What Is Sciatica?
Sciatica is one of the most common reasons patients visit my pain management practice in Hoffman Estates, Illinois. The term refers to pain that radiates along the path of the sciatic nerve — the largest nerve in your body — which runs from your lower back through your hips and buttocks and down each leg. Most people experience sciatica on only one side of the body, and the pain can range from a mild ache to a sharp, burning sensation or excruciating discomfort.
As a triple board-certified pain management specialist, I want to help you understand what causes sciatica, how it’s diagnosed, and what treatment options are available — from conservative measures to advanced interventional procedures.
Common Causes of Sciatica
Sciatica occurs when the sciatic nerve becomes compressed or irritated. The most frequent causes include herniated or bulging lumbar discs, which account for the majority of sciatica cases. When the soft inner material of a spinal disc pushes through a crack in the tougher exterior, it can press on the nerve roots that form the sciatic nerve. Lumbar spinal stenosis — a narrowing of the spinal canal in the lower back — can also compress the nerve roots, particularly in patients over 50. Degenerative disc disease, where the discs between vertebrae break down with age, can lead to bone spurs or disc collapse that irritates the sciatic nerve. Spondylolisthesis, a condition where one vertebra slips forward over another, may pinch the nerve roots. And piriformis syndrome, where the piriformis muscle in the buttock spasms and irritates the sciatic nerve, is another possible cause.
Recognizing the Symptoms
Sciatica symptoms are distinctive and typically include pain that radiates from the lower back or buttock down the back of one leg, a burning or searing quality to the pain, numbness or tingling in the affected leg or foot, weakness in the leg or foot that may cause difficulty walking, pain that worsens when sitting for prolonged periods, and sharp pain when standing up or changing positions. If you experience sudden, severe pain in your lower back or leg, numbness or muscle weakness, loss of bladder or bowel control, or pain following a violent injury, seek medical attention immediately.
How Sciatica Is Diagnosed
At my Hoffman Estates clinic, I conduct a thorough diagnostic evaluation for every patient presenting with sciatic symptoms. This begins with a detailed medical history including when the pain started, what activities make it better or worse, and what treatments you’ve already tried. A physical examination tests your reflexes, muscle strength, and sensation along the nerve pathway. I may perform the straight leg raise test, which can help confirm nerve root irritation. Advanced imaging such as MRI is often essential to identify the specific structural cause — whether it’s a herniated disc, stenosis, or another condition compressing the nerve. In some cases, electrodiagnostic studies like EMG and nerve conduction tests help determine which nerve roots are affected and the severity of the damage.
Conservative Treatment Approaches
Many cases of sciatica improve with conservative treatment within several weeks. Initial approaches typically include activity modification — not bed rest, but avoiding specific movements that aggravate the pain while staying as active as tolerable. Over-the-counter anti-inflammatory medications can help reduce nerve inflammation. Physical therapy is one of the most effective conservative treatments, focusing on core strengthening, flexibility, and proper body mechanics to take pressure off the nerve. Heat and ice therapy can provide symptomatic relief, and short courses of oral corticosteroids may be prescribed for severe acute episodes.
When Conservative Treatment Isn’t Enough: Interventional Options
If sciatica persists beyond 4 to 6 weeks of conservative care, or if the pain is severe enough to significantly limit daily function, interventional pain management procedures can provide meaningful and often lasting relief.
Epidural Steroid Injections
Epidural steroid injections deliver anti-inflammatory medication directly to the area around the compressed nerve root. I perform these under fluoroscopic (X-ray) guidance to ensure precise placement. Options include transforaminal epidural injections, which target the specific nerve root involved, and interlaminar epidural injections, which provide broader coverage. Many patients experience significant relief within days of the injection, and the effects can last weeks to months.
Selective Nerve Root Blocks
These targeted injections serve both a diagnostic and therapeutic purpose. By injecting a small amount of anesthetic and steroid directly around a specific nerve root, we can confirm which level is causing your pain and provide relief simultaneously.
Radiofrequency Ablation
For patients with facet joint-mediated sciatica or chronic recurrent symptoms, radiofrequency ablation uses controlled heat energy to disrupt pain signal transmission along specific nerves. This can provide pain relief lasting 6 to 18 months.
Spinal Cord Stimulation
For patients with chronic, refractory sciatica — particularly those with failed back surgery syndrome — spinal cord stimulation can be transformative. This technology uses mild electrical impulses to interrupt pain signals before they reach the brain. Modern systems offer multiple waveforms and programming options that can be customized to each patient’s specific pain pattern. I always begin with a trial period so patients can experience the relief before committing to a permanent implant.
Preventing Sciatica Recurrence
Once sciatica has resolved, prevention becomes a priority. I counsel my patients on maintaining a strong core through regular exercise, using proper lifting techniques, maintaining a healthy weight to reduce spinal load, taking frequent breaks from prolonged sitting, using ergonomic seating at work, and staying active with low-impact activities like swimming, walking, or cycling.
When to See a Pain Management Specialist
You should consider seeing a specialist like me if your sciatica has lasted longer than 4 weeks, if it’s getting progressively worse, if conservative treatments haven’t provided adequate relief, if you’re having difficulty with daily activities or work, or if you’re experiencing numbness or weakness in your leg. As a pain management specialist serving patients from Hoffman Estates, Schaumburg, Arlington Heights, Palatine, Barrington, and the greater Chicago northwest suburbs, I provide the full spectrum of diagnostic and treatment options for sciatica.
Don’t let sciatica control your life. Call (847) 981-3630 to schedule a consultation at our Hoffman Estates office, or visit keithschmidtmd.com to learn more.
Keith Schmidt, MD, is a triple board-certified pain management specialist at 1555 Barrington Road DOB 3, Suite 2400, Hoffman Estates, IL 60169.