Condition guide
It happens when a disc in the lower back bulges out and presses on a nerve root that runs to the leg. The pain shoots from the buttock down the leg, sometimes as far as the foot. The good news: most people recover without surgery, and the herniation often shrinks on its own.
When the outer ring of a disc between the vertebrae weakens and tears, the gel-like core inside bulges out. The part that escapes presses on the nerve root running to the leg and causes inflammation there.
Sciatica is not the name of a disease but a symptom: pain spreading from the buttock down the leg along the sciatic nerve. Its most common cause is a lumbar disc herniation.
If the pain does not spread into your leg: Low back pain page →
Pain and numbness spread to different areas depending on which nerve root is compressed. Because 95% of lumbar disc herniations occur at the two lowest levels, the L5 and S1 roots are the most commonly affected.
The diagnosis is made first through a physical examination. The most important clues are leg pain brought on by raising your straight leg while you lie on your back (the straight leg raise test), along with checks of muscle strength, reflexes and sensation.
An MRI is needed if surgery or an injection is being considered, or if there are warning signs. Because disc herniations are also common in people without pain, MRI findings must always be interpreted together with your symptoms and examination.
The natural course of a lumbar disc herniation is usually good. Over time, the body can clear away the disc material that has pushed out; the larger the herniation, the more likely it is to shrink. In a study comparing 283 patients who had had severe sciatica for 6–12 weeks, 39% of the group initially managed without surgery eventually had an operation; after one year, the results of the two groups were similar.
Exercises at home
If the leg pain moves up towards your lower back during exercise, that is a good sign. If pain, numbness or tingling travels down the leg towards your foot, stop that exercise. For strengthening, you can also try the low back pain exercises.
When the pain is very severe, lie on your back and rest your calves on a chair or sofa, with your hips and knees bent at 90 degrees. This position reduces the load on your lower back and the nerve root.
10–15 minutes, if it brings reliefLie on your front. Bring your elbows under your shoulders and slowly lift your chest off the floor, keeping your hips on the floor and your lower back relaxed. If the leg pain moves up towards your lower back, carry on; if it spreads down into your leg, stop.
10 reps, or hold for 1–2 minutesSit up straight near the front edge of a chair. As you straighten your knee, gently tilt your head back to look up at the ceiling. As you bend your knee, tilt your head forwards. The nerve is tightened at one end as it slackens at the other, so it glides without being stretched.
10 slow reps. Stop if the numbness increasesLie on your back with your knees bent and feet flat on the floor. Squeeze your buttocks and lift your back off the floor so that your shoulders, hips and knees form a straight line. Hold for 3–5 seconds, then lower slowly.
10–15 reps, 1–2 times a dayVideo
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
Safe movements to start with when pain spreads into your leg.
A key exercise for lumbar disc herniation and spinal stenosis, and how to do it correctly.
In most people, yes. Leg pain usually eases within weeks or a few months. What is more, the herniation can also shrink on MRI: it has been seen to regress on its own in about 70% of extruded herniations and in 96% of fragments that have broken away completely.
Usually not. In a study comparing patients who had had sciatica for 6–12 weeks, early surgery relieved leg pain faster, but after one year the results of the two groups were similar, and 95% of patients in both groups felt they had recovered. Loss of bladder or bowel control and worsening weakness, however, may need emergency surgery.
With a lumbar disc herniation, sitting for a long time makes the pain worse for most people. Keep sitting times short, and get up often to walk a few steps. Short, frequent walks usually help.
Yes, as far as the pain allows. Starting with gentle activities such as walking and swimming, then moving on to exercises that strengthen your back and hip muscles, supports recovery. For a while, avoid movements that send the pain down your leg.
Don't worry. Even among 20-year-olds with no pain at all, about one in three have a disc herniation (protrusion) on MRI. If you have no symptoms, you do not need treatment; keep your back healthy with regular exercise.
The following signs may point to a condition called cauda equina syndrome, which can need emergency surgery, or to serious nerve damage. Go to an emergency department without delay:
Sources
İhsan Eren