Sciatica vs. a Herniated Disc: How to Tell the Difference

Sciatica and herniated discs share some of the same signs and symptoms but are two different conditions. Knowing the difference between the two can help you and your doctor decide which treatment is appropriate and will provide the most benefit.

At Santa Cruz Osteopathic, physiatrist and physical medicine specialist Dr. Richard Bernstein understands how problematic back pain can be, especially when it comes to diagnosing two conditions with similar symptoms. Here’s how you can tell the difference between the two and some treatment options, including the SpineMED® decompression platform, that can help.

Background on your backbone

The human adult has 24 bony vertebrae in their spine, forming the backbone stretching from the skull’s base to the tailbone, allowing you to stand upright. Between each pair of vertebrae are spinal discs, which contain a hard outer shell (annulus fibrosus) and a gel-like interior (nucleus pulposus).

The discs have three functions: absorbing the shock the spine endures from all types of movement, preventing the bones from grating against each other, and allowing you to twist and bend.

Discs are strong, but they’re not indestructible. Trauma to the spine, either from an acute injury or wear and tear over time, can cause the annulus to crack. The nucleus leaks into the spinal canal, the spinal cord, and cerebrospinal fluid region. If the material presses against spinal nerve roots inside the canal, the nerves respond by sending out pain signals and causing weakness and/or numbness in the extremity they serve.

Herniated disc symptoms

Disc herniation can occur anywhere along the spinal column; however, it’s most common in the lumbar (lower back) and cervical (neck) regions because they experience the most movement and the greatest wear-and-tear damage.

It’s possible for a herniated disc to produce no symptoms, but most people experience some form of pain, which can be mild and intermittent or severe and unrelenting.

Other symptoms you may experience with a herniated disc include:

• Sudden pain when you cough or sneeze
• Inability to remain in one position for long
• Muscle weakness
• Numbness and/or tingling/burning sensations in extremity
• Balance issues from altered gait
• Limping from weakness and pain
• Poor posture

Symptoms vary between people, and some symptoms of a herniated disc may be attributable to other problems. That’s why getting an accurate diagnosis before starting treatment is important.

Radiculopathy and sciatica

While a herniated spinal disc can cause no symptoms, it’s much more likely for its nucleus to impinge upon surrounding nerves and their roots, causing radicular pain.

The sciatic nerve is the longest in your body, stretching from the L4-L5 vertebral junction into the buttocks and down the outer length of the leg into the foot. When the nerve root becomes compressed at this level, say from a herniated disc, it sends out pain signals that can travel from the root down the entire length of the nerve into the foot. When radiculopathy is caused by compression of the sciatic nerve specifically, the condition is called sciatica.

Radiculopathy affects about 85 out of 100,000 US adults each year. It can happen at any age because of injury or even genetics; however, the risks increase as you get older because of osteoarthritis (OA) and degenerative disc disease (DDD) in the spine, which are age-related.

The difference between a herniated disc and sciatica

As we mentioned above, it’s possible for a herniated disc to cause no symptoms, though usually there’s some pain, tingling, and weakness. Sciatica, on the other hand, is defined by its symptoms, particularly the pain’s ability to travel. 

Other indicators for sciatica include:

• Unilateral leg pain greater than low back pain
• Numbness and paraesthesia (tingling) that overlap
• Straight leg raising test causes increased leg pain
• Localized neurology (limited to a single nerve root)

As a rule, if you have pain that moves down the nerve into the foot, it’s most likely sciatica.

Treating nerve compression

Dr. Bernstein is a physiatrist, a medical specialty sometimes called “rehabilitation medicine.” Physiatrists take a holistic approach to patient care as they diagnose, prevent, and treat disabilities related to the brain, nerves, bones, and muscles.

To treat your herniated disc problems, Dr. Bernstein combines physical therapy and pain management to maximize physical functioning, decrease or eliminate pain, and improve quality of life. Ideally, this approach improves your symptoms enough to avoid a surgical solution.

One of the most effective therapies for a herniated disc is SpineMed, which pulls the affected vertebrae apart slightly and then releases them, decreasing compression and pain.

If you have radiating pain in your lower back, or if you experience pain anywhere along your spine, it’s time to come into Santa Cruz Osteopathic for a proper diagnosis and effective treatment.

To learn more or to schedule a consultation with Dr. Bernstein, call us at 831-464-1605 or book online today.