Sciatica: Causes, Symptoms & Treatment

Sciatica refers to pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. The pain typically affects only one side of the body and is caused by compression or irritation of a spinal nerve root in the lower back, most commonly by a herniated disc.

Sciatica is very common, affecting up to 40% of people at some point in their lives. While it can be severely painful, most cases resolve with conservative treatment within 4 to 6 weeks.

• Herniated disc: The most common cause (~90% of cases); disc material presses on a nerve root
• Spinal stenosis: Narrowing of the spinal canal
• Spondylolisthesis: A vertebra slips forward over the one below it
• Piriformis syndrome: The piriformis muscle in the buttock irritates the sciatic nerve
• Degenerative disc disease: Age-related disc changes
• Rare causes: Tumors, infections, injury

• Sharp, shooting, or burning pain from the lower back through the buttock and down the back of the leg
• Pain that worsens with sitting, coughing, or sneezing
• Numbness or tingling in the leg or foot
• Muscle weakness in the affected leg
• Difficulty moving the leg or foot
• Pain typically affects one side only

• Clinical examination: Straight leg raise test (positive if lifting the straightened leg reproduces pain), neurological exam
• MRI: Best imaging for visualizing disc herniation and nerve compression
• CT scan: Alternative if MRI is not available
• Imaging is generally reserved for severe or persistent symptoms (beyond 6-8 weeks), progressive neurological deficits, or suspected serious underlying cause

Conservative treatment (first-line for most patients):

• Stay active: Bed rest is discouraged; gentle activity promotes recovery
• Pain medications: NSAIDs (ibuprofen, naproxen), acetaminophen, short courses of oral corticosteroids for severe pain
• Physical therapy: Core strengthening, stretching, McKenzie exercises, nerve gliding techniques
• Heat/cold therapy: Ice packs initially, then alternating with heat
• Epidural steroid injections: For persistent pain not responding to oral medications; provide temporary relief

Surgical treatment (for severe or persistent cases):

• Microdiscectomy: Minimally invasive removal of the herniated disc fragment compressing the nerve; success rate approximately 85-90%
• Surgery is considered when: symptoms persist beyond 6-12 weeks despite conservative treatment, there is progressive neurological deficit, or cauda equina syndrome is present

• Maintain good posture
• Use proper body mechanics when lifting (bend at the knees, keep the back straight)
• Exercise regularly to strengthen core and back muscles
• Maintain a healthy weight
• Avoid prolonged sitting; take regular breaks to stand and stretch
• Use ergonomic furniture and workplace setup

See a doctor if leg pain persists for more than a week, is severe and worsening, or is accompanied by numbness or weakness. Seek emergency care for sudden severe symptoms or loss of bladder/bowel control.