Sciatica overview

Overview

Sciatica is a condition where you have pain that travels along the path of the sciatic nerve, which runs from your lower back down through your buttock and into one leg. It is not a disease itself but a symptom of a problem in the lower back, such as a slipped disc or narrowing of the spine.

Yes, sciatica is a very common problem. It affects about 1 in 10 people at some point in their lives, especially between the ages of 30 and 50.

Sciatica can affect anyone, but it is more common in people who are middle-aged, have a physically demanding job, are overweight, or sit for long periods. It can also occur during pregnancy.

Symptoms

Common symptoms

• Pain that starts in the lower back and travels down the back of one leg, sometimes into the foot or toes.
• Numbness or a pins-and-needles feeling in the leg or foot.
• Muscle weakness in the affected leg or foot.
• A burning or sharp pain that gets worse with sitting, coughing, or sneezing.

Symptoms in children

• Sciatica is rare in children, but if it occurs, symptoms are similar to adults: leg pain, numbness, or weakness.
• Children may complain of a limp or trouble walking.
• They might not be able to describe the pain clearly, so watch for changes in movement or posture.

Symptoms in older adults

• Older adults may experience sciatica due to age-related changes like spinal stenosis (narrowing of the spine).
• Symptoms can be more subtle, such as a dull ache or stiffness in the leg.
• Weakness in the legs may increase the risk of falls.

Causes

Main causes

• A herniated disc (also called slipped disc) where the soft inner part of a spinal disc bulges out and presses on the sciatic nerve.
• Spinal stenosis, a narrowing of the spinal canal that puts pressure on the nerve roots.
• Spondylolisthesis, where a vertebra slips out of place and pinches the nerve.

Risk factors

• Age: most common between 30 and 50.
• Prolonged sitting, especially with poor posture.
• Lifting heavy objects incorrectly or twisting the back.
• Being overweight or obese.
• Diabetes, which can increase the risk of nerve damage.

When to see a doctor

See a doctor urgently if:

• If you experience any of the emergency symptoms listed above (loss of bladder/bowel control, saddle numbness, sudden leg weakness) – call your local emergency number immediately.
• If you have severe pain that is not controlled with over-the-counter pain relief or rest.

Book a routine appointment if:

• If mild to moderate pain lasts longer than a week and does not improve with self-care.
• If you have numbness or weakness that is slowly getting worse.
• To get a proper diagnosis and rule out other causes.

Diagnosis

Your doctor will ask about your symptoms and do a physical exam. They will check your muscle strength, reflexes, and sensation. You may be asked to walk, bend, or move your leg in certain ways.

Tests that may be done

• Imaging tests like an MRI or CT scan are not always needed, but may be done if symptoms are severe or not improving after a few weeks.
• X-rays can show problems with the bones, but not nerve issues.
• Nerve conduction studies (electromyography or EMG) may help confirm nerve irritation.

What to expect at your appointment

Most people do not need imaging right away. Your doctor may recommend trying simple treatments first. If symptoms persist, further tests can help guide treatment.

Treatment

Treatment for sciatica usually focuses on managing pain and helping you stay active. Most people get better with simple steps like changing position, gentle movement, and over-the-counter pain relief. Your doctor may also suggest physical therapy.

Self-care at home

• Stay active but avoid activities that make the pain worse, like heavy lifting or prolonged sitting.
• Apply heat or cold packs to the painful area for 15–20 minutes several times a day.
• Try gentle stretches, such as lying on your back and pulling one knee toward your chest.
• Use over-the-counter pain relievers like paracetamol or ibuprofen, but follow the package directions and check with your pharmacist if you have other health conditions.

Medical treatments

If self-care is not enough, your doctor may recommend prescription pain relievers or muscle relaxants (always take as directed). Physical therapy with specific exercises to strengthen your back and core muscles can be very helpful. In some cases, a doctor may suggest an epidural steroid injection to reduce inflammation around the nerve.

When is surgery considered?

Surgery is rarely needed and is usually only considered if you have severe symptoms that do not improve after 6 to 12 weeks of nonsurgical treatment, or if you have progressive muscle weakness or emergency signs (like cauda equina syndrome). The most common surgery is a microdiscectomy to remove the part of the disc pressing on the nerve.

Living with this condition

Living with sciatica can be uncomfortable, but most people find that simple changes help. Take short, frequent walks to avoid stiffness. When sitting, keep your back straight and use a small pillow for support. Avoid bending and twisting at the waist.

Lifestyle tips

• Maintain good posture when sitting, standing, and sleeping.
• Take breaks from sitting every 30 minutes to stand and stretch.
• Use a firm mattress that supports your spine.
• Sleep on your side with a pillow between your knees to keep your spine aligned.

Diet and exercise

Aim for a healthy diet rich in fruits, vegetables, whole grains, and lean protein to help maintain a healthy weight and reduce inflammation. Regular gentle exercise like walking, swimming, or yoga can strengthen your back and core without jarring it. Avoid high-impact activities like running or jumping while symptoms are acute.

Mental health and emotional wellbeing

Chronic pain can be frustrating and may lead to anxiety or low mood. It is okay to ask for help. Talk to your healthcare provider about how you are feeling. They can suggest counselling or support services to help you cope.

Prevention

You cannot always prevent sciatica, but you can lower your risk by maintaining a healthy weight, staying physically active, using good posture, and practicing safe lifting techniques. Strengthening your core muscles helps support your spine.

Complications

If left untreated

• Chronic pain that lasts for months or years.
• Weakness or numbness in the leg that may become permanent.
• Loss of sensation or control over bladder or bowel (cauda equina syndrome) – this is rare but requires emergency treatment.

Long-term outlook

The outlook for sciatica is very good. Most people get better within a few weeks to months without any special treatment. Even for those with more severe symptoms, appropriate care can help you return to normal activities. With sensible self-care and support, you can manage the condition and reduce the chance of it coming back.

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