Published September 26, 2024
Pain radiating down the back of the leg could be a sign of sciatica, a common condition that can also be associated with numbness and weakness. Often this uncomfortable sensation can be treated with conservative interventions and lifestyle modifications.
Sciatica is pain along the sciatic nerve, which runs from the back of the buttocks, thigh and calf and into the top or bottom of the foot. It can be caused by conditions affecting the sciatic nerve.
Piriformis syndrome is a form of sciatic nerve compression that can result in sciatica-like symptoms, often developed in patients who do a lot of weightlifting.
Sciatica can also be caused by a herniated disc (i.e. lumbar radiculopathy or “pinched nerve”) that can push on one or more of the nerve roots that make up the sciatic nerves. In older patients, spinal stenosis can cause symptoms as well.
As people get older and develop arthritic changes to the spine, it’s more likely they will develop sciatica. Certain activities like lifting with poor mechanics can put people at risk, but oftentimes it’s not something you can control.
“There are plenty of times I meet with a patient who says, ‘I just lifted my kid and all of a sudden now I have pain in the back of my leg.’ There are some genetic components to this that can make the connected tissue more predisposed to injury, but sometimes you can't control some of these things.” said Daniel Rubio, MD, Co-Medical Director, Spine Center at Yale New Haven Hospital and Assistant Professor of Orthopaedics & Rehabilitation at Yale School of Medicine.
Dr. Rubio says the first step in treatment is usually conservative management that may include physical therapy, acupuncture, anti-inflammatory medication and activity modifications.
“Usually, many patients do get better with conservative management and 90% of the patients that I see with sciatica usually get better with six weeks of physical therapy. If that doesn’t work there are other treatments we can use,” said Dr. Rubio.
Next steps may include additional medications such as a steroid, nerve medications or an injection of corticosteroid where there is a disc herniation. There are also surgical options which may include decompression operations that do not require any rods, screws or fusing to take pressure off the nerve. Sometimes a patient may require a fusion operation depending on where the disc herniation is.
In all cases, lifestyle modifications are important too. For example, anyone who lifts weights needs to use proper technique to reduce the chance of injury. Controlling chronic medical diseases that result in microvascular changes to the spine include maintaining a healthy weight, controlling diabetes and quitting smoking. Dr. Rubio also recommends patients maintain an active lifestyle as much as possible, especially as we age.
“There are many, many benefits for low impact exercises as you start to get older, not just for your back, but for your heart, your lungs, your psyche, your mental health,” he said.
Patients dealing with back and leg pain can reach out to their primary doctor first, who can make an initial assessment and the appropriate referrals for physical therapy, as well as a specialist if additional treatment is needed.
