Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. It is typically caused by compression or irritation of the sciatic nerve roots rather than the nerve itself. Sciatica can vary greatly, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It can be periodic, occasional or chronic. While sciatica is a common form of low back pain and leg pain, the good news is that true sciatica usually goes away in 4-6 weeks.
What Causes Sciatica?
The most common cause of sciatica is a herniated disc in the lumbar spine. Disks act as cushions between the vertebrae that make up the spinal column. The soft material inside a disk can bulge or rupture and press on a nerve. However, there are many potential causes of sciatica pain including:
- Lumbar spinal stenosis – Narrowing of the spinal canal that puts pressure on the spinal cord and nerves.
- Spondylolisthesis – A condition in which one vertebra slips forward over another one.
- Pregnancy – The extra weight and increased fluid in the body during pregnancy can cause swelling that compresses the sciatic nerve.
- Muscle tension and spasms in the lower back, buttocks and legs.
- Infection in the lumbar spine.
- Tumors impinging on the sciatic nerve roots.
- Injury or trauma to the spine, leg, pelvis or buttocks.
- Sitting for prolonged periods.
- Diabetes damaging the sciatic nerve.
In most cases, sciatica is caused by a combination of factors rather than a single factor. Aging, injury, poor posture, and overuse can cause changes in the spine over time that affect the nerves. Obesity, smoking, strenuous physical work, and having a sedentary lifestyle are risk factors for developing sciatica. In many cases, no specific cause can be identified. Acute sciatica can follow viral illnesses like the flu.
Is Sciatica Permanent?
For most people, true sciatica caused by a lumbar disc herniation or other problems with the structures of the low back improves significantly or disappears completely within 4 to 6 weeks. About 90% of such cases resolve within 12 weeks. Therefore, sciatica pain generally does not last a lifetime.
However, for some patients, sciatica can become a chronic, long-term condition. Around 20% of people with sciatica end up with some permanent nerve damage. Chronic sciatica is defined as symptoms lasting longer than 12 weeks. Several factors make it more likely for sciatica to become chronic, such as:
- Being over age 40.
- Smoking or lung problems like chronic bronchitis or emphysema.
- Diabetes or other metabolic disorders that damage nerves.
- Work-related tasks like heavy lifting, driving trucks or tractors.
- Lack of exercise and weak core muscles.
- Being overweight or obese.
- Genetic predisposition.
- Ongoing exposure to risk factors like vibrations.
The natural aging process can cause spinal changes over decades that press on nerves. People who have mild sciatica for years are prone to developing chronic sciatic nerve pain. Long-term compression or irritation of a nerve root can lead to permanent nerve damage. In some cases, the exact cause of chronic sciatica is never found. Even after the original injury has healed, problematic nervous system responses continue sending pain signals.
Does Sciatica Ever Go Away Completely?
Many patients want to know, does sciatica completely disappear or could it come back even after treatments? Unfortunately, this varies greatly.
For newer cases of acute sciatica with a clear cause like a herniated disc, symptoms often resolve fully with conservative treatment. But some people are left with residual achiness or the occasional flare up.
Recurrent sciatica is common – up to 40% of people will experience it to some degree within 1-2 years. It may feel like the pain goes away and then comes back again. Recurrent sciatica is often triggered by re-injury, poor posture, degenerative disc disease or attempting too much activity too soon after recovery.
Chronic sciatica with permanent nerve damage is less likely to completely disappear. However, the right treatment can still reduce symptoms dramatically and allow patients to be active. Ongoing management helps control flares.
Even long-standing sciatica that lasts for years can sometimes get significantly better or go into remission. But in general, the longer someone has sciatica pain, the lower the chances of complete resolution. For severe, chronic sciatica, the goal is to reduce the pain to a manageable level and prevent progression.
Factors That Affect Sciatica Prognosis
The prognosis for sciatica often depends on the cause and these factors:
Age
Sciatica is more likely to become chronic in those over age 40 or 50. The natural aging process brings degenerative changes in the lumbar spine.
