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Sciatica and Spondylitis: What’s the Connection?

Posted on November 14, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Asha Woodfolk

Spondylitis is an autoimmune disease that causes pain, stiffness, and damage to the axial skeleton (neck, spine, and hip joints). For some people living with spondylitis, changes to the spine result in sciatica, a painful condition in which a major leg nerve becomes pinched. Around 600 members of MySpondylitisTeam report having sciatica in addition to spondylitis.

If you are living with both sciatica and spondylitis, there are treatments that can help. It’s important to recognize the symptoms of sciatica, understand its causes, and know about potential treatments so that you can discuss this complication with your doctor.

What Does Sciatica Feel Like?

Spondylitis causes spinal stiffness and lower back pain. Sciatica, meanwhile, can cause sharp shooting pains that radiate from the lower back through the buttock and down either the right or left leg. The pain can be accompanied by tingling, lower-extremity numbness, and weakness. Significantly, sciatica pain usually occurs on one side of the body. In comparison, spondylitis pain is generally felt on both sides of the body.

Sciatica has been known to restrict activity, movement, and productivity. Members of MySpondylitisTeam describe their experiences with sciatica:

  • “I’ve had jolts of sharp pains shooting down my leg multiple times. I’m also having trouble just trying to walk!”
  • “I’m having horrible pain down the back of my thigh.”
  • “Sciatica is taking over my life. …The pain dictates what I do.”
  • “I was up most of the night with bad sciatica.”

What Causes Sciatica in Spondylitis?

Spondylitis can contribute to the development of sciatica in many ways. Sciatica develops when the space within the spine in your lower back narrows, a condition known as spinal stenosis. Spinal stenosis causes a bundle of nerves within your lumbar spine (the sciatic nerve root) to be pinched, resulting in pain.

Changes in Spinal Structure

In ankylosing spondylitis (AS) — a severe subtype of axial spondyloarthritis — changes in spinal structure can occur, such as the growth of new bone, bone spurs, and bone fusion. These changes can affect the ligaments that support spinal strength and shape. There’s also a decrease in flexibility that encourages compression and pinching of the sciatic nerve.

The Role of Inflammation

Spondylitis can also increase the risk of sciatica through repeated inflammatory attacks. This occurs when the immune system mistakenly attacks your spine joints. Inflammation from AS can cause spinal changes that result in spinal fractures and bone spurs in the lumbar region. These in turn can add to pressure on the sciatic nerve.

Other Conditions

Other conditions that can increase the risk of developing sciatica include obesity and diabetes. Increased age and lifestyle factors such as prolonged sitting are also associated with sciatica.

How Is Sciatica Treated?

Managing symptoms like numbness, weakness, and intense shooting or stabbing leg pain can be very difficult. Some people may not feel especially motivated to solve the issue, due to symptom fatigue.

Medications

Aside from over-the-counter medications, the first line of sciatica-pain management involves nonsteroidal anti-inflammatory drugs (NSAIDs). This family of drugs — including ibuprofen, naproxen (sold as Aleve and Naprosyn), and celecoxib (Celebrex) — helps stop the inflammatory reaction and decrease pain. However, some people with sciatica can’t tolerate NSAIDs for various reasons, including allergies and other health conditions. If NSAIDs aren’t an option for you, your physician may offer other types of pain relievers.

Muscle relaxants are another medical option. These medications can help some people find relief during muscle spasms in their low back and around their spine. Muscle spasms can intensify sciatica pain by adding pressure to the sciatic nerve. Releasing the spasm can help with pain.

Injections

If medications aren’t helpful in relieving your sciatic nerve pain, spinal injections may be the next step. Your doctor may propose injections of corticosteroid (steroids) into your lower back to relieve inflammation.

Similar to medications, steroidal injections don’t provide relief indefinitely. Research and clinical studies have shown that repeated use of steroid injections isn’t safe due to the increased risk of osteoporosis, high cholesterol, and insulin resistance. Pain-relief injections should be timed carefully and may be used after other treatment options have failed.

Physical Therapy

Research has shown that physical therapy can be very beneficial for people with sciatica. Physical therapy has proved instrumental in helping some people with sciatica maintain flexibility and mobility and in taking pressure off the sciatic nerve.

Each person experiences sciatic nerve pain differently. The type of exercises, stretches, and interventions a physical therapist provides you will depend on the severity of your sciatic pain and its originating cause. Your physical therapist should work with you to create a personalized treatment plan that addresses your specific needs.

Physical therapy sometimes doesn’t alleviate all sciatic pain. This is why it’s important to try several different methods of pain-relief techniques alongside your physical therapy.

Surgery

If medications, injections, and physical therapy don’t relieve your sciatica pain, you may consider surgery. There are different versions of corrective surgery for sciatica, and the type you receive will depend on what’s causing the condition. However, all of these surgeries can relieve pressure on the sciatic nerve and ease pain and discomfort.

Laminectomy

Laminectomy entails removing a piece of your spinal canal to widen the space, relieving pressure on your spinal nerves. This process generally takes no more than three hours. You’ll have to stay in the hospital for about three days post-surgery and wait about four weeks to resume regular physical activity (depending on the physician’s post-surgery report).

Microdiscectomy

Microdiscectomy relieves sciatic pain caused by a herniated disc. The surgery lasts no more than two hours. It starts with a small incision (cut) in your back, which allows the surgeon to use special tools to remove any bone fragment that’s putting pressure on your nerve. You should be able to go home the same day you undergo the surgery. You may be asked to wear a back brace for a short time afterward to ensure full recovery.

These procedures are high-risk and invasive. There is a possibility that numbness will still persist after surgery, though you should experience pain relief.

Tips for Managing Sciatica at Home

Members of MySpondylitisTeam often share tips on what has worked for them when trying to manage their sciatica. Their recommendations include:

  • Massages
  • Meditation and relaxation
  • Medical cannabis or cannabidiol
  • Pain relief gels
  • Heat or cold packs
  • Yoga
  • Stretching exercises
  • Water aerobic classes
  • Acupuncture

Heat and Cold

Harvard Health recommends ways to ease sciatica pain using heat and cold. One approach is to use ice packs during the first seven days of a sciatica flare. Apply ice packs for intervals of 15 to 20 minutes to the affected area, which will reduce inflammation. Take breaks of 15 to 20 minutes in between applications. Continue this cycle for 75 to 100 minutes and see how you feel. Do this three to five times per day.

After a week of using ice, switch to heat. Apply a hot water bottle or heating pad to the affected area for at least 15 minutes, but don’t exceed two hours in one session. Avoid burning yourself by making sure the bottle or pad is warm, not hot. Make sure you have a layer of cloth between the source of heat and your skin.

Gentle Exercise

Moving your body usually helps with spondylitis pain, and it can be useful for helping ease sciatica pain, too. Fight the temptation to remain still: Low-impact movement such as walking and gentle stretching can strengthen your muscles, improve your flexibility, and increase blood flow to promote healing. Importantly, though, don’t overexert yourself. You should speak to your doctor if moving makes the pain worse.

Communicate With Your Doctor

It’s important to communicate with your doctor about the severity of your pain and discomfort. Understanding your experiences will help them guide you through your options for treating sciatica.

Although sciatica and spondylitis are two separate conditions, sciatic pain does occur with many people who have spondylitis. Sciatica can be lifelong without appropriate treatment.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you living with sciatica in addition to spondylitis? Do you experience shooting pains, numbness, or weakness in one leg? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Asha Woodfolk is a freelance health writer, health education enthusiast, and health & wellness advocate. Learn more about her here.

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