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.
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.
Getting Through a Sciatica Episode
Most sciatica resolves without anything dramatic, but the weeks in between are miserable, and the choices made during them decide whether the episode ends in six weeks or becomes a chronic problem.
The expected timeline
Leg pain from a disc herniation typically eases substantially within four to six weeks and continues improving for three months, as the disc material shrinks and nerve inflammation settles. Pain that is unchanged at six weeks, or any weakness that is getting worse, is when an MRI and a specialist opinion are arranged; our low back pain in primary care article explains the stepwise approach.
Using medication so it helps
A short scheduled course of naproxen or ibuprofen taken with food for one to two weeks works better than occasional doses, and is avoided in people with chronic kidney disease, a history of peptic ulcer disease, or on blood thinners, where acetaminophen is the substitute. A muscle relaxant such as cyclobenzaprine helps sleep in the first days but adds little after that. Gabapentin and pregabalin have weaker evidence for sciatica than for other nerve pain and are trialed, not assumed to work. A brief course of prednisone gives modest relief for some people. Opioids do not shorten recovery and are avoided; our managing pain without opioids article covers the alternatives.
Movement, sitting, and sleep
Walking several times a day, even short distances, does more than any single exercise, and sitting is the position tolerated worst; standing to work, breaking long drives every hour, and lying down rather than sitting to rest all help. Long drives south and a return to golf after a layoff are common local triggers; our golf injury prevention guide covers the return to play. Sleeping on the side with a pillow between the knees, or on the back with knees raised, eases night pain.
Injections and surgery: what they can and cannot do
An epidural steroid injection gives many people a few weeks of relief, enough to sleep and do physical therapy, but does not change the outcome at a year. Microdiscectomy relieves leg pain faster and is offered when severe pain persists beyond six to twelve weeks of good conservative care; by a year, most people who waited have done about as well, so the choice is about time lost. Progressive weakness or bladder symptoms are the exceptions and are surgical questions the same week.
What else causes leg pain like this
Buttock pain without back pain may be piriformis syndrome; our sciatica versus piriformis syndrome article tells the two apart. Leg pain on walking that eases with sitting or leaning forward is spinal stenosis, and calf pain on walking that eases with standing still is peripheral arterial disease. Groin pain with a stiff hip is hip osteoarthritis, and symmetric numb feet are diabetic neuropathy rather than a nerve root. The lumbosacral radiculopathy page covers the broader nerve-root picture; our musculoskeletal team coordinates therapy and referral. NINDS and MedlinePlus publish patient guidance on sciatica.
If leg pain has not improved after six weeks, or weakness is getting worse, schedule a visit.