Sciatica: Symptoms and Treatment

Sciatica is one of the most uncomfortable kinds of pain a person can experience. It often starts in the lower back or buttock and shoots down the back of the leg, sometimes all the way to the foot. Many people describe it as burning, electric or like a toothache in the leg.

The word "sciatica" describes a set of symptoms rather than a single disease. It means the sciatic nerve, or one of the nerve roots that form it, is being irritated or compressed. The good news is that most cases improve without surgery, especially when diagnosed and managed early.

What is the sciatic nerve?

The sciatic nerve is the longest and thickest nerve in the body. It is formed by nerve roots that leave the lower spine, join together in the pelvis, and run through the buttock and down the back of each thigh. Above the knee it divides into branches that supply the lower leg and foot.

Because it covers such a long distance, irritation anywhere along its path, most often where the nerve roots leave the spine, can cause symptoms anywhere from the lower back to the toes.

Common symptoms

Sciatica usually affects one side of the body. Symptoms can include:

• Pain that travels from the lower back or buttock down the back of the thigh and into the calf or foot
• Burning, sharp or shooting pain, sometimes like an electric shock
• Tingling or "pins and needles" in the leg or foot
• Numbness in parts of the leg or foot
• Weakness in the leg or foot, such as difficulty standing on your toes or heels
• Pain that gets worse when sitting for a long time, coughing, sneezing or straining

For many people, the leg pain is worse than the back pain.

What causes sciatica?

Slipped (herniated) disc

This is the most common cause, especially in people aged 30 to 50. The soft centre of a spinal disc pushes through its tougher outer layer and presses on or inflames a nearby nerve root.

Spinal stenosis

In older adults, narrowing of the spinal canal or the openings where nerves exit can squeeze the nerve roots. This type of sciatica often affects both legs and gets worse with walking or standing.

Spondylolisthesis

When one vertebra slips forward over the one below, it can narrow the space for the nerves and cause sciatica.

Piriformis syndrome

The piriformis muscle sits deep in the buttock, close to the sciatic nerve. If it becomes tight or goes into spasm, it can irritate the nerve and cause sciatica-like pain.

Less common causes

Rarely, sciatica is caused by injury, infection, cysts or tumours near the spine. These causes are uncommon but are one of the reasons persistent symptoms should be properly assessed.

Who is more likely to get sciatica?

• People who sit for long hours, including office workers and drivers
• Jobs involving heavy lifting, twisting or prolonged bending
• Being overweight, which increases pressure on the spine
• Age-related changes in the spine, most often after the age of 30
• Diabetes, which increases the risk of nerve damage
• Smoking, which affects the health of spinal discs

Warning signs that need urgent care

Seek emergency care immediately if sciatica comes with loss of bladder or bowel control, numbness in the groin or "saddle" area, or weakness that is getting rapidly worse. These can be signs of cauda equina syndrome, a rare condition that needs urgent surgery to prevent permanent damage.

You should also see a specialist promptly if:

• The pain is severe and not improving after a few weeks
• You have numbness or weakness in the leg or foot
• Symptoms are affecting both legs
• The pain started after an injury or fall

How sciatica is diagnosed

Diagnosis begins with a detailed history and a physical examination. Your doctor will check how far you can bend, test your muscle strength, reflexes and sensation, and may perform a straight leg raise test, in which lifting the straightened leg reproduces the pain if a nerve root is irritated.

Imaging is not usually needed at first. An MRI scan is recommended if symptoms are severe, if there is weakness or numbness, if pain does not improve with treatment, or if an injection or surgery is being considered. MRI shows the discs and nerves clearly and helps confirm exactly where the nerve is being compressed. Nerve conduction studies may occasionally be used to assess nerve function.

Treatment options

Initial self-care

• Keep moving. Gentle walking and continuing light daily activities usually helps more than bed rest.
• Heat or ice. Ice may help in the first couple of days, followed by heat to relax tight muscles.
• Avoid long periods of sitting, and change position frequently.
• Short-term pain relief, as advised by your doctor or pharmacist.

Physiotherapy

A targeted exercise programme can reduce pressure on the nerve, strengthen the core and back muscles, and improve flexibility. Nerve-gliding exercises and posture training are often part of rehabilitation.

Medication

Your doctor may prescribe anti-inflammatory medicines, short courses of muscle relaxants, or medicines specifically designed for nerve pain. The choice depends on your symptoms and overall health.

Epidural steroid injections and nerve root blocks

If pain remains severe despite medication and physiotherapy, an image-guided injection can place anti-inflammatory medication directly around the irritated nerve root. For many patients, this reduces pain enough to allow them to return to normal activity and continue rehabilitation.

Surgery

Surgery is considered when:

• There is progressive weakness or loss of nerve function
• There are signs of cauda equina syndrome
• Severe pain continues despite several weeks of good non-surgical treatment

The most common operation for a slipped disc is a microdiscectomy, where the part of the disc pressing on the nerve is removed. With modern minimally invasive spine surgery, this is done through a small incision, and many patients notice relief of leg pain soon after surgery.

Recovery and outlook

Most people with sciatica improve significantly within six to twelve weeks with non-surgical treatment. Recovery is often gradual: leg pain tends to ease first, while numbness or tingling can take longer to fully settle.

Preventing sciatica from coming back

• Exercise regularly, with a focus on core and back strength
• Maintain good posture when sitting, and take regular movement breaks
• Use proper lifting technique: bend your knees, keep the load close, and avoid twisting
• Maintain a healthy weight
• Stop smoking to protect your spinal discs

The bottom line

Sciatica can be very painful, but in most cases it gets better with time and the right care. Early diagnosis, staying active and a structured treatment plan give the best chance of a full recovery. If your symptoms are severe, persistent, or come with numbness or weakness, a specialist assessment can identify the cause and the most effective treatment.