That Literal Pain In Your Butt Might Be Your Sciatic Nerve

If you have pain that starts in your lower back and runs down through your buttock and your leg, you probably have what is commonly called “sciatica.”

“The correct terminology for this condition is actually ‘radiculopathy,’ or radicular pain,” explains Jaspal Ricky Singh, MD, vice chair and associate professor in the department of rehabilitation at Weill Cornell Medicine.

Causes of Sciatic Pain

The sciatic nerves are the longest nerves in the body; they begin in the lumbar (lower back) area and extend through the buttocks down each leg to the feet. Sciatica can be acute, lasting a few weeks, or chronic, persisting for more than three months. Often, the pain resolves without treatment within a few weeks or months.

Some medical conditions that can cause these symptoms include herniated discs, lumbar spinal stenosis, and degenerative disc disease.

Often, sciatica is a result of a bulging or herniated disc in the lumbar spine. Intervertebral discs are gel- and fiber-filled structures that act as shock absorbers and prevent your vertebrae from rubbing together when you move your upper body.

“Think of the disc as a jelly donut; if the donut is squeezed or compressed, the ‘jelly’ squirts out and can come into contact with a nerve. When a bulging disc presses on one of these exiting nerves in the lower back, the patient often reports shooting pain down the leg,” explains Dr. Singh.

Symptoms and Diagnosis

A patient who has radiculopathy usually reports sharp, stabbing pain starting in the lower back and radiating down the buttock and leg. If the nerve compression is severe, the patient may report weakness in the leg. The pain can vary from mild to debilitating, depending on the degree of pressure exerted on the sciatic nerve. Other symptoms include:

• Numbness or a burning or tingling sensation in the leg or foot
• Weakness of the leg or foot
• Pain in the buttock area and leg that increases with coughing, sneezing, or straining
• Pain that increases with bending backward and with prolonged sitting or standing

An evaluation for sciatica includes a complete medical history, a physical examination, and an assessment of neuromuscular function. Imaging procedures, such as X-ray, MRI, CT scan, and electromyogram, and/or nerve conduction tests may be necessary to confirm the diagnosis and/or identify the exact location of the nerve impingement.

Treatment Options

“The first goal of treatment is to minimize the inflammation of the nerve; this may require an oral medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or an oral steroid. In addition, it is critical to take the compression off the disc and the nerve, which can sometimes be accomplished with physical therapy and core-strengthening exercises,” says Dr. Singh. Applying ice or heat, massage, and manual manipulation may also help relieve the pain.

If conservative options do not provide relief, epidural steroid injections usually are effective in alleviating symptoms.

If symptoms persist and the patient reports any neurological problems, such as weakness or numbness, surgical intervention should be considered. Conditions that may be treated with surgery include herniated discs, lumbar spinal stenosis, spondylolisthesis, and degenerative disc disease.

Finally, Dr. Singh emphasizes the importance of doing exercises that strengthen your core muscles.

“To prevent sciatic pain or to keep it from returning once you’ve had it, keep your core strong; this will minimize the compressive forces on the discs and prevent pressure on the sciatic nerve.”

Ask your doctor for a referral to a physical therapist or other health-care provider who can teach you core exercises that are safe and effective.

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