What Causes Sciatica and How Do You Know If You Have It?

What causes sciatica? Sciatica commonly develops when a nerve root in the lower back that contributes to the sciatic nerve becomes irritated or compressed. This can cause pain that travels from the lower back or buttock into one leg and may also cause numbness, tingling or weakness.

But not every pain that runs into the hip or leg is sciatica. The first step is figuring out where the symptoms are coming from and why.

What Is Sciatica?

Sciatica isn’t really a single disease. It’s a term used to describe symptoms involving the sciatic nerve pathway, usually because one or more nerve roots in the lower spine are irritated or compressed.

The sciatic nerve is the largest nerve in the body. Nerve roots leave the lower spine and ultimately contribute to the sciatic nerve, which travels through the buttock and down the leg.

When one of these nerve roots becomes irritated or compressed, symptoms can travel along the nerve pathway rather than staying only in the lower back.

That’s why someone with sciatica may say, “My back doesn’t really hurt that much — it’s my leg that hurts.”

The source of the problem can still be in the lower spine.

What Does Sciatica Feel Like?

Sciatica doesn’t feel exactly the same for everyone.

Symptoms may include:

• Low-back pain
• Buttock pain
• Pain traveling down one leg
• Burning pain
• Sharp or shooting pain
• An electric or shock-like sensation
• Numbness
• Tingling or pins and needles
• Leg or foot weakness

Some people primarily feel pain. Others are more concerned about numbness or tingling.

Symptoms commonly affect one side, although the exact location can depend partly on which nerve structures are involved.

The pattern of the symptoms can provide important clues about their source.

What Causes Sciatica and Sciatic Nerve Pain?

Several conditions can irritate or put pressure on nerves in the lower spine.

Herniated or Bulging Discs

The discs between the vertebrae provide cushioning and allow movement of the spine.

When disc material bulges or herniates, it can sometimes irritate or compress a nearby nerve root. When that nerve contributes to the sciatic nerve, pain, tingling, numbness or weakness can travel into the leg.

However, finding a disc bulge on an image does not automatically prove that it is causing someone’s symptoms.

The examination, symptoms and imaging findings need to make sense together.

Learn more about the difference between a bulging disc and a herniated disc.

Spinal Stenosis

Spinal stenosis means there is narrowing in an area through which nerves travel.

If that narrowing affects nerves in the lower spine, it can contribute to leg pain, numbness, tingling or weakness.

Some people with lumbar spinal stenosis notice that symptoms become worse with prolonged standing or walking and improve when sitting or bending forward.

Degenerative Changes

Age-related changes can occur in the discs, joints and bones of the spine.

In some people, these changes reduce the amount of space available around a nerve root and may contribute to irritation or compression.

Again, an X-ray finding by itself doesn’t necessarily explain a person’s pain. Structural changes can exist without producing symptoms.

That’s one reason the examination matters.

Why Can Sitting Make Sciatica Worse?

Some people notice that their leg pain becomes worse during a long workday, while driving or after sitting for an extended period.

Sitting changes the mechanical demands placed on the lower back. Depending on the underlying problem, certain positions may aggravate an irritated nerve or disc.

That doesn’t mean sitting itself is necessarily the underlying cause.

That’s what needs to be evaluated.

Is Every Pain Down the Leg Sciatica?

No.

Hip problems, muscular problems, peripheral nerve conditions and other disorders can sometimes produce symptoms that patients describe as “sciatica.”

Where the pain begins, where it travels, what movements aggravate it and whether there is numbness, tingling or weakness all help differentiate possible causes.

This is why diagnosing yourself based only on where you hurt can be misleading.

Two people can both say, “My leg hurts,” while having very different underlying problems.

How Do We Evaluate Sciatica?

At West Coast Chiropractic Center here in Carlsbad, we don’t want to simply hear “pain down the leg” and assume we know what’s wrong.

Understand first. Treat second.

An evaluation may include a detailed history and appropriate orthopedic, neurological, chiropractic and functional testing.

We want to understand questions such as:

• Where does the pain start?
• How far down the leg does it travel?
• Is there numbness or tingling?
• Is there weakness?
• Does sitting make it worse?
• Does standing or walking make it worse?
• Does coughing or sneezing aggravate it?
• Was there an injury or auto accident?
• Is the problem improving, staying the same or getting worse?

