Sciatica: Symptoms, Causes and Treatment

What is sciatica?

Sciatica is pain that runs along the path of the sciatic nerve, from the lower back or buttock down the back or side of the leg, often to below the knee and sometimes into the foot. It is a symptom rather than a diagnosis. Doctors also call it lumbar radicular pain or radiculopathy, because it comes from a nerve root as it leaves the spine.

Sciatica symptoms

• Pain in one leg that is often worse than the back pain, typically sharp, shooting, burning or electric
• Pins and needles or numbness in the leg or foot
• Weakness in the leg or foot in some people
• Pain that’s worse with sitting, bending, coughing or sneezing

It usually affects one side. Sciatica in both legs is less common and needs prompt assessment.

What causes sciatica?

• A disc bulge or herniation is the most common cause. Part of the disc between two vertebrae pushes out and presses on or inflames a nerve root.
• Spinal stenosis, a narrowing of the spaces the nerves pass through, is more common in older people and often causes leg pain with walking that eases with sitting or bending forward.
• Spondylolisthesis, where one vertebra slips forward on another.
• Rarely, infection, a tumour or a cyst presses on the nerve.

Pain from muscles or joints in the back and buttock can also spread into the thigh. This “referred” pain usually stays above the knee and doesn’t cause numbness or weakness, which helps doctors tell it apart from true sciatica.

How long does sciatica last?

For most people, sciatica improves over weeks to a few months, and a disc bulge often shrinks on its own. Some people have symptoms for longer. See how long sciatica lasts.

Sciatica treatment

• Stay active. Keep moving as much as you can. Bed rest doesn’t help.
• Exercise and physiotherapy. These can help, especially once the worst of the pain eases. See sciatica stretches and exercises.
• Heat, positioning and pacing can ease symptoms day to day.
• Medicines. The evidence for many commonly used medicines in sciatica is weak, and some carry risks. Talk to your GP about what’s appropriate.
• Injections. Some people get short-term relief from an injection near the nerve.
• Surgery. For people with severe or lasting leg pain from a disc, surgery tends to relieve leg pain faster. After a year or so, results are often similar to non-surgical care, so the decision depends on how severe symptoms are and personal preference.

Do I need an MRI?

Not straight away for most people. An MRI is useful if there are warning signs, if symptoms aren’t improving after about six to eight weeks, or if surgery or an injection is being considered.

When to get help

See a GP if leg pain is severe, isn’t improving, comes with numbness or weakness, or is affecting your sleep or work.

Go to an emergency department for numbness around the groin or buttocks, new trouble controlling your bladder or bowel, sciatica in both legs, or leg weakness that’s getting worse. See back pain red flags.

References

1. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015;372(13):1240-8.
2. Jensen RK, Kongsted A, Kjaer P, et al. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273.
3. Fernandez M, Ferreira ML, Refshauge KM, et al. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. Eur Spine J. 2016;25(11):3495-3512.
4. Konstantinou K, Dunn KM, Ogollah R, et al. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J. 2018;18(6):1030-1040.
5. healthdirect. Sciatica.
6. Better Health Channel (Victorian Government). Sciatica.