Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. It most often occurs when a herniated disk or bone spur compresses part of the nerve, causing inflammation, pain, and often numbness in the affected leg.

Although sciatica pain can be severe, most cases resolve with conservative treatment within weeks. Surgery is reserved for cases with significant weakness, bowel/bladder dysfunction, or pain that does not improve with non-surgical care.

Sciatica symptoms can include:

• Pain that radiates from the lower (lumbar) spine to the buttock and down the back of the leg
• Pain ranging from mild ache to sharp, burning sensation or excruciating discomfort
• Pain that worsens with coughing, sneezing, or prolonged sitting
• Numbness, tingling, or muscle weakness in the affected leg or foot
• Usually one side of the body is affected

Red-flag symptoms that need urgent evaluation include progressive leg weakness, numbness in the groin or genital area (saddle anesthesia), and loss of bowel or bladder control — possible signs of cauda equina syndrome.

Sciatica most commonly results from compression of a lumbar nerve root, especially L5 or S1. Causes include:

• Herniated (slipped) disk
• Bone spurs (osteophytes) from spinal osteoarthritis
• Spinal stenosis (narrowing of the spinal canal)
• Spondylolisthesis
• Piriformis syndrome (less common, nerve compression in the buttock)
• Rarely, tumors, infection, or bleeding near the nerve roots

Risk factors include:

• Age-related spinal changes (peak incidence in middle age for disk herniation)
• Obesity
• Occupations involving twisting, heavy lifting, or prolonged driving
• Prolonged sitting
• Diabetes (increased risk of nerve damage)
• Smoking (impairs disk nutrition and healing)

Most people recover fully. Possible complications include:

• Chronic pain
• Permanent nerve damage with persistent weakness or numbness if severe compression is left untreated
• Loss of bowel or bladder control (cauda equina syndrome — surgical emergency)
• Falls related to leg weakness

To protect your back:

• Exercise regularly, focusing on core strength and flexibility
• Maintain good posture when sitting and standing
• Use proper lifting technique (bend at knees, keep load close)
• Maintain a healthy weight
• Do not smoke
• Take breaks from prolonged sitting

Diagnosis is based on history and neurologic examination (straight-leg raise, strength, reflexes, sensation). Imaging is not required for most acute cases but is indicated when:

• Symptoms persist beyond 6–8 weeks of conservative care
• Red-flag features are present
• Surgery or injections are being considered

MRI is the preferred imaging study for soft-tissue detail. CT or CT myelography is an alternative when MRI is contraindicated.

See a clinician if pain lasts longer than a week, is severe, or gets worse. Seek emergency care for sudden severe pain after injury, progressive weakness, saddle numbness, or bowel/bladder dysfunction.

Most sciatica improves with time and conservative care:

• Activity modification (avoid prolonged bed rest; stay as active as tolerated)
• NSAIDs or acetaminophen for pain
• Physical therapy — exercises to improve posture, core strength, and flexibility
• Heat or cold packs
• Short course of oral corticosteroids in selected cases
• Epidural steroid injections for persistent radicular pain
• Surgery (microdiscectomy or decompression) for severe or progressive neurologic deficit, cauda equina syndrome, or refractory pain with a clear compressive lesion

Opioids are generally avoided for long-term management. Address contributing factors such as obesity and smoking.

Helpful measures:

• Continue gentle activity; walking is often beneficial
• Alternate ice and heat for comfort
• Use good posture and lumbar support when sitting
• Follow the home exercise program from physical therapy
• Avoid heavy lifting and twisting during acute flares
• Return for care if weakness worsens or bowel/bladder symptoms appear

Bring:

• Description of pain pattern (location, radiation, what worsens or relieves it)
• Any weakness, numbness, or bowel/bladder changes
• Prior back problems, imaging, or treatments
• List of medicines
• Questions about physical therapy, injections, and when surgery is considered