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Is It Sciatica from a Herniated Disk or Lumbar Spinal Stenosis?

Getting the Diagnosis Correct Is Critical, as the Treatments for Each Differ

May 2024

Sciatica is a symptom of a medical problem that causes pain, numbness, tingling, or weakness in the leg. It is most commonly associated with two different conditions: a herniated disk or lumbar spinal stenosis

Sciatica pain occurs along the path of the sciatic nerve, which runs down the lower back and into the legs. This symptom can result from a herniated disk, where the disk ruptures and its gel center pressures the lumbar nerve roots.

Lumbar spinal stenosis can also cause sciatica pain or cramping in one or both legs. Lumbar (lower back) spinal stenosis is usually caused by osteoarthritis. This is a “wear and tear” condition resulting in bone overgrowth. This overgrowth can extend into the spinal canal, narrowing the space, which pinches and puts pressure on nerves within the spine.

The potential for misdiagnosis is understandable, given the similarities in the leg pain and sciatica symptoms between these two conditions. However, getting the diagnosis correct is critical, as the treatments for each differ.

In this article, we’ll take a deeper look at the causes and symptoms of each.

Older man with sciatica clutches back

Herniated Disks and Sciatica

Disks sit between vertebrae bones that stack to make the spine. These disks act as rubbery cushions that allow you to bend and move easily.

Each spinal disk has a soft, gel-like center called a nucleus and a firmer outer layer known as the annulus. A herniated disk occurs when the annulus tears and some of the nucleus’s gel center pushes through the opening. It is also known as a ruptured disk or slipped disk.

Herniated disks usually occur in the lower back or neck. Since our discussion is on sciatica symptoms, this review is specifically on ruptured lower spine disks. Aging, excessive weight, repetitive motions, and sudden strain from improper lifting or twisting can all contribute to a disk rupture.

Often, people experience no symptoms from a herniated disk. But for some, the rupture creates pressure on one of the sciatic nerve’s nerve roots. With sciatica symptoms, this usually occurs in the last lumber nerve root (L5) or the first sacral nerve root (S1) as they exit the lower spinal column. 

Sciatica from a Herniated Disk Symptoms

Sciatica pain may be experienced anywhere along its nerve pathway. Frequently, it follows a path that radiates from the lower back down one side of the buttocks into the leg and sometimes the foot. The pain can vary from a mild ache to a sharp burning. 

Other symptoms may include:

  • Lower back pain.
  • Tingling or numbness in the legs and/or feet.
  • Muscle weakness.
  • Pain while sitting and rising from a sitting position.
  • Worsening pain from prolonged standing.
  • Pain when bending forward.
  • Pain that improves throughout the day after rising.

Treating Sciatica from a Herniated Disk

In most cases, pain from a herniated disk can be treated at home. If the pain is severe, it is recommended that sciatica sufferers rest for one to three days but avoid long periods of laying down to prevent stiffness. You can also take an over-the-counter pain reliever, such as ibuprofen or acetaminophen, and apply heat or ice to the affected area.

However, you should see a doctor if the symptoms don’t improve after four to six weeks or get worse. You should also see your doctor if the pain interferes with your everyday life, you develop loss of bladder or bowel control, or you have trouble standing or walking.

Lumbar Spinal Stenosis and Sciatica

By age 50, degenerative changes begin to affect 95% of people. One of those changes is spinal stenosis, the narrowing of one or more spaces within the spinal canal. The spinal canal is the tunnel that runs through the vertebrae bones of the spine. It contains the spinal cord, which connects the brain to the lower back.

As the spinal canal narrows due to bone overgrowth from spinal stenosis, it can cramp the spinal cord and the nerve roots that branch off it. The tightened space can irritate, compress, or pinch the spinal cord and nerves, leading to back pain and other nerve issues like sciatica. 

Spinal stenosis usually develops slowly over time. Lumbar spinal stenosis is less commonly known as lower back spinal stenosis.

Sciatica from Lumbar Spinal Stenosis Symptoms

Sciatica pain from lumbar spinal stenosis begins in the buttocks, runs down the leg, and may continue into the foot. It may involve one or both legs. 

Other symptoms involve neurogenic claudication, including:

  • Lower back pain.
  • A heavy feeling in your legs, which may lead to cramping.
  • Numbness or “pins and needles” tingling in the buttocks, legs, or feet.
  • Pain worsens when standing for long periods, walking downhill, or bending backward.
  • Pain that lessens when you lean forward, walk uphill, or sit.

Treating Sciatica from Lumbar Spinal Stenosis

The treatment for lumbar spinal stenosis varies depending on the severity of the symptoms.

For mild symptoms, at-home care may be appropriate. This may include:

  • Over-the-counter pain relievers.
  • Head and cold applied to the aching joints.

If at-home care is insufficient, your doctor may recommend nonsurgical treatment options, including:

  • Physical therapy to strengthen spine-supporting muscles and improve flexibility and balance.
  • Corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain, and irritation.

Surgery for spinal stenosis is only considered in rare cases where all other treatment options have failed to provide adequate relief.

Wrapping It Up

Sciatica may result from two different conditions: a Herniated Disk or Lumbar Spinal Stenosis. Knowing which condition is causing sciatica pain is essential to establish the appropriate course of treatment.

You should usually see your doctor to get an accurate diagnosis.

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