Diagnosing Sciatic Pain

If you’ve ever felt a sharp, shooting pain down your lower back and leg, you may be dealing with sciatica. This condition is common, but it can be uncomfortable and affect your daily life. 

Getting a diagnosis is the first step toward feeling better. At Banner Health, we take the time to determine the cause of your pain so we can help you heal.

Why you shouldn’t ignore sciatica symptoms

For most people, sciatica improves on its own. Symptoms often fade within about 90 days (three months). 

But if your pain lasts longer than that, or if it becomes harder to manage, check in with a health care specialist. Sometimes, ongoing pain may indicate that another issue with your spine.

Getting an accurate diagnosis helps you:

• Find the cause of your pain
• Get treatment that targets the problem
• Prevent long-term nerve damage
• Get back to normal activities sooner

How is sciatica diagnosed?

Your diagnosis begins with a thorough review of your symptoms and a physical exam. Your health care provider will want to know:

• When the pain started
• Where you feel it
• What makes your pain worse or better
• If you’ve had any injuries or other back problems in the past

They may also ask about your job, exercise habits and daily activities. This information helps them figure out what’s causing your symptoms. 

Physical exam

During your physical exam, your provider will check:

• Range of motion: How easily you can move your back and legs
• Muscle strength: Whether you have weakness in your leg or foot
• Reflexes: How well your nerves respond to certain movements
• Pain response: Where the pain starts and if it spreads when you move a certain way

Two standard tests your provider may use are:

• Straight leg raise (SLR) test: While lying on your back, the provider lifts your leg to see if it causes pain down the back of the leg. This helps identify nerve irritation.
• Slump test: In this test, you sit upright with your hands behind your back. Then, you bend forward at the hips, tuck your chin to your chest and straighten one leg as far as you can. If this position causes pain, it may be a sign of sciatica. 

Imaging tests

If your symptoms are severe or don’t improve after a few weeks, your provider may recommend imaging tests. These can show if something is pressing on your sciatic nerve and rule out other causes. 

Common tests include:

• MRI (magnetic resonance imaging): Uses magnets and radio waves to create detailed images of your spine. MRI is the best imaging method for visualizing bones, disks and nerves. 
• X-ray: Can help rule out other causes of back pain, such as fractures.
• CT scan (computer tomography): Uses X-rays to create cross-sectional images of your spine.
• Electromyography (EMG): Measures how well your nerves and muscles work together. This test can help confirm nerve compression. 
• Myelogram: A contrast dye is injected into the fluid surrounding your spinal cord and nerves. X-rays or CT scans are then taken to show the spinal canal in detail. 
• Selective nerve root block (SNRB): With the help of fluoroscopy (live X-ray) or CT guidance, your provider injects numbing medicine around a specific spinal nerve root. If your pain improves after the injection, it helps confirm that this nerve is the source of your sciatica.

Ruling out other conditions

Sciatica symptoms can sometimes look like other health problems. To make sure sciatica is the actual cause of your pain, your provider may need to rule out conditions such as:

• Piriformis syndrome: When the piriformis muscle in your buttocks irritates or presses on the sciatic nerve.
• Herniated disk (slipped, ruptured or bulging disk): A piece of a spinal disk in your spine has slipped out of place and is pressing on a nerve.
• Spinal arthritis or spinal stenosis: Conditions that cause narrowing in the spine, which can put pressure on nerves.
• Muscle strain: A pulled or injured muscle in the back or buttocks that can mimic sciatic pain.
• Peripheral neuropathy: Nerve damage outside the spine, often linked to conditions like diabetes.
• Sacroiliitis: Inflammation of the sacroiliac joints (the joints connecting the lower part of the spine to the pelvis. Inflammation in these joints can cause low back, buttock, and pain down the back of the leg, similar to sciatica.

How to prepare for your appointment

Here are some tips to make your visit go smoothly:

• Write down your symptoms: Note when your pain started, how often it happens and what makes it worse or better. 
• Bring a list of medications: Include prescription drugs, over-the-counter (OTC) medicines, vitamins and supplements. 
• Know your medical history: This includes past injuries, surgeries and chronic conditions.
• Wear comfortable clothing: You may need to move, bend or stretch during the physical exam.

When to see a provider immediately

Sciatic nerve pain alone is usually not a cause for urgent treatment, but you should seek medical care right away if you have:

• Sudden, severe pain after an injury
• Weakness in your leg or foot that gets worse
• Trouble controlling your bladder or bowels
• Pain that doesn’t improve with rest or over-the-counter medicine

Living with sciatica

If you’re diagnosed with sciatica, your health care provider will explain treatment options. These may include physical therapy, medication, injections, lifestyle changes or, in rare cases, surgery. 

While waiting for treatment, you can:

• Stay active with gentle stretching or short walks (stretches to relieve your pain)
• Use ice or heat on your lower back
• Avoid sitting or standing too long in one position
• Practice good posture to take pressure off your spine

How Banner Brain & Spine can help

If you’re living with back and leg pain, don’t wait to get help. Schedule an appointment with a Banner specialist today to find out if sciatica is the cause of your discomfort. 

At Banner Health, we take a team approach to diagnosing and treating sciatic nerve pain. Our providers use the latest tools and techniques to find the root cause of your pain. Then we create a treatment plan designed just for you.

Schedule an appointment today.