Sciatica

Sciatica affects about 40% of people during their lifetime, causing pain that radiates from the lower back down through the leg. While it can be debilitating, most people recover with time and self-care, though understanding its causes and treatment options is essential for effective management.

Table of contents

• What is sciatica?
• The sciatic nerve
• Symptoms of sciatica
• What causes sciatica?
• How doctors diagnose sciatica
• Treatment options
• Self-care and lifestyle changes
• Recovery and outlook
• When to see a doctor

What is sciatica?

Sciatica is nerve pain that comes from an injury or irritation to your sciatic nerve (the nerve that runs from your lower back through your legs). The term describes pain or discomfort felt along the path of this nerve, rather than being a disease itself^[1]. Many people mistakenly call any lower back or leg pain “sciatica,” but true sciatica specifically involves pain resulting from sciatic nerve or nerve root problems^[5].

The condition is very common, affecting approximately 40% of people in the United States at some point during their lifetime^[1]. It rarely occurs before age 20 unless related to an injury^[1]. While sciatica is most likely to develop between ages 30 and 50, older adults often experience it due to age-related wear and tear on the spine^[4].

The sciatic nerve

The sciatic nerve is the longest and thickest nerve in your body, measuring up to 2 centimeters wide^[1]. Despite its name, it’s not just one nerve but actually a bundle of nerves that come from five nerve roots branching off from your spinal cord. These nerve roots come from the lumbar (lower) spine and sacral spine, specifically from the L4 to S3 levels^[5].

You have two sciatic nerves, one on each side of your body. Each sciatic nerve runs through your hip and buttock on one side, then travels down the leg until reaching just below your knee. At that point, they split into smaller branches that connect to your lower leg, foot, and toes^[1].

The sciatic nerve provides important functions for your lower body. It gives direct control to your hamstring muscles and the muscles that help you pull your leg toward your body. It also provides indirect control to your calf muscles, the muscles at the front of your lower leg, and certain muscles in your foot. Additionally, its branches help you feel sensations in the back and outer side of your lower leg and the bottom of your foot^[5].

• Lower back (lumbar spine)
• Buttocks
• Hip
• Leg
• Foot
• Toes

Symptoms of sciatica

Sciatica symptoms usually affect your bottom and the back of one leg, often including your foot and toes^[6]. The pain typically starts in your lower back or buttock and radiates down one leg. This pattern of pain traveling from the back into the leg is the key symptom that suggests sciatica rather than another type of back pain^[7].

The pain can vary widely from person to person. Some people describe it as a dull ache, while others experience sharp, shooting pain^[2]. Many describe sciatica pain as burning or feeling like an electric shock^[1]. The pain may feel like a bad leg cramp that can last for weeks^[4].

Besides pain, you may experience:

• Tingling or “pins and needles” sensations, similar to what happens when your leg falls asleep^[1]
• Numbness where you can’t feel sensations on the skin in affected areas. This happens because signals from your back or leg have trouble reaching your brain^[1]
• Muscle weakness in your back or legs, which is a more severe symptom indicating that muscle command signals are having difficulty reaching their destinations^[1]

Your symptoms may come on suddenly or start slowly. The pain often worsens when you move, sneeze, or cough^[6]. It commonly happens with bending or lifting your legs upward when lying on your back^[1]. Prolonged sitting can also make symptoms worse^[4].

In very severe cases, you might experience urinary incontinence or fecal incontinence (loss of bladder or bowel control). This is a very serious symptom that means signals controlling your bladder and bowels aren’t reaching their destinations^[1]. If this happens, you need immediate medical attention.

What causes sciatica?

Sciatica happens when something presses or rubs on the sciatic nerve^[6]. Any condition that affects the sciatic nerve or the nerve roots that form it can cause sciatica symptoms. The pain most frequently originates from an irritated nerve root in the lower spine^[7].

The most common causes include:

Herniated disc (also called slipped or ruptured disc) is the most common cause of sciatica^[5]. This occurs when the soft, gel-like center of a disc between the bones in your spine pushes out through a tear in its outer ring. This herniation puts pressure on the nerve root located next to the disc^[7]. Herniated discs are the typical cause in people under age 40^[4].

Spinal stenosis is a narrowing of the spaces within your spine, particularly the canal that houses the spinal nerves. This narrowing can put pressure on the nerves^[6]. This condition is more common in older adults and typically causes sciatica symptoms in people over 60^[4].

Spondylolisthesis occurs when one of the bones in your spine slips out of position relative to the bone above or below it^[6].

Other causes can include:

• Bone spurs (bony projections that develop along bone edges) from arthritis or general wear and tear of aging^[4]
• Back injuries, such as fractures^[3]
• Muscle spasms in the buttock area that can irritate the sciatic nerve^[3]
• Pregnancy, due to changes in weight distribution and posture^[3]
• Tumors or infections, though these are less common^[7]

In many cases, no specific cause can be found^[3].

Certain factors can increase your risk of developing sciatica. These include age-related changes in the spine, obesity (which puts extra stress on your spine), prolonged sitting, diabetes, and smoking^[7].

How doctors diagnose sciatica

Diagnosis begins with a complete patient history. Your doctor will ask you to explain how your pain started, where it travels, and exactly what it feels like^[4].

During the physical exam, your doctor may check your muscle strength and reflexes (automatic responses your body makes to certain stimuli). You may be asked to perform certain movements, such as walking on your toes or heels, rising from a squatting position, or lifting your legs one at a time while lying on your back^[4][10]. A physical examination may help pinpoint which nerve root is irritated^[4].

