The Real Story Behind What’s Causing Your Sciatica

Are you confused about why you’ve got Sciatica – and wondering what you can do about it?

About 40 percent of Americans suffer from Sciatica at some time in their lives. Unfortunately, it is more common in people as we age. 

This blog helps you understand Sciatica – the causes and symptoms, and we explain how to get out of pain quickly. 

What Is Sciatica?


The sciatic nerve originates at the spinal cord, moves through the hips, and buttocks and divides and moves into both legs. It is one of the most critical (and the longest) nerves we have in the human body. It directly affects the sensations we feel in our legs and controls their movement.

When the sciatic nerve is inflamed or irritated for any reason, it causes the tell-tale symptoms of Sciatica to appear. You don’t need to ask whether you’ve got it. You’ll know because you’ll feel intense pain in the buttocks, back, and legs, and you may also experience numbness, tingling, or weakness in the muscles in your legs.

Sciatica usually occurs in response to an injury to the sciatica nerve itself or the surrounding area – such as the vertebrae in the lower back.

What Are The Symptoms Of Sciatica?

The unmistakable symptoms of Sciatica are very specific and usually appear in the form of pain that travels down through the lower back region, through the buttocks, and into the legs. Any movement that involves the lower back, hips, or legs tends to exacerbate the pain and cause more intense symptoms.

Many patients also report a “pins and needles” sensation accompanied by uncomfortable tingling in the feet or toes. Others say weakness in the leg muscles and numbness in the feet and legs along the sciatic nerve route. There may even be a complete loss of movement and sensation in areas along the path that the sciatic nerve travels down your leg in severe cases.

Although rare, in extreme cases, Sciatica may also cause bladder or bowel incontinence. This complaint is symptomatic of CES (cauda equina syndrome), where nerve roots in your spine can’t send messages from your brain anymore due to swelling. 

What Causes Sciatica?


Several conditions related to the spinal cord and the nerves connected to it can cause Sciatica. These conditions include tumors of the sciatic nerve. Traumatic injuries may also cause it, such as falling or being involved in a road traffic accident either as the driver, passenger, or pedestrian. Other types of collisions, accidents, and sporting injuries can also cause damage to the sciatic nerve or surrounding tissue, joints, or vertebrae. It’s also common in pregnant women due to lower back problems caused by the weight of their growing baby.

Some of the most common causes of Sciatica we see at the Level 4 clinic include: 

Herniated discs: Cartilage separates the vertebrae of the spinal cord. These soft pads that protect the spine are composed of a thick material that allows flexibility and cushion movement. A herniated disc happens when the first cartilage layer is ruptured. The material within the disc then compresses the sciatic nerve and causes numbness and pain. Slipped discs are a common cause of Sciatica in many of the patients we see. 

Spondylolisthesis: This is another associated ailment associated with a degenerative (worn) disc. It happens when a vertebra or spinal bone extends over another. This overlap then pinches the nerves leading to the sciatic nerve.   

Spinal stenosis: also referred to as lumbar spinal stenosis, leads to narrowing of the lower part of the spinal canal. This narrowing exerts pressure on the spine as well as the sciatic nerve.  

Piriformis syndrome: is one of the rarer neuromuscular ailments. The piriformis muscle (that runs through your butt) tightens or contracts involuntarily, leading to Sciatica. The piriformis muscle links the lower spine to the thighbones. It can get exacerbated if you sit for long periods. It’s also susceptible to injury from falls, sports, or road traffic collisions. 

How We Diagnose Sciatica

First off – no two cases are the same. The symptoms of Sciatica vary from one individual to another, depending on how the inflammation of the nerve occurred. But we always start with your complete medical history to look for clues as to what caused your sciatic nerve to become injured or inflamed. Next, we check for any adjacent injuries, areas of tenderness, or pain. Finally, we get you to describe the pain you feel, what makes it better and worse, and how it started initially. 

The physical exam to check for Sciatica includes testing the reflexes in your legs and measuring your muscle strength. We may also ask you to perform stretching and movement exercises to determine what type of movement increases your pain.

