Severe Sciatica and Lower Back Pain: Causes and Treatment

Sciatica pain takes place in the lower back and usually extends through the left or right leg. It can result in unique and sometimes severe aches, causing an understandable alarm.

We’re here to tell you, don’t panic. “Although sciatica can be painful and oftentimes exhausting, a majority of sciatica-related injuries are easily resolved with the assistance of your physical therapist and a few exercises,” says Dr. Bhavik Sheth, Physical Therapist.

In this article, we will further define what sciatica is, why you shouldn’t panic, and discuss a few common causes and treatments for sciatica.

What Is Sciatica Pain?

The sciatic nerve is the largest nerve in the human body, extending all the way from the lower lumbar spine (low back) to the big toe. Its primary duty is to direct the movement of the back and leg muscles. The top of the sciatic nerve is composed of nerve roots located in the low lumbar spine.

When one or more of these nerve roots are compressed, sciatica occurs and may worsen with lifting, sitting, or lying down, interfering with our ability to drive, walk, work, and sleep. So, what are some common sciatica symptoms? Sciatica pain will more than likely be accompanied by a combination of the following:

• Low back pain
• Hip pain
• Leg pain
• Burning or tingling sensations down one leg
• Consistent pain on one side of the buttock
• Weakness and difficulty moving the leg or foot

As irritating these symptoms can be, they are the cause of an underlying injury. Therefore, to effectively resolve sciatica pain, your doctor will more than likely perform a sciatica test and attempt to find the root cause of discomfort.

Common Causes of Sciatica Pain

As mentioned above, sciatica occurs when a nerve root located in the lower lumbar spine has been pinched. Pinched nerve roots are typically the result of one of the following injuries.

Herniated Discs

Herniated intervertebral discs in the lumbar spine are commonly the culprits behind sciatica. Intervertebral discs look like short cylinders and act as a cushion between each vertebra, or bone, in our spine. The discs’ rigid exterior and jelly-like interior prevent painful bone to bone contact during impact, but age, heavy lifting, frequent sitting, and other natural causes deteriorate the protective exterior.

When the exterior is compromised, the soft interior seeps through and touches spinal nerves, irritating or placing pressure on them, causing sciatica. Since the lower back bears a majority of our body weight, herniated discs are extremely common in the lumbar spine—where the sciatic nerve begins.

Bone Spurs

Bone spurs refer to the overgrowth of a bone’s edge, typically near the joint. These growths are usually the result of worn-down cartilage by the joints of the spine or weakened ligaments from age. Weak ligaments struggle to hold joints together, so they thicken, and over time, transform into bony flakes. Bone spurs are usually harmless, but if they push up against nearby structures such as the nerves, they can lead to painful conditions like sciatica.

Spondylolisthesis

Spondylolisthesis is a slipped spinal bone, or vertebra, and is most common in the lower back. This slip is often the result of spondylosis—a crack or fractured piece of vertebra usually occurring in young children or high-impact athletes. This crack or fractured piece of bone can shift forward, backward, or over another spinal bone. If the injured bone shifts too far, it places excess pressure on nerves, inducing an episode of sciatica.

SEE ALSO: Best Mattresses for Spondylolisthesis

Treatment for Sciatica Pain

In most cases, your doctor will recommend low-impact exercise to naturally manage or completely resolve the above causes. However, chronic pain may warrant more serious procedures like steroid injections or surgery. Let’s discuss the purpose behind each of these treatments.

Low-Impact Exercises for Sciatica Pain Relief

Exercises recommended to relieve sciatica include basic stretching routines and walking.

Stretching Routine

Gentle stretches loosen up your back and hip muscles to prevent and reduce spasms, while also protecting the neutral position of your spine. If your sciatica or lower back pain is causing frequent muscle spasms or limiting your daily activities, try practicing this routine every 1 to 2 hours.

• Lie face down on a hard surface, place your arms at your side and turn your head to the right or left. Remain in this position for a few minutes, practicing slow and controlled breathing. You may feel the pain centralize, or move closer to the middle of your back. Once you are comfortable and calm, move to the next stretch.

• Remain on your stomach, but prop your elbows up as if in a half upward dog position. Only your chest should be lifted from the ground. You will feel a slight bend in your lower back. Once again, practice slow and controlled breathing. You may feel the pain move toward the middle of your spine and find slight relief. Hold this stretch for a few minutes then return to the face-down position. Repeat this cycle 3 to 5 times.

• Once you have returned to the face-down position for the final time, slide your hands below your shoulders and use them to completely lift your upper body off the ground, as if in a full upward dog position.

To do this stretch, keep your hands flat on the ground beneath your shoulders. Then extend your arms to push your head, chest, stomach, and hips off the ground, so your chest points in front of you and your lower back arches. In this position, the front of your legs and feet will remain resting flat on the ground. Shift from the first, face down position to this stretch 10 to 15 times. It is easy to tense up during this exercise, so focus closely on relaxing your lower back and controlling your breathing. You may feel your pain centralize or decrease.

If you find it difficult to stand up, return to the last scratch and bend one knee in at a time until you are steady on your feet in a crouched position. Next, slowly rise to a standing position.

Walking

An episode of back pain may move you to migrate toward your bed for rest, but this isn’t always the best choice. Lying still for prolonged periods of time will stiffen your back muscles and worsen sciatica. If you are experiencing intense pain, 1 to 2 days of rest are okay, but be sure to weave in some low-impact exercise, such as walking, as soon as you are able.