We may also evaluate strength, sensation, reflexes, movement and other neurological or orthopedic findings when appropriate.

The goal is to determine whether the symptoms appear consistent with nerve involvement and what may be contributing to it.

Do You Need an X-Ray or MRI for Sciatica?

Not everyone with sciatica needs imaging.

For many people with new sciatic-type symptoms and no concerning neurological or other warning signs, imaging isn’t routinely necessary at the beginning.

The decision depends on your history, examination findings, severity and duration of symptoms, neurological findings, previous injuries and whether the results would change how your condition is managed.

At West Coast Chiropractic Center, we have digital X-ray capability when X-rays are clinically appropriate. X-rays are useful for evaluating bones and certain structural findings, but they don’t show spinal discs and nerves the way an MRI can.

An MRI may be considered when there are significant or progressive neurological findings, when a serious underlying condition is suspected, or in selected patients with persistent symptoms when additional information about the discs, nerves and surrounding tissues would affect the next step in care.

Can Chiropractic Care Help Someone With Sciatica?

That depends on what’s causing the sciatica.

There isn’t one treatment that’s appropriate for every patient with leg pain.

After an examination, conservative care may be considered when the findings indicate that it is appropriate.

Depending on the individual patient and the suspected cause, a care plan at West Coast Chiropractic Center may include chiropractic adjustments, movement or rehabilitation recommendations and other conservative approaches.

For selected patients with disc-related conditions, spinal decompression may also be considered.

The important point is that treatment should follow the evaluation — not the other way around.

What About Spinal Decompression for Sciatica?

Spinal decompression is a form of traction-based therapy available at West Coast Chiropractic Center.

We may consider lumbar decompression for selected patients when their examination and clinical findings suggest that a disc-related or other mechanical spinal condition may be contributing to their symptoms.

It isn’t automatically appropriate just because someone has pain traveling down a leg.

That’s why we evaluate the patient first.

When Is Sciatica an Emergency?

Most sciatica isn’t a medical emergency. However, certain symptoms can indicate significant nerve involvement or another serious problem.

If you’re unsure whether your symptoms could represent an emergency, seek prompt medical evaluation.

Will Sciatica Go Away?

Many cases improve over time, particularly with appropriate conservative management, but recovery varies considerably depending on the cause and severity.

That’s why simply waiting indefinitely isn’t always the best strategy, particularly when symptoms are severe, worsening or accompanied by neurological changes.

If symptoms continue to interfere with sitting, driving, walking, sleeping, working or exercising, an evaluation can help determine what’s going on.

Why Does My Sciatica Keep Coming Back?

Recurring symptoms deserve another question:

Repeated episodes can have different contributing factors.

The goal shouldn’t simply be to label every episode “sciatica.” It should be to understand the underlying problem, what activities or positions are aggravating it and whether anything has changed.

That’s particularly important when symptoms begin traveling farther down the leg or numbness, tingling or weakness develops.

When Should I Have My Sciatica Evaluated?

Consider an evaluation when pain is persistent, worsening, repeatedly returning or interfering with normal activities.

You should also seek appropriate evaluation if you’re developing numbness, tingling or weakness.

At West Coast Chiropractic Center here in Carlsbad, we see patients who arrive saying, “I have sciatica,” but our job isn’t simply to accept the label.

Our job is to determine what the examination tells us.

If your findings indicate that you’re a candidate for conservative chiropractic care, we’ll explain why and discuss your options.

If we believe additional imaging or another type of healthcare provider is appropriate, we’ll explain that too.

We test, we don’t guess.

Frequently Asked Questions About Sciatica

The First Step Is Understanding the Problem

Pain running from your back or buttock into your leg can make sitting, driving, working, exercising and even sleeping difficult.

But “sciatica” tells us what you’re experiencing more than it tells us exactly why it’s happening.

That’s the question we want to answer.

If you’re dealing with persistent or recurring sciatic-type pain, numbness or tingling, schedule an evaluation with West Coast Chiropractic Center here in Carlsbad.

We’ll start by listening, examining the problem and determining what the findings tell us.

Understand first. Treat second.