pain is severe, or if the patient has lost a significant amount of function, surgery may be considered as the most effective treatment.
The appropriate surgical procedure depends on the condition causing the sciatica.
For example, microdiscectomy (microdecompression) may be useful for a herniated disc, while lumbar laminectomy (open decompression) is a common surgical treatment for spinal stenosis. These two procedures have high success rates for relieving patients’ pain.
Truth: Exercise Is Usually Critical To Help Heal the Problem Causing Sciatica
Some patients believe that staying in bed and avoiding physical activity is the best idea when sciatica occurs. For the initial flare up of sciatica, bed rest is usually fine for a day or two.
However, avoiding activity any longer can typically lead to a downward spiral where episodes of pain lead to inactivity, leading to more pain, and so on.
Without proper exercise, low back muscles become weak and deconditioned, leaving them less able to support the back and the spine.
Keeping the hamstrings flexible by stretching is particularly important for sciatica patients, because tight hamstrings add stress to the low back, which can aggravate low back problems.
Exercise also helps exchange nutrients within the spinal discs, keeping them healthy and preventing injury that can cause sciatica.
Patients should develop a gentle exercise program that includes stretching, strengthening and low-impact aerobic exercise.
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Remember that even after sciatica is relieved and other back problems have been treated, the exercise routine should be maintained to keep the back healthy and to help avoid future problems.
Before beginning an exercise program, patients should always consult a health professional. Once the cause of sciatica is diagnosed, the professional can advise the patient about which exercises will be most appropriate and which should be avoided.
Truth: It Is Best To Consult a Professional Before Self-Treating Sciatica
Patients with sciatica should not attempt to self-treat their condition without consulting a health professional.
Establishing a correct diagnosis is the first step towards sciatica relief, as the sciatica treatment options and precautions are different for each diagnosis.
A professional can also detect any serious problems early on and take action to prevent permanent damage or injury.
As described above, there are many myths about sciatica that patients often believe to be true. However, by gaining a clear understanding of their condition, patients will be better equipped to work with a spine specialist to determine the causes and the best course of treatment for sciatica.
Combining his or her own knowledge with the expertise of a spine specialist is usually a patients’ best strategy for obtaining long term relief from sciatica.
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