Sciatica
Also known as: Sciatic nerve pain، Lumbar radiculopathy
Sciatica is sharp pain radiating from the lower back through the buttock and down one leg — caused by irritation or compression of a nerve root in the lumbar spine. About 40% of adults experience it at some point in life.
Common Symptoms
- Sharp pain shooting from the lower back into the buttock and down one leg
- Pain that may extend to the foot
- Burning, electric, or shooting quality (not just dull aching)
- Pain worsened by sitting, sneezing, or coughing
- Numbness or tingling in the leg or foot
- Muscle weakness in the affected leg
- Usually affects one leg, rarely both
Causes & Risk Factors
- Lumbar disc herniation (most common cause in patients under 50)
- Lumbar spinal stenosis (more common over 60)
- Spondylolisthesis (one vertebra slipping forward)
- Piriformis syndrome (piriformis muscle in buttock irritating the sciatic nerve)
- Rarely: tumor or infection along the nerve path
Treatment Options
Stay gently active
Bed rest beyond 1-2 days worsens recovery. Walking 15-30 minutes daily from day one is therapeutic. Avoid the specific aggravating positions (prolonged sitting, heavy lifting).
Targeted physical therapy
Spine specialist physiotherapist using McKenzie extensions, neural mobilization, core stabilization. Often the most effective intervention.
NSAIDs and neuropathic medications
NSAIDs (ibuprofen, diclofenac) for inflammation; gabapentin or pregabalin for nerve-quality pain (burning, shooting, numbness).
Epidural steroid injection
Cortisone injected around the inflamed nerve root. About 60-70% of patients get significant relief lasting 2-3 months. Buys time for natural healing.
Microdiscectomy (when conservative care fails)
Minimally invasive surgery for cases not responding to 8-12 weeks of conservative care, OR with progressive neurological deficits, OR cauda equina symptoms.
When to See a Doctor
- Sciatica persisting more than 4-6 weeks
- Progressive weakness in the leg (e.g., foot drop)
- Severe pain unresponsive to medication
- Pain following significant trauma
- URGENT: loss of bladder/bowel control, numbness in groin/inner thighs, severe weakness in both legs (cauda equina syndrome)
Frequently Asked Questions
How long does sciatica last?
Most cases improve significantly within 4-6 weeks of conservative treatment and resolve within 6-12 weeks. Cases persisting beyond 12 weeks need imaging and specialist assessment.
Can sciatica cause permanent nerve damage?
Rare with prompt treatment, but possible if severe nerve compression is untreated for months. Progressive weakness, foot drop, or loss of bladder/bowel control require urgent evaluation to prevent permanent damage.
Should I rest or stay active with sciatica?
Stay gently active. Bed rest beyond 1-2 days worsens outcomes. Walking 15-30 minutes daily, avoiding aggravating positions, and following physical therapy produces faster recovery than rest.
When is surgery needed for sciatica?
Surgery is considered when: pain persists beyond 8-12 weeks despite optimal conservative care; progressive neurological deficits; cauda equina symptoms (emergency); or severe pain unresponsive to all conservative measures including epidural injection.
Can I prevent sciatica from coming back?
Significantly, yes. Core strengthening, proper lifting technique, regular movement breaks during sitting, maintaining healthy weight, and good sleeping posture all reduce recurrence. The patients who follow these habits have markedly lower recurrence rates.