Sciatica (Sciatic Nerve Pain)
Pain shooting from the lower back down the leg
Quick Facts
- Type: Neurological / musculoskeletal symptom
- Common causes: Herniated disc, spinal stenosis, pinched nerve
- Typical path: Lower back, buttock, back of one leg
- Seek emergency care: Loss of bladder/bowel control, leg weakness
Overview
Sciatica is pain that travels along the path of the sciatic nerve, the large nerve that runs from the lower back, through the buttock, and down the back of each leg. Although many people use "sciatica" as if it were a diagnosis, it is really a symptom of an underlying problem irritating or compressing the nerve root in the lower spine. The pain usually affects just one side of the body.
Sciatica often feels like a sharp, burning, or electric pain that shoots down the leg, sometimes with tingling, numbness, or weakness. It can range from a mild ache to severe, disabling pain. The good news is that most sciatica improves within a few weeks with self-care and does not require surgery. However, certain warning signs point to a serious problem that needs urgent attention. For a related condition, see sciatica.
Common Causes
Sciatica results from pressure on or irritation of the sciatic nerve roots, usually in the lower back:
- Herniated disc: The most common cause, where a herniated disc presses on a nerve root.
- Spinal stenosis: Narrowing of the spinal canal (spinal stenosis) that pinches nerves, more common with age.
- Degenerative disc disease: Age-related disc wear (degenerative disc disease).
- Bone spurs or arthritis: Osteoarthritis of the spine narrowing the space around nerves.
- Muscle-related compression: Tight buttock muscles (piriformis) irritating the nerve.
Risk rises with age, prolonged sitting, heavy lifting, excess weight, and certain occupations.
Associated Symptoms
Sciatica usually comes with a recognizable set of symptoms:
- Leg pain radiating down the back of one leg, often past the knee
- Low back pain or buttock pain
- Numbness, tingling, or pins-and-needles in the leg or foot
- Muscle weakness in the affected leg or foot
- Pain that worsens with sitting, coughing, sneezing, or bending
Numbness around the groin, loss of bladder or bowel control, or weakness in both legs is a medical emergency.
Diagnosis & Evaluation
Sciatica is usually diagnosed from the history and a physical exam:
- Symptom pattern: Pain radiating down one leg in the sciatic nerve's path.
- Physical and neurological exam: Testing leg strength, reflexes, sensation, and movements such as the straight-leg-raise test.
- Imaging: MRI or CT scans are used when pain is severe, persistent, or accompanied by red-flag symptoms, to locate the affected nerve and cause.
Imaging is generally not needed in the first few weeks for typical, improving sciatica.
Treatment & Management
Most sciatica improves with conservative care over a few weeks:
- Stay active: Gentle movement and avoiding prolonged bed rest speed recovery.
- Pain relief: Over-the-counter anti-inflammatories or acetaminophen, used as directed; doctors may prescribe stronger or nerve-specific medicines for severe pain.
- Heat and cold: Applied to the lower back and buttock for comfort.
- Physical therapy: Stretching and strengthening exercises to support the spine and reduce nerve pressure.
- Injections or surgery: Steroid injections or, rarely, surgery for severe or persistent cases or significant nerve compression.
Surgery is reserved for those who do not improve or who have progressive weakness or emergency symptoms.
Self-Care & Prevention
You can reduce the risk of sciatica and its return with spine-friendly habits:
- Exercise regularly, focusing on core and back strength to support the spine.
- Lift safely, bending at the knees, keeping loads close, and avoiding twisting.
- Maintain good posture and take breaks from prolonged sitting.
- Keep a healthy weight to lessen strain on the lower back.
- Set up an ergonomic workspace with good lumbar support.
Staying active and avoiding long periods of sitting are among the best ways to keep the lower back and sciatic nerve healthy.
When to See a Doctor
See a doctor if sciatica is severe, lasts more than a few weeks, or keeps returning. Seek emergency care immediately if you have:
- Loss of bladder or bowel control
- Numbness around the groin, buttocks, or inner thighs (saddle area)
- Sudden, severe weakness in one or both legs
- Sciatica after a serious fall or injury
- Fever with back pain, or unexplained weight loss
The combination of saddle numbness, leg weakness, and bladder or bowel changes can indicate cauda equina syndrome, a surgical emergency that requires immediate care.
Frequently Asked Questions
What does sciatica feel like?
Sciatica typically causes a sharp, burning, or electric pain that shoots from the lower back or buttock down the back of one leg, sometimes past the knee. It may come with numbness, tingling, or weakness in the leg or foot and often worsens with sitting.
How long does sciatica last?
Most cases of sciatica improve within a few weeks with self-care such as staying active, pain relief, and gentle stretching. If pain is severe, lasts longer than six weeks, or worsens, see a doctor to check for ongoing nerve compression.
What is the best way to relieve sciatica at home?
Stay gently active rather than resting in bed, use over-the-counter pain relievers as directed, apply heat or cold to the lower back and buttock, and do gentle stretches. Physical therapy can help if symptoms persist.
Is sciatica an emergency?
Usually not, but it can be. Seek emergency care if you develop loss of bladder or bowel control, numbness around the groin or inner thighs, or sudden severe leg weakness, as these can indicate cauda equina syndrome, which needs urgent surgery.
What causes sciatica?
Sciatica is most often caused by a herniated disc pressing on a sciatic nerve root in the lower back. Spinal stenosis, degenerative disc disease, bone spurs, and arthritis of the spine are other common causes.
References
- Mayo Clinic. Sciatica — Symptoms and causes.
- National Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain.
- MedlinePlus, U.S. National Library of Medicine. Sciatica.
- American Academy of Orthopaedic Surgeons (AAOS).