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Sciatica

Sciatica is pain that radiates from the lower back down the leg along the sciatic nerve, usually from a herniated disc or bone spur; most cases improve within weeks with conservative care.

MusculoskeletalNeurologic
Sciatica is pain that radiates along the path of the sciatic nerve — from the lower back through the buttock and down the back of one leg. It is a symptom rather than a disease in itself, and it is one of the most common forms of lumbosacral radiculopathy, meaning irritation of a nerve root in the lower spine. The sciatic nerve is the largest nerve in the body, formed from nerve roots that exit the lower spine, which is why irritation near the spine can be felt all the way down the leg. Most episodes are painful but self-limited: the majority of people improve substantially within weeks without surgery.

Causes

Sciatica occurs when a nerve root in the lower spine is compressed or irritated. Common causes include:
  • Herniated disc: The most frequent cause — the soft center of a spinal disc bulges out and presses on an adjacent nerve root.
  • Bone spurs and arthritis: Bony overgrowth from spinal osteoarthritis can narrow the openings where nerves exit the spine.
  • Narrowing of the spinal canal: Age-related narrowing (spinal stenosis) can crowd the nerve roots in the lower back.
  • Spondylolisthesis: One vertebra slipping forward over another can stretch or pinch a nerve.
  • Risk factors: Age-related spine changes, occupations involving heavy lifting or prolonged sitting, excess body weight, and diabetes all increase risk.

Symptoms

Sciatica typically affects one side and follows a recognizable pattern:
  • Radiating pain: A burning, electric, or shooting pain that travels from the low back or buttock down the leg, sometimes reaching the calf or foot.
  • Numbness and tingling: "Pins and needles" sensations along the same nerve pathway.
  • Worse with certain movements: Coughing, sneezing, or long periods of sitting often aggravate the pain.
  • Muscle weakness: Significant or progressive weakness in the leg or foot signals more serious nerve compression.
Seek emergency care if you develop numbness in the saddle area, new loss of bladder or bowel control, or rapidly worsening leg weakness — these can indicate cauda equina syndrome, a surgical emergency. Prompt evaluation is also wise when sciatica follows a significant injury such as a fall or car accident.

Diagnosis

Diagnosis is usually made from the history and a physical examination, including strength, reflex, and straight-leg-raise testing. It helps to describe exactly where the pain travels, because the path of the pain often points to the specific nerve root involved. Imaging such as MRI is reserved for red-flag symptoms, severe or progressive weakness, or pain that persists beyond several weeks despite appropriate treatment, since disc abnormalities are common even in people without pain.

Treatment

Most people recover within several weeks to a few months, and only a small minority ultimately need surgery. Care is conservative and stepwise:
  • Staying active: Gentle movement and a gradual return to normal activity speed recovery; prolonged bed rest slows it.
  • Physical therapy: Targeted stretching, core strengthening, and posture work reduce pressure on the nerve and help prevent recurrences.
  • Medications: NSAIDs such as naproxen relieve pain and inflammation — used with care, since long-term NSAID use can irritate the stomach and contribute to peptic ulcer disease. Nerve-pain medicines such as gabapentin may help persistent radiating pain.
  • Epidural steroid injections: An option for severe pain that limits participation in therapy.
  • Surgery: Considered when there is progressive weakness, cauda equina syndrome, or disabling pain that fails months of conservative treatment.
If leg pain, numbness, or weakness is limiting your life, the internal-medicine team at Zimmer Medical Group can evaluate the cause, start treatment, and coordinate imaging or specialty referral when appropriate.

Related Medications

Commonly prescribed medications for this condition

GabapentinNaproxen

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