Coexisting Health Issues
Disorders like diabetes, autoimmune diseases and metabolic imbalances negatively impact nerve health. Patients with these conditions are prone to developing chronic or permanent nerve damage. Obesity places excessive stresses on the spine that can aggravate sciatica.
Occupational Hazards
Jobs that involve heavy lifting, bending and twisting, whole body vibrations from vehicles or prolonged sitting make recurring sciatica and permanent nerve damage more likely.
Spinal Structural Problems
Severe spinal abnormalities or neurological conditions often worsen the long-term outlook. Examples are spinal stenosis, grade 2 or higher spondylolisthesis, tumors pressing on the sciatic nerve, spinal infections and cauda equina syndrome with loss of bladder control.
Multiple Levels of Nerve Compression
Sciatica affecting multiple areas of the nerve roots, such as L3-L4 and L5-S1, increases the risk of chronic symptoms. Widespread nerve involvement is harder to treat.
Delayed Treatment
Beginning appropriate treatment as early as possible, within the first 6 weeks, greatly improves the prognosis before permanent nerve injury sets in.
Smoking
Studies consistently show worse outcomes in smokers. Smoking reduces microcirculation and oxygen delivery to discs and nerves, hampering healing.
Mental Outlook
Patients who feel hopeless and distressed about sciatic pain end up with poorer outcomes. Conversely, a positive mental attitude helps patients stick with physical therapy and exercise regimens that aid recovery.
Diagnosing the Cause of Sciatica
To properly treat sciatica, it’s essential to diagnose the underlying cause. The most common causes are:
Herniated Disc
Also called a slipped or ruptured disc. The gel-like center of an intervertebral disc in the lumbar spine can bulge or break open through a weak area in the tough exterior and put pressure on a nerve root. This occurs most often at L4-L5 or L5-S1 level.
Degenerative Disc Disease
Wear and tear on the spinal discs over time can cause weak spots and injuries. Discs lose height and flexibility. Bone spurs form. Inflammation develops. These aging changes pinch or irritate the sciatic nerve roots.
Spinal Stenosis
Narrowing of the spinal canal or vertebral openings where nerves exit typically due to osteoarthritis and enlarged facet joints. This compresses the nerves and can cause sciatica, numbness or weakness in one or both legs. It usually develops gradually over decades.
Spondylolisthesis
A spinal condition where one vertebra slips out of position onto the vertebra below it. This narrows the spinal canal space and compresses nerves. It develops most often at L4-L5 and L5-S1.
The first step is an in-depth medical history and physical exam of the patient’s symptoms, pain locations, any numbness/tingling and aggravating factors. The strength, reflexes and sensation in the legs will be tested.
Diagnostic tests for sciatica include:
- X-ray – Views bone alignment and structure.
- MRI – Gives a detailed picture of the spine and nerve roots.
- CT Scan – Excellent for assessing bone spurs and spinal stenosis.
- Nerve Studies – Electromyography and nerve conduction studies check how nerves are signaling.
These imaging scans and tests pinpoint the cause of nerve compression and help guide appropriate treatment.
Treatments for Sciatica
In the early weeks of acute sciatica, conservative treatments aim to relieve pain and allow the injury to heal:
- Rest initially for a few days to let inflammation settle down.
- Ice packs can relieve soreness and swelling.
- Over-the-counter anti-inflammatory medication reduces inflammation pressing on the sciatic nerve. Ibuprofen or naproxen are frequently used.
- Pain relievers such as acetaminophen (Tylenol) provide temporary pain relief.
- Chiropractic adjustments improve spinal biomechanics.
- Physical therapy exercises gently stretch and strengthen the back and leg muscles for better support.
If these do not resolve acute sciatica within 6-8 weeks, the following medical treatments may be used:
- Epidural steroid injections deliver anti-inflammatory corticosteroid medication near the compressed nerve root to relieve irritation and swelling.
- Nerve root or spinal injections of numbing medication can interrupt pain signals.
- Prescription medications that calm nerve transmission, relax muscles or mildly sedate the patient, allowing rest.
For severe or chronic sciatica, surgery may be needed to correct the underlying problem compressing the sciatic nerve. Common procedures include:
- Microdiscectomy – Removing the portion of a herniated disc pressing on a nerve.