If you have severe pain or pain that doesn’t improve within a few weeks, your doctor may order imaging tests^[10]:

• X-rays can reveal changes in bone structure that might affect the spaces where nerve roots exit the spine^[10]
• MRI (magnetic resonance imaging) uses powerful magnets and radio waves to produce detailed images of soft tissues, so herniated discs and pinched nerves show clearly on the scan^[10]
• CT scan (computed tomography) may be used, sometimes with dye injected into the spinal canal to make the spinal cord and nerves easier to see^[10]
• Electromyography (EMG) measures the electrical impulses produced by nerves and the responses of muscles. This test can confirm how severe a nerve root injury is^[10]

Treatment options

Most people with sciatica get better on their own with time and self-care treatments^[1]. The condition usually heals itself given sufficient time and rest. Approximately 80 to 90% of patients with sciatica improve over time without surgery, typically within several weeks if a herniated disc is the underlying cause^[4].

Sciatica usually gets better in a few weeks to a few months, though it can sometimes last longer^[6]. Treatment is aimed at helping you manage your pain without long-term use of medications^[4].

Medications

Several types of medications might be used to treat sciatica pain:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may offer relief^[4]
• Muscle relaxants may help ease discomfort^[4]
• Corticosteroids to reduce inflammation^[10]
• In some cases, doctors may prescribe antidepressants or anti-seizure medications for pain relief^[10]

It’s worth noting that paracetamol is unlikely to help with sciatica, and it’s not clear how much NSAIDs help^[6].

Physical therapy

Once your pain improves, a healthcare professional can design a program to help prevent future injuries^[10]. Physical therapy typically includes targeted exercises and stretches to strengthen the muscles that support your back and improve flexibility^[3]. These exercises usually focus on correcting posture, strengthening your core muscles, and improving your range of motion^[10].

Steroid injections

In some cases, your doctor may recommend a shot of a corticosteroid medication into the area around the nerve root that’s causing pain. These injections can help reduce inflammation and provide temporary relief^[10].

Surgery

Severe cases may need surgery^[1]. Surgery is typically reserved for people who have severe pain that hasn’t improved with other treatments, or those who develop serious symptoms like muscle weakness or loss of bladder or bowel control^[2]. Surgical options may include decompression surgery to remove bone spurs or other structures compressing the nerve^[6].

Self-care and lifestyle changes

There are many things you can do at home to help relieve your pain and speed up recovery:

Stay active

Carry on with your normal activities as much as possible^[6]. Start gentle exercise as soon as you can—anything that gets you moving can help^[6]. Movement actually helps reduce inflammation in the area^[13]. However, avoid sitting or lying down for long periods, even if moving hurts. This isn’t harmful and can help you get better faster^[6].

Walking is particularly helpful. Brief walks a few times a day can help keep sciatica pain at bay^[13].

Apply heat or cold

You can hold heat packs to the painful areas to find relief^[6]. Some people find it soothing to put gentle heat or cold on painful muscles^[4].

Strengthen your core

When you strengthen all the muscles that run alongside your spine—your abdominals, back, hips, buttocks, and pelvis—you’re helping to support and stabilize your spine^[13]. Activities like yoga, tai chi, and Pilates are gentle, effective ways to strengthen your core^[13].

Stretch regularly

Tight muscles can aggravate the sciatic nerve. Doing targeted stretches can help open up the muscles surrounding the nerve, relieving some of the pressure^[13].

Improve your posture

Make sure you have good posture when sitting and standing^[6]. If you work at a computer, sit correctly and take frequent breaks^[6]. If your job requires a lot of sitting, take frequent breaks or try a standing desk^[16].

Use safe lifting techniques

Use a safe technique when lifting heavy objects^[6]. Bend with your knees, not your back^[19].

Maintain a healthy weight

If you’re overweight, losing weight can help reduce stress on your spine^[6].

Quit smoking

Don’t smoke—smoking can increase your risk of getting sciatica^[6]. Besides its general harmful effects on health, smoking reduces oxygen supply to your tissues. Because the discs in the spine don’t have a great oxygen supply to begin with, smoking can increase the risk of disc degeneration and damage that can lead to sciatica^[16].

Get enough sleep

Like your brain, your spine also needs rest. Aim for seven to nine hours of sleep each night^[16].

Recovery and outlook

Sciatica is usually not a serious or dangerous condition^[1]. Most people with sciatica get better on their own with time and self-care treatments^[1]. Those cases caused by a herniated disc can clear up with treatment in a few weeks to months^[2].

If you get sciatica, there’s a chance that it could happen again at some point^[6]. The causes of the pain—bulging discs, pinched nerves—often linger, so symptoms can flare up again later^[13].

When to see a doctor

See your doctor if you have sciatica and the pain has not improved after trying home treatments for a few weeks, is getting worse, or is stopping you from doing your normal activities^[6].

Mild sciatica usually goes away over time. However, call your healthcare provider if self-care measures don’t ease symptoms, or if pain lasts longer than a week, is severe, or gets worse^[2].

Get immediate medical care by going to the emergency room or calling emergency services if you experience:

• Sciatica on both sides of your body
• Weakness or numbness in both legs that’s severe or getting worse
• Numbness around or under your genitals or around your bottom
• Difficulty starting to urinate, inability to urinate, or loss of control when you urinate (and this is not normal for you)
• Not noticing when you need to have a bowel movement or inability to control bowel movements (and this is not normal for you)^[6]
• Sudden numbness or muscle weakness in a leg
• Pain after a violent injury^[2]

These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible^[6].