Spinal Stenosis and Sciatica: Warning Signs You Shouldn’t Ignore

Pain that travels from your lower back into your leg can be alarming and confusing. Many people assume sciatica is the diagnosis, but sciatica is often a symptom, not the root cause.

One of the most common underlying conditions behind persistent sciatic pain is spinal stenosis, a narrowing of the spaces in the spine that places pressure on the nerves.

At Palm Beach Pain Institute in Delray Beach, Florida, board-certified pain management physician Marcie Merson, MD, frequently evaluates patients whose leg pain, numbness, or weakness stems from a combination of spinal stenosis and sciatica. While the two are closely connected, they aren’t the same — and their treatments can differ.

Recognizing the warning signs early can help prevent worsening pain and mobility loss.

What is sciatica?

Sciatica refers to pain that follows the path of the sciatic nerve, which runs from the lower spine through the hips, buttocks, and down each leg.

Rather than being a condition itself, sciatica describes a pattern of nerve pain caused by irritation or compression of the sciatic nerve.

Common symptoms include:

• Sharp, burning, or shooting pain down one leg
• Tingling, numbness, or weakness in the leg or foot
• Pain that worsens with sitting, bending, or twisting
• Discomfort that may ease when lying down

Sciatica is often caused by disc herniation, bone spurs, or spinal narrowing, which is where spinal stenosis frequently enters the picture.

What is spinal stenosis?

Spinal stenosis occurs when the spaces within the spine narrow, reducing room for the spinal cord or nerve roots. This narrowing most commonly develops in the lumbar (lower back) region.

Spinal stenosis is often related to age-related degeneration, including:

• Thickened ligaments
• Arthritic changes in the facet joints
• Bulging or herniated discs
• Bone spurs

When stenosis compresses the nerves that form the sciatic nerve, sciatica symptoms can develop or worsen.

How spinal stenosis–related sciatica feels different

While disc-related sciatica often causes sudden, sharp pain, sciatica from spinal stenosis tends to follow a different pattern.

Warning signs commonly include:

• Leg pain, heaviness, or cramping when walking or standing
• Symptoms that improve when sitting or bending forward
• Numbness or weakness in both legs rather than just one
• Gradually worsening pain over time

Many patients notice they can walk farther when leaning on a shopping cart or bending slightly forward — a classic sign of lumbar spinal stenosis.

Why the correct diagnosis matters

Because sciatica describes symptoms — not the source — treating it without identifying why the nerve is irritated can limit results.

An expert evaluation allows Dr. Merson to determine:

• Whether spinal stenosis, disc disease, or another condition is compressing the nerve
• Which spinal level is involved
• How inflammation, joint changes, or instability contribute to pain

This precision matters because treatments that help a disc herniation may not provide the same relief for stenosis-related nerve compression.

Nonsurgical treatments for spinal stenosis and sciatica

Many patients find meaningful relief without surgery, especially when treatment targets the specific cause of nerve irritation.

Treatment options may include:

Epidural steroid injections

These injections deliver anti-inflammatory medication around compressed nerves, helping reduce swelling and ease leg pain.

Targeted spinal injections

Facet joint or nerve root injections can help identify and treat specific pain generators.

Physical therapy and movement guidance

Focused therapy can improve flexibility, core strength, and spinal mechanics, reducing stress on narrowed areas.

Advanced interventional procedures

For persistent symptoms, treatments such as the MILD procedure  may help reduce pain signals and improve function.  The MILD procedure is a minimally invasive procedure  which opens up the space that the nerves live in.  It is indicated for central canal stenosis.

The goal is not only pain relief, but restoring mobility and helping patients stay active safely.

When you shouldn’t ignore your symptoms

You should seek evaluation if you experience:

• Leg pain that worsens with walking or standing
• Numbness, tingling, or weakness that doesn’t improve
• Pain affecting both legs
• Symptoms that steadily worsen over time
• Difficulty with balance or coordination

Left untreated, nerve compression from spinal stenosis can progressively limit mobility and quality of life.

Get clarity and relief with expert care

Sciatica and spinal stenosis often go hand in hand, but understanding which condition is driving your pain makes all the difference in treatment.

Dr. Marcie Merson brings extensive experience diagnosing and treating complex spinal conditions using evidence-based, minimally invasive techniques.

To find out what’s behind your leg and back pain, call Palm Beach Pain Institute at 561-499-7020, or schedule an appointment online. The sooner you identify the warning signs, the sooner you can take steps toward lasting relief and improved mobility.