- Laminectomy – Taking out part of a vertebra to increase space for nerves.
- Foraminotomy – Widening the passage where a nerve root exits the spine.
- Discectomy – Removing an entire damaged disc to reduce compression of nerve roots.
- Spinal fusion – Permanently joining two vertebrae together for stability.
Sciatica Exercises and Stretches
Once the sharp leg and buttock pain of sciatica begins to subside, light exercise can help relieve residual achiness and prevent future episodes. However, all exercises for sciatica should be done cautiously to avoid aggravating inflamed nerves. It’s best to get guidance from a physical therapist experienced in sciatica exercise rehab. Helpful stretches and exercises for sciatica include:
Knee to Chest Stretch
Lying on back, clasp hands behind one knee and bring it up towards chest. Hold for 30 seconds, relax and repeat with other leg. Do 2-4 reps per leg.
Child’s Pose
From hands and knees position, sit back to rest buttocks on heels and torso between thighs. Reach arms forward fully and hold for 30 seconds. Repeat 2-3 times.
Seated Piriformis Stretch
Sit on edge of chair with one leg crossed over the other knee. Lean forward slightly, hold onto foot and gently pull bent leg toward chest until stretch is felt in buttock. Hold 30 seconds, switch legs. Repeat 2-3 times per side.
Garland Pose
Stand with feet wide apart. Squat down with weight mostly in heels. Bring arms inside knees and press elbows against inner thighs to open hips. Hold for 30 seconds.
Bridge Pose
Lie on back with knees bent and feet flat. Tilt pelvis to flatten lower back and lift hips up off floor. Extend spine and avoid overarching. Hold 5-10 seconds, lower down. Repeat 10 times.
Hamstring Stretch
Sit on floor with both legs straight out. Loop towel or strap around ball of one foot. Keeping leg straight, gently pull strap until stretch is felt in back of thigh. Hold 30 seconds, relax and switch legs.
Sciatic Nerve Glides
Lie down and bring one knee up to chest while rotating hip slightly inward. Straighten leg out to natural resting point. Bend knee again and return to starting position. Repeat 10 times then switch legs.
| Exercise | Repetitions | Sets | Frequency |
|---|---|---|---|
| Knee to Chest Stretch | 2-4 per leg | 2 | Daily |
| Child’s Pose | 2-3 | 2 | Daily |
| Seated Piriformis Stretch | 2-3 per side | 2 | Daily |
| Garland Pose | Hold 30 seconds | 2 | Daily |
| Bridge Pose | 10 | 2-3 | Daily |
| Hamstring Stretch | Hold 30 seconds per leg | 2 | Daily |
| Sciatic Nerve Glides | 10 per leg | 2 | Daily |
Tips for Preventing Sciatica
Making healthy lifestyle changes and addressing risk factors can help prevent sciatic nerve pain, including:
- Exercise regularly – Strengthen back, abdomen and leg muscles for better spine support.
- Practice good posture – Stand and sit tall, avoid slouching.
- Control weight – Excess pounds overload the spine.
- Quit smoking – Smoking impairs circulation and slows disc healing.
- Use ergonomic furniture and proper lifting techniques.
- Take breaks when driving long distances.
- Wear supportive footwear.
- Get treatment for coexisting medical conditions.
- Do sciatica stretches if you have early symptoms.
- Get chiropractic care and massage therapy.
Making adjustments to your daily habits and workspace can reduce unnecessary strain on your back. Consult a physical therapist or ergonomics specialist for guidance on safe movements and optimal arrangement of computer workstations.
Conclusion
For most patients, sciatica is an acute condition causing temporary nerve pain that improves significantly within several weeks or months with conservative treatment. However, this depends greatly on the cause and severity. In some cases, permanent nerve damage can occur leading to chronic lifelong symptoms. Proper diagnosis, following doctor’s orders for activity modification and receiving prompt treatment provide the best chances for full recovery. Patients should also make lifestyle changes to manage underlying causes and risk factors to help prevent future recurrences.