If the cause of your Sciatica isn’t immediately apparent, then your doctor may want to conduct nerve tests to find out how the sciatic nerve is transmitting nerve impulses and to look for any abnormalities. These tests can help diagnose the root cause – the area that is affected and the extent to which nerve function is affected. Your doctor may also refer you for a spinal X-ray, MRI, or CT scan.  

These imaging tests examine the spine in detail, so your doctor can diagnose the exact cause of your Sciatica. 

In the case of an MRI scan, radio waves and magnets – believe it or not – provide your doctor with an incredibly detailed picture of your spine. CT scans do the same thing – and allow your doctor to look inside your body and examine your spine in detail, except CT scans do so using an advanced form of X-ray. 

Your doctor can also perform a CT myelogram – where a dye is injected into the spinal cord to provide better clarity on the imaging. But most cases of Sciatica can be dealt with at your Physical Therapists office – without the need to see a medical doctor. 

How To Treat Sciatica and Inflammation of the Sciatic Nerve

After your diagnosis of Sciatica is confirmed, your doctor will provide you with information on how best to manage it and reduce the pain. In mild cases, you should be able to continue with your daily routine as much as possible. And this is key because inactivity and lying horizontal (in front of Netflix) can exacerbate the symptoms. Here’s what they’re likely to recommend:

Over-the-counter medication: Your physician may prescribe Advil or other anti-inflammatory medicines such as aspirin for pain and swelling. These drugs reduce inflammation in the body, and they can help reduce inflammation around the sciatic nerve. But ideally, they should be used as a last resort as they can have adverse side effects when used for longer than three days. Follow your doctor’s advice. 

Cold packs: Ice packs (bags of frozen peas or the ice for your margaritas) can be rolled in a towel and applied to the affected area to relieve pain and swelling. Try for 15-20 minutes, 3-4 times per day. 

Heat packs: In the same way that you can use ice packs to reduce swelling, heat can be helpful to soothe and relieve pain. You may want to alternate between the two for different benefits. But we wouldn’t advise using heat therapy until you are sure of the cause of your Sciatica. Then, you are under the care of a doctor or physical therapist who can advise you on whether heat or cold is appropriate for your specific situation. 

Exercise: The more active you are in your daily life, the less likely you will suffer from a condition like Sciatica. Exercise can also be helpful for pain relief. Physical activity, especially if it’s outdoor in the sunshine, releases endorphins. Endorphins are nature’s natural pain relievers. Low-impact exercise like stationary bike cycling, swimming, or walking can be helpful if you’re able. 

Stretching exercises: Certain therapeutic stretching exercises, which a physical therapist can teach you, are an excellent way to combat the symptoms of sciatic nerve pain. But make sure you get a trained therapist to take you through the exercises first. Don’t try doing them at home on your own – as you could worsen your situation and make the pain worse. 

Additional medication: Your doctor may consider prescribing additional medication like muscle relaxants or even antidepressants if you have a severe case of really disabling Sciatica. 

Epidural steroids: In severe cases, your doctor might inject corticosteroids into the epidural region of the spinal cord. 

Surgery: As a last option only, surgery might be recommended for severe cases where bladder or bowel movements are impaired or because of excessive impairment in movement.

Pilates: It is highly recommended that those suffering from sciatica try Pilates. Pilates provides gentle movement that allows exercise without igniting harrowing sciatic pain. Engaging with Pilates prevents further damage as, unlike harsh exercise, you will not over stretch the area. You can find out more about our Pilates (and how it can be the perfect bridge into physical therapy) on our designated Pilates blog page.

Physical Therapy To Treat Sciatica

We saved the best until last.

Suppose you want to avoid dangerous surgeries, medication with unpleasant side effects, and steroid injections. In that case, one of the best ways to treat Sciatica – without medication or other invasive treatments like steroid injections or surgery is to undergo physical therapy with a therapist who specializes in treating sciatic nerve problems. 

We strengthen the back muscles and posture and help prevent future flareups of Sciatica. At Level 4 Physical Therapy, Sciatica is one of our areas of particular interest. We have many years of experience in helping patients overcome sciatic nerve pain and the associated symptoms.  Get in touch with us through our inquiry page anytime! 

Latest posts by Oscar Andalon, DPT, STC, MTC, CSCS, CF-L1, MWOD, USAW, FMS/SFMA (see all)

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