If done correctly, walking can alleviate sciatica and low back pain, but if done incorrectly, it will place pressure on your lower back and intensify sciatica symptoms. Let’s go over a few ways to optimize your walking regimen.

• Walk at a comfortable pace and focus on controlling your breathing. You may consider humming while walking to ensure you are not overexerting yourself. When you overexert yourself, proper posture is compromised.
• Shorten your stride. Long strides may place excess pressure on a herniated disc and cause a larger stretch to the nerve. Your foot should land between your midfoot or heel then roll to the toe.
• Engage your abdominal muscles. This will help your core support some of the weight your lower back muscles carry. It may sound silly but a quick and easy way to engage your abdominal muscles is to pretend someone is going to punch you in the stomach.
• Practice good posture. Keep your head and shoulders lifted and fix your eyes on something in the distance. This will maintain healthy spinal alignment during the impact of each step.

Steroid Injection

If your sciatica pain is chronic or simply unbearable, epidural steroid injections can provide short-term relief lasting an average of 3 months. This may be enough time for your injury to heal on its own.

During spinal injection, a doctor inserts an epidural steroid shot to the affected area, between the spinal canal and spinal cord. The steroid injection contains anti-inflammatory medicine to reduce the inflammation compressing the nerve roots and alleviate severe pain.

Spinal Surgery

Muscle weakness or delayed reflexes in your leg from sciatica is rare, but if left untreated, could become permanent. Therefore, these sciatica symptoms often warrant the expertise of a specialist and sometimes, spinal surgery.

During spinal surgery, an orthopedic surgeon will remove the disc material or bone spur placing pressure on the nerve roots. This type of surgery is minimally invasive and fairly successful, with 90 percent of patients experiencing substantial relief.

Still, the surgery focuses primarily on specific vertebrae and does not guarantee the prevention of additional herniated discs or bone spurs. If you are prone to lower back pain, we recommend doing everything in your power to prevent recurring episodes of sciatica. Let’s take a look at some ways to do so.

Other Ways to Treat Sciatica and Lower Back Pain

• Maintain proper posture. Good posture will remove unnecessary pressure from your lumbar spine, potentially curbing injuries related to sciatica and low back pain. Maintaining your posture is much easier to do when standing than when sitting. If you work a job that requires you to sit all day, consider placing a small pillow at your waistline then adjust it as necessary. A pillow will adequately support the forward curve of your lumbar spine. Practicing proper posture also helps you avoid neck and shoulder pains, as well.

• Invest in a mattress for back pain. The right mattress can make a world of difference. Some beds are not fit to meet the needs of back pain sufferers while others were specifically designed to. The type of mattress you sleep on should be much more than comfortable. It should support your sleeping position, body type, provide pressure relief, and maintain a safe position for your spine—even if you tend to toss and turn.

• Stay active. Regular physical activity will build your stomach, back, and leg muscles, all of which work to support your lumbar spine. Strengthening these muscles will remove unnecessary pressure from your lower back, preventing sciatic pain.

FAQ

Can you use ice and heat to treat sciatica?

Both a cold pack and hot compress are great home remedies to treat sciatica pain. Most medical professionals suggest using a cold pack for the first 72 hours after your pain starts. A cold pack will reduce painful inflammation. Once a majority of your swelling has subsided you can begin using heat. A hot compress increases blood flow to the affected area, facilitating healing. Do not use either any longer than 30 minutes per session.

Can too much walking make sciatica worse?

Too much walking cannot worsen sciatica. Exercise actually releases endorphins—a chemical our body uses to relieve stress and pain. However, if you have a poor walking posture, it may continue to place pressure on the nerve roots of your lumbar spine, intensifying your sciatica. To ensure your walking routine is effective, follow the above advice.

How long can sciatica last?

The amount of time your sciatica lasts depends on the type of injury that’s causing it. Sciatica episodes are most commonly caused by herniated discs which typically resolve within 4 weeks, with the assistance of a medical professional. To prevent future sciatic pain, we recommend routinely following your doctor’s advice, as this will more than likely benefit your overall health as well.

What should I avoid with sciatica?

You will probably have to adjust your normal activities to speed the healing of your sciatica. For instance, work-related activities like extended sitting or lifting more than 30 pounds will place pressure on the lumbar spine where the irritated nerve roots are located. Therefore, these activities will more than likely prolong nerve pain.

How should I lay with sciatica?

A quick and easy way to find comfort during sleep is to utilize a few extra pillows. If you are a back sleeper, place a pillow beneath your knees to alleviate the pressure your hips and legs place on your lumbar area. You may add additional pillows as necessary. If you are a side sleeper, you can relieve this same pressure relief by placing a knee pillow (or head or body pillow) between your legs.

Avoid sleeping on your stomach, entirely. This position comprises the natural arch of your spine and often causes the lower back to descend into the bed which will place even more pressure on the irritated nerves.

Conclusion

Living with sciatica can be challenging, as its pain and (sometimes) debilitating symptoms interfere with our daily living activities. Despite the discomfort it can cause, we suggest keeping a positive mindset—sciatica is almost never as detrimental as it feels. In fact, nearly three out of four patients’ symptoms improve within the first few weeks of starting treatment.

If you experience sciatica or lower back pain, remain calm, and patiently follow the advice of your doctor. Over time, you’ll find relief from discomfort and begin living a happier, pain-free life.