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📋 Condition Guide2024-01-19

Sciatica: Causes, Symptoms, and Treatment

Sciatica refers to pain that radiates along the path of the sciatic nerve — from the lower back through the hip and buttock and down each leg. Most cases resolve with conservative treatment.

Educational content only. This article is not medical advice. Always consult a qualified orthopedic surgeon or physician for diagnosis and treatment.

What Is Sciatica?

Sciatica is not a diagnosis in itself — it's a term describing a set of symptoms caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest and widest nerve in the human body, originating from nerve roots in the lower lumbar and sacral spine (L4, L5, S1, S2, S3), merging into a single nerve that runs through the buttock, down the back of the thigh, and branches into the lower leg and foot.

When this nerve or any of its roots are compressed or irritated, pain, numbness, and tingling travel along its path — sometimes all the way to the foot.

Common Causes

  • Lumbar disc herniation (most common): Herniated disc material pressing on a nerve root
  • Spinal stenosis: Narrowing of the spinal canal or foramina
  • Piriformis syndrome: The piriformis muscle in the buttock compresses or irritates the sciatic nerve
  • Spondylolisthesis: Vertebral slippage pinching nerve roots
  • Bone spurs: Arthritic osteophytes encroaching on nerve foramina
  • Tumors (rare): Masses in the lumbar spine or pelvis
  • Sacroiliac joint dysfunction: SI joint inflammation can mimic sciatica

Symptoms

Sciatica typically affects one side of the body (unilateral). Symptoms include:

  • Sharp, burning, or shooting pain from the low back into the buttock and down the leg
  • Numbness or "pins and needles" sensation in the leg or foot
  • Weakness in the leg or foot (foot drop in severe cases)
  • Pain that worsens with prolonged sitting, coughing, or sneezing
  • Pain that improves with walking or changing positions

Sciatica can range from a mild ache to excruciating, disabling pain.

Diagnosis

Diagnosis is primarily clinical based on history and physical examination:

  • Straight Leg Raise (SLR) test: Positive if lifting the affected leg at 30–70 degrees reproduces pain — a key indicator of disc herniation
  • Neurological exam: Reflexes (knee jerk, ankle jerk), muscle strength testing, and sensory evaluation
  • MRI: Identifies the underlying cause (disc herniation, stenosis, etc.)
  • EMG/NCS: Can pinpoint which nerve root is affected and gauge severity

Treatment Options

Conservative Care (First-Line)

  • NSAIDs (ibuprofen, naproxen)
  • Muscle relaxants for associated spasm
  • Physical therapy focusing on McKenzie exercises, nerve mobilization (nerve flossing), and core strengthening
  • Heat and ice alternation
  • Activity modification and posture correction

Epidural Steroid Injections

Targeted injections of corticosteroid around the compressed nerve root provide significant temporary relief in many patients and can allow participation in physical therapy.

Surgical Treatment

When conservative measures fail or when neurological deficits are progressive, microdiscectomy (for disc herniation) or laminectomy (for stenosis) can effectively relieve sciatica. Success rates for leg pain resolution are excellent (85–95%).

Recovery

Most sciatica caused by disc herniation resolves within 6–12 weeks. Nerve healing can be slow — residual numbness and tingling may persist for months even after the underlying cause is treated.

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