Nerve pain that travels from the lower back down the leg, usually from a compressed spinal nerve.

Overview

• Sciatica is pain that travels along the path of the sciatic nerve — the longest nerve in the human body. It runs from the lower back, through the hips and buttocks and down each leg.
• Sciatica is not a diagnosis in itself — it is a symptom of an underlying problem, usually a compressed or irritated nerve in the lower spine.
• It typically affects only one side of the body. The pain can range from a mild ache to a sharp, burning, or electric shock-like sensation.

How common is sciatica?

• Sciatica affects 2–40% of people at some point in their lifetime
• It most commonly develops in people between the ages of 40 and 50
• It is one of the most common causes of lower back and leg pain worldwide
• The good news: 80–90% of patients recover without surgery, typically within a few weeks to months

What causes sciatica?

Sciatica occurs when something presses on or irritates the sciatic nerve roots in the lower spine. The most common causes are:

• Herniated (slipped) disc — the soft inner cushion of a spinal disc pushes out and presses on a nerve root. This is the most common cause of sciatica
• Spinal stenosis — the spinal canal narrows, putting pressure on the nerves passing through it. More common in older adults
• Bone spurs — bony overgrowths on the spine that can pinch nerve roots
• Piriformis syndrome — the piriformis muscle in the buttock tightens or spasms and irritates the sciatic nerve that runs underneath or through it
• Spondylolisthesis — one vertebra slips forward over the one below it, narrowing the opening through which nerve roots exit
• Injury or trauma — a fall, accident, or sports injury can damage the spine and compress nerve roots

Who is at higher risk?

• Age 40–50 years — spinal discs naturally degenerate with age
• Obesity or overweight — excess body weight increases stress on the spine
• Prolonged sitting — desk workers, drivers and people with sedentary jobs are at higher risk
• Physically demanding work — jobs involving heavy lifting, twisting, or prolonged standing
• Smoking — associated with disc degeneration and increased inflammation
• Diabetes — nerve damage from diabetes can increase susceptibility to sciatica
• Previous history of low back pain or a prior episode of sciatica

Symptoms

The hallmark symptom is pain that starts in the lower back or buttock and shoots down one leg, following the path of the sciatic nerve.

• Sharp, burning, or electric shock-like pain in the lower back, buttock and leg
• Pain that worsens when sitting, coughing, sneezing, or straining
• Numbness or tingling (pins and needles) in the leg or foot
• Muscle weakness in the affected leg
• Difficulty moving the foot or toes
• The pain usually affects only one leg at a time

Diagnosis

How is sciatica diagnosed?

Your doctor will take a detailed history of your symptoms and perform a physical examination. In most uncomplicated cases, imaging is not immediately needed.

Physical examination

• Straight-Leg Raise Test — you lie flat and the doctor raises your leg; reproduction of your shooting leg pain strongly suggests sciatica
• Neurological assessment — checking reflexes, muscle strength and sensation in the leg to identify which nerve root is affected

Imaging tests

Imaging is recommended if symptoms are severe, not improving, or red flags are present.

• MRI scan — the best imaging test for sciatica; clearly shows discs, nerve roots and soft tissue
• CT scan — used when MRI is not available; shows bony structures well
• X-ray — shows bony changes and alignment but cannot show discs or nerves directly
• Nerve conduction studies (EMG) — occasionally used to assess nerve damage if diagnosis is unclear

Treatment

Will sciatica get better on its own?

In most cases, yes. The majority of sciatica cases — especially those caused by a herniated disc — improve significantly within 4–8 weeks with conservative care.

Self-care at home

• Apply ice packs for the first 48–72 hours to reduce inflammation (20 minutes on, 20 minutes off)
• Switch to heat after the first few days — a warm compress or heating pad can relax muscle spasm
• Stay as active as possible — complete bed rest is not recommended and can slow recovery
• Avoid positions that worsen pain — many people find lying flat with a pillow under the knees helpful

Medicines

• NSAIDs (e.g., ibuprofen, naproxen) — reduce pain and inflammation
• Muscle relaxants — may be prescribed if muscle spasm is present
• Oral steroids (e.g., prednisone) — short course to reduce severe nerve inflammation
• Neuropathic pain medicines (e.g., gabapentin, pregabalin) — for nerve-type burning pain
• Always take medicines as prescribed by your doctor and do not exceed recommended doses

Physical therapy

• A physiotherapist can design a personalised exercise programme to strengthen the core and back muscles supporting the spine
• Stretching exercises targeting the piriformis, hamstrings and lower back are commonly used
• Postural correction and body mechanics training — learning to sit, stand, lift and move safely
• Regular moderate-intensity physical activity helps prevent recurrence of sciatica and reduces disability

Epidural steroid injections

• A corticosteroid is injected into the epidural space around the nerve roots in the spine
• Can provide significant short-term pain relief, helping patients engage in physiotherapy
• Usually offered if pain is severe and not responding to medicines and physiotherapy

Surgery

• Surgery is considered only when conservative treatment has failed after 6–12 weeks, or if there is progressive neurological weakness or cauda equina syndrome
• Microdiscectomy — the most common procedure; the portion of the disc pressing on the nerve is removed
• Laminectomy — removes part of the bone (lamina) to relieve pressure in spinal stenosis
• Most patients with disc herniation have good outcomes after surgery — significant improvement in leg pain

Complications

• Permanent nerve damage — prolonged compression of the sciatic nerve can lead to lasting numbness, weakness, or loss of sensation in the leg
• Cauda Equina Syndrome — if the nerve compression is severe and goes untreated, permanent paralysis or loss of bladder and bowel control can result
• Chronic pain — untreated or poorly managed sciatica can become a long-term, debilitating pain condition
• Reduced mobility and quality of life — persistent pain leads to inactivity, muscle wasting and loss of independence
• Mental health impact — chronic sciatica is strongly associated with anxiety, depression and social withdrawal

Lifestyle and long-term care

• Exercise regularly — strengthen core and back muscles to support the spine; regular moderate-intensity activity is protective
• Maintain a healthy weight — reduces mechanical stress on lumbar discs
• Quit smoking — smoking accelerates disc degeneration and increases inflammation
• Lift correctly — always bend at the knees, keep the back straight and hold the load close to your body
• Avoid prolonged sitting — take regular breaks to stand and walk every 30–45 minutes
• Use an ergonomic chair with good lumbar support at your workstation
• Sleep on a medium-firm mattress — a mattress that is too soft or too hard can worsen back problems
• Continue your physiotherapy exercises even after symptoms resolve
• Attend follow-up appointments as scheduled
• Report any worsening symptoms, new weakness, or bladder/bowel changes to your doctor immediately
• If you have had surgery, follow your surgeon's rehabilitation programme carefully

When to contact a doctor?

• Loss of bladder or bowel control
• Numbness in the groin or inner thighs
• Sudden severe weakness in both legs
• Pain following a significant injury, accident, or fall
• Pain is severe and not improving with home care after a few days
• Leg weakness or numbness is getting worse
• Sciatica has lasted more than 4–6 weeks without improvement
• Pain is waking you from sleep or preventing all daily activity

Myths & Facts

Frequently Asked Questions