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Breaking Free from Sciatica

Sciatica refers to pain that begins in the hip and buttocks and continues all the way down the leg. Sciatica (technically known as lumbar radiculopathy) refers to pain in the distribution of the sciatic nerve, the largest nerve in the body (about the width of a finger).


True sciatica is a condition that occurs when a herniated lumbar disc compresses one of the contributing roots of the sciatic nerve. This condition is often accompanied by low back pain, which can be more or less severe than the leg pain. The term "sciatica" indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition.

Sciatica is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica. The challenge for a physician is to distinguish between radicular pain, which is caused by an inflamed nerve root, and referred pain, which is a result of a musculoskeletal sprain or strain.

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The most common symptom of true sciatica is posterior thigh, lower leg or foot pain that can be much worse than the accompanying lower back pain. Usually a patient will experience moderate to severe pain, which begins in the buttocks and runs down through the leg or foot. It is important to know that true sciatica will produce pain that radiates beyond the knee. Often a patient will have a previous history of lower back pain beginning a few days or weeks before the leg pain occurs, then the leg pain becomes worse than the back pain, and in some cases the back pain will completely disappear.

However, in the case of longstanding history of sciatica, the pain may gradually become localized to the buttocks and back of the leg. In this situation, the patient may have a vague aching pain that does not reach all the way to the lower leg or foot, though it may have done so earlier in the course of the disease.

Often there is not a specific traumatic event or motion associated with the onset of sciatica. Standing, sitting, heavy lifting, sneezing, or having a bowel movement may aggravate the pain. Lying down is usually the most comfortable position. Occasionally paresthesias, weakness and diminished bowel or bladder function will accompany sciatica, but these are rare symptoms.


A thorough history and physical examination is an important part of the diagnosis of sciatica. Nerve root tension tests can be used to confirm the presence of sciatica by attempting to reproduce the discomfort with certain motions and body positions. These tests are performed by a doctor and involve moving the legs in certain ways that slightly stretch the sciatic nerve. If the patient experiences pain during these tests, an irritated sciatic nerve is likely to be a source of the pain.

Treatment Options

Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. Non-surgical therapies such as medication, rest or physical therapy are typically recommended first.

However, if these therapies fail to provide lasting relief over the reasonable length of time, or if there is evidence that nerve root compression is causing nerve damage, your doctor may recommend spine surgery. The goal of surgery is alleviate your symptoms and prevent further damage by removing the source of pressure on the spinal nerve roots. Spinal surgeons perform a variety of procedures to achieve spinal decompression. 

When determining the optimal surgical procedure, a surgeon will consider patient pathology (the structural and functional changes that led to the patient's neurological dysfunction), the level or levels of the spine affected, the patient's medical history and his or her surgical experience and training. Today, spinal decompression also can be performed using a minimally invasive technique that allows your spine surgeon to dilate the muscles surrounding your spine rather than stripping the muscles away from the spine. The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.

Sciatica Specialist

Sciatica is one of the leading causes of lower back pain, affecting about 40% of all American adults. At the Center for the Functional Restoration of the Spine in Shrewsbury, Toms River, and Edison, New Jersey, Steve Paragioudakis, MD, and Marc Menkowitz, MD, offer a wide range of solutions to treat and manage sciatica pain. To schedule an appointment, call your nearest office or book a consultation online today.

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Sciatica Q & A

What is sciatica?

What are the symptoms of sciatica?

Who is at risk of sciatica?

How is sciatica diagnosed?

How is sciatica treated?

What is sciatica?

Sciatica is a painful condition that occurs as a result of undue pressure on your sciatic nerve. The sciatic nerve is the longest in your body and runs from your lower back to your buttocks and down your legs. Sciatica pain typically only affects one side of the body. The most common sciatica causes include auto injuries, herniated discs, bone spurs, and spinal stenosis.

What are the symptoms of sciatica?

The most common symptom of sciatica is lower back pain that radiates into your buttocks and legs. As it progresses, your leg pain may become worse than your back pain. You might also experience muscle weakness, tingling, or numbness in your feet, making it difficult to stand up, walk around, or exercise. Certain positions, such as standing or sitting, may aggravate your pain while lying down may provide the most relief. Pain caused by sciatica varies greatly. Some people only experience a dull ache while others suffer excruciating burning sensations.

Who is at risk of sciatica?

Sciatica affects people of all ages and backgrounds, but several factors may increase your risk, including:

  • Being middle-aged or older
  • Being overweight or obese
  • Sitting for long periods
  • Having diabetes

You are also more likely to experience sciatica if you have a physically demanding job. This is particularly true if you have to lift and carry objects or sit in one position for a long time.

How is sciatica diagnosed?

At the Center for the Functional Restoration of the Spine, your provider diagnoses sciatica by reviewing your medical history, asking about your symptoms, and conducting a physical exam. They also conduct a nerve root tension test, in which your doctor moves your legs in certain positions to stretch the sciatic nerve. If you feel pain during the test, it’s most likely you have sciatica.

How is sciatica treated?

The treatment for sciatica depends on the severity of your symptoms and their effect on your daily routine. Whenever possible, the Center for the Functional Restoration of the Spine recommends conservative, nonsurgical therapies, including:

  • Medication
  • Rest
  • Physical therapy

If these treatments fail to provide relief or if nerve root compression is causing nerve damage, your doctor may recommend spine surgery to remove the pressure on the spinal nerve roots. Spinal decompression can be performed using a minimally invasive technique, allowing for a quicker recovery. Your surgeon discusses the risks and benefits of surgery with you to ensure you understand your options. To learn more about sciatica treatments, call the Center for the Functional Restoration of the Spine to schedule an appointment or book a consultation online today.

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