Sciatica: Causes, Symptoms, and Treatments

Sciatica occurs when there’s a problem along your sciatic nerve, which is the longest nerve in your body. You have two sciatic nerves, which start in your lower back and run down each of your legs. Sciatic nerve pain can manifest as lower back pain, pain in one leg, and sometimes foot pain.

Sciatica is also known as lumbar radiculopathy. Radiculopathy happens when a nerve root in the spinal column is pinched—common symptoms include pain, numbness, tingling, and weakness. Usually, patients can manage radiculopathy with nonsurgical measures.

Causes of Sciatica

Common causes of sciatica include:

• A herniated or ruptured disc. When one of the soft, fluid-filled discs that cushion your vertebrae leaks or shifts out of place, it may irritate the nerves around it.
• Lumbar spinal stenosis, a condition where your spinal canal narrows and puts pressure on the spinal cord and the nerves around it.
• Piriformis syndrome is when the piriformis muscle creates pressure on the sciatic nerve. It is more common in women than in men.
• Spondylolisthesis is when a vertebra in your spine shifts forward onto the vertebra beneath it. The shift can pinch your sciatic nerve.
• Bone spurs are an overgrowth on your vertebrae that can pinch the sciatic nerve.
• An injury can cause sciatica. For example, a fracture from falling.

Keep in mind that sometimes there is no apparent cause.

Symptoms of Sciatica

Common symptoms of sciatica include leg pain, lower back pain, and hip pain. Often, the pain traces from your lower back, down a buttock, and to one of your thighs and calves. You may feel it as far down as your foot, and the pain may worsen when you sit or make it difficult to stand up.

Typically, sciatic pain affects only one side of the body. The exact degree of pain varies. You might experience infrequent pain that’s no more than an irritant, or you might experience severe pain that interferes with your ability to perform daily activities.

If you experience any of the following symptoms, seek immediate medical attention:

• Muscle weakness in your lower extremities (your hips, thigh, knees, legs, ankle, and foot)
• Numbness in your upper thighs
• Loss of control over your bladder or bowels

Sciatica Risk Factors

A risk factor is a condition or lifestyle choice that increases your chances of developing a medical condition like sciatica. Common risk factors for sciatica include:

• Age: The risk of developing a herniated disk or bone spur increases as you age.
• Diabetes: The condition increases your chances of nerve damage, including the sciatic nerve.
• Obesity: The more you weigh, the more stress you place on your spine.
• Jobs: Twisting your back or carrying heavy loads frequently may increase your risk of sciatica. So does sitting for long periods, common to those who work in an office or drive a motor vehicle for a living.

It’s not possible to eliminate the risk of developing sciatica. However, regular exercise of your core muscles and proper posture when sitting and lifting can minimize your risks.

Diagnosing Sciatica and Treatments

Your doctor may diagnose sciatica by considering your medical history and conducting a physical examination that tests your muscles and reflexes. The doctor may ask how the pain in your legs is distributed and if it radiates below your knee. Doctors may also use imaging tests such as spinal X-rays, MRIs, and CT scans to determine the cause of your sciatica.

The best course of treatment depends on what’s causing sciatica, but hot and cold compresses, physical therapy, and over-the-counter medications like aspirin and ibuprofen are sufficient in most cases. Speak with a doctor to plan out your care routine. 

Often sciatica pain goes away on its own—if not, surgery may be an option. If a disc herniation is the cause of your sciatica and the pain does not clear up in a few months, your doctor may consider a discectomy. In a discectomy, surgeons make small cuts on your back and may use a small tube or a laser to remove part of the disc, relieving the pressure on your spine.

Sleeping with Sciatica

Using heat treatments before bed can make it easier to fall asleep. Try soaking in a warm bath (go for pleasantly warm, not hot) or apply a heating pad for up to 20 minutes. A few gentle stretches before bed can ease the pain as well.

If you have difficulty sleeping, you might want to consider replacing your mattress—an old and unsupportive mattress can aggravate your sciatica. Signs a mattress needs replacing include:

• You wake up with more pain than you fell asleep with
• Your mattress is more than eight years old
• Your mattress sags or has lumps and tears
• You get a full night’s sleep, yet wake up tired
• Your allergy symptoms are worse in the morning

Because sciatica is often a symptom of a herniated disc, you should look for a good mattress for a herniated disc—which means a bed with back support and pressure point relief.

Our recommendation is a memory foam mattress, since it’s the best type of bed for pressure relief. The right mattress firmness depends on your sleeping position.

Lying on your back is one of the best positions for sciatica, because it evenly distributes your body weight and keeps your back in contact with the mattress. A mattress for a back sleeper should have a medium-firm feel; research has found it’s the best firmness for alleviating and preventing back pain.

Side sleeping in the fetal position can ease the pain of a herniated disc by opening up the spaces between your spine’s vertebrae. Since sciatic pain tends to concentrate on one side of your body, you might want to build a pillow wall to prevent yourself from rolling over on your more sensitive side. A mattress for side sleeping should have a medium to soft feel.

If you’re a stomach sleeper, we strongly recommend you switch to side or back sleeping while recovering from sciatica, because stomach sleeping tends to not support your back.

Think about the pillows you use. If you’re a back sleeper, one of the best pillows to alleviate low back pain is placing a wedge pillow under your knees—by elevating your knees, you reduce pressure on the lower spine. Side sleepers should sleep with a body pillow between their legs and support their top arm to better maintain hip alignment.

Did We Help?

Whether it’s temporary or chronic pain, living with sciatica is manageable. Try to continue living your normal life as much as possible, since too much inactivity can worsen symptoms. Finding one of the best mattresses for back pain can help you get a good night’s sleep, leaving you better prepared to resume your daily activities.