Back pain is probably sciatica if it runs below the knee, follows a line down the back or side of the leg, and comes with tingling, numbness or weakness in the leg or foot. Muscular back pain stays in the back and buttock and eases with gentle movement. Sciatica is a pinched nerve root in the lower spine, usually from a bulging or herniated disc, and while most cases settle within weeks, it should be examined rather than stretched.
Where the pain goes
The sciatic nerve is formed by nerve roots that leave the lower spine, runs through the buttock, and travels down the back of the thigh before branching below the knee. When one of those roots is irritated, the pain follows the nerve's path. It is often worse in the leg than in the back, and patients describe it as sharp, burning or electric rather than dull. Sitting, bending forward, coughing and sneezing tend to make it worse. Muscular back pain, by contrast, sits across the lower back or in the buttock, feels like an ache or a spasm, and does not travel below the knee.
Signs that a nerve is involved
- Pain that runs past the knee, into the calf or foot.
- Pins and needles, numbness or a patch of skin that feels different to touch.
- Weakness, such as the foot slapping when you walk or difficulty rising onto your toes.
- Pain that shoots down the leg when you cough, sneeze or strain.
- Pain on one side only, following a consistent line.
Signs that need urgent care
Go to the emergency room if you have new difficulty controlling your bladder or bowels, numbness in the area you sit on, or weakness in both legs. These can mean severe pressure on the nerves at the base of the spine and need same-day treatment in a hospital. Fever with back pain, pain after a fall or crash, and unexplained weight loss also need prompt examination.
What causes it
A herniated or bulging disc is the most common cause, pressing on the nerve root where it leaves the spine. Narrowing of the spinal canal from arthritis (spinal stenosis) causes a similar picture in older adults, often worse with walking and better sitting. Less often, a slipped vertebra or tightness in the piriformis muscle of the buttock is responsible. The examination and, when needed, imaging tell them apart, and the treatment depends on which it is.
How our physicians treat sciatica
Most sciatica from a disc improves over six to twelve weeks as the inflammation around the nerve settles. Treatment in that period keeps you moving and comfortable: medication aimed at nerve pain and inflammation, activity that is modified rather than stopped, and physical therapy. If pain is severe or not settling, the doctor may use targeted injections or a nerve block. Epidural steroid injections are not performed in our offices; when one is needed we coordinate a referral and continue managing your care. Surgery is reserved for progressive weakness or pain that has not responded to everything else. The back pain and sciatica page goes into more detail.
When to be seen
If your leg pain has lasted more than two weeks, if it is getting worse, or if you have any numbness or weakness, book an appointment online. AffordaHealth has pain physicians and neurologists in the same practice at Davie and Boynton Beach, which matters when the question is which nerve is involved. Medicare, Aetna, Blue Cross Blue Shield and Cigna are accepted.
Questions patients ask
How do I know if my back pain is a pinched nerve?
Pain that travels below the knee along a line down the leg, with tingling, numbness or weakness, points to a pinched nerve root. Muscular back pain stays in the back and buttock and feels like an ache or spasm.
How long does sciatica take to go away?
Most sciatica from a disc improves over six to twelve weeks as the inflammation settles. Pain that is severe, worsening, or accompanied by weakness should be examined sooner.
Should I stretch if I have sciatica?
Not until you have been examined. Stretching can aggravate a pinched nerve. Gentle walking is usually fine. A physician can tell you which movements are safe once the cause is known.
Who treats sciatica at AffordaHealth?
Dr. Irvine Mason, double board-certified in pain management and neurology, and Dr. Charley Scheim, who treats neurology and chronic pain, at both the Davie and Boynton Beach clinics.