Given time and the right kind of care, most cases of sciatica will go away on their own. It's only a small group of people who become saddled with chronic pain, muscle weakness, numbness or permanent sciatic nerve damage.
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"About 70 to 75 percent of sciatica cases get better within a few weeks of the actual injury," confirms Jesse N. Charnoff, MD, a physiatrist with the Hospital for Special Surgery in New York City. These are acute cases. "We haven't been able to say why one person veers onto the chronic side and one does not."
When sciatica does become chronic, it can leave a lasting impact. We'll dig into the causes behind sciatica here, along with the possible long-term effects.
First, What Is Sciatica?
Sciatica has to do with the sciatic nerve, the largest nerve in the body that extends from the spine down the leg.
"Sciatica is a layman's term for radiculopathy, which is irritation of the nerve root as it exits the spine," explains Andrew Gitkind, MD, medical director of the Spine Center at Montefiore Health System in New York City. "Irritation is typically caused by compression somewhere along the path."
You can also think of it as a pinched nerve where the nerve exits the spine.
A herniated disk is the most common cause of sciatica. "A disk is like a marshmallow between the spine and the bones," says Sahil Gupta, MD, a pain physician with Southern Illinois Health. "If a disk bulges right next to the nerve, it can pinch off that nerve, leading to pain, numbness and weakness."
Another cause is spinal stenosis. "As we age, the canal through which the nerve and spinal cord run can become narrow," Dr. Gupta says. This puts pressure on the nerves, causing pain.
Then there's a spine fracture, muscle spasms and cancer of the spine. Anything that changes the orientation of the spine, including pregnancy, can also result in sciatica, Dr. Charnoff says.
Now, let's talk about the potential effects of sciatica.
1. Chronic Pain
Although the pain of sciatica can be anywhere along the sciatic nerve, typically it travels from your lower spine to your buttocks and down the back of your leg.
The condition can cause different types of pain (burning or shooting pain in the lower back, for instance), and symptoms may come and go. They might appear only when you're sitting or only when you're engaged in a certain activity, and severity varies.
"It can be anywhere on the spectrum from mild to severe — mildly uncomfortable to really functionally limiting," notes Dr. Gitkind.
It's important to note, though, that worse pain does not mean worse results. "We see patients with a concern that this hurts so much they're going to be in a wheelchair, but we can say with a great degree of confidence that this is not the typical progression," says Dr. Gitkind
2. Numbness or Weakness
Sciatica is more worrisome if the pain comes with neurological symptoms like numbness and muscle or leg weakness.
"If it's muscular weakness, it indicates a higher level of potential nerve damage, which would require more immediate and aggressive intervention," Dr. Gitkind says.
If you have new or worsening numbness or weakness, see a doctor as soon as possible.
If continuing pain or weakness from sciatica causes you to be inactive, other issues may arise.
"Inactivity can cause weakness [and] impaired posture," Dr. Charnoff says. "If you have motor weakness or decreased sensation in your legs that is causing you to not walk correctly, you'll have a chain effect with your ankle, knee and back."
Some people with sciatica develop "foot drop" or "drop foot" (when you can't lift the front of your foot) or find that their leg gives out on them. This can disrupt your balance and result in falls as well as trouble walking.
Most cases of sciatica affect people ages 30 to 50, but in older people, falls can result in severe and even life-threatening fractures.
4. Difficulty Walking
"The sciatic nerve provides strength in our legs," says Dr. Gupta. "When it's affected to the degree that it causes weakness of the leg, you can have functionality issues."
People with sciatica who cannot walk may have to use a wheelchair
5. Posture Issues
Just as changes in the orientation of your spine can cause sciatica, so can sciatica alter your posture and make you feel unwell, says Dr. Chernoff.
Prolonged poor posture from any cause can set you up for more pain, including headaches, and even digestion and respiratory problems as well as constipation, according to Harvard Health Publishing.
6. Bowel and Bladder Problems
In some cases, the underlying cause of sciatica can affect the cauda equina, or the grouping of nerves that connect to the pelvic region. Cauda equina syndrome, which usually results from a very large herniated disc, can cause incontinence (urinary and fecal) as well as a condition called "saddle anesthesia," which is numbness in the genital region.
"That's an acute emergency that often requires surgical intervention," Dr. Charnoff says.
Seek medical attention immediately if you have incontinence or numbness in the genital region.
7. Permanent Nerve Damage
Left untreated, neurological symptoms like numbness and leg weakness can progress to permanent nerve damage in the last stages of sciatica, according to Johns Hopkins Medicine.
Although this happens only in a small minority of cases, it underscores the importance of taking this type of symptom seriously so you can recover fully.
Although some cases of sciatica heal on their own, early treatment is always better, says Dr. Chernoff. That treatment usually involves exercise, including core strength and stability training, says Dr. Gitkind. Many patients without neurological issues benefit from over-the-counter pain relievers, notes Dr. Gupta.
Options for later-stage sciatica include steroid shots and even surgery, but be aware that surgery does not always help and may even make pain worse, according to Harvard Health Publishing.
- Mayo Clinic: "Foot drop"
- American Association of Neurological Surgeons: "Cauda Equina Syndrome"
- Cleveland Clinic: "Poor Posture Hurts Your Health More Than You Realize: Tips for Fixing It"
- Harvard Health Publishing: "3 surprising risks of poor posture"
- Harvard Health Publishing: "Taming the pain of sciatica: For most people, time heals and less is more"
- Johns Hopkins Medicine: "Sciatica"
- Johns Hopkins Medicine: “5 Questions to Answer Before Considering Sciatica Surgery"
- Harvard Medical School: “Taming the pain of sciatica: For most people, time heals and less is more”
- Jesse N. Charnoff, MD, physiatrist, Hospital for Special Surgery, New York City
- Cleveland Clinic: “Sciatica”
- Andrew Gitkind, MD, medical director, Spine Center, Montefiore Health System, New York City
- Sahil Gupta, pain physician, Southern Illinois Health, Carbondale
- Mayo Clinic: “Sciatica”
- University of Pennsylvania Medicine: “Sciatica”
- American Association of Neurological Surgeons: “Cauda Equina Syndrome”