12792 Sciatica

Overview

Sciatica is a symptom, not a disease. It is pain that travels along the path of the sciatic nerve, which runs from your lower back, through your buttock, and down the back of each leg. The pain is usually caused by something pressing on or irritating the nerve, such as a slipped disc (a cushion between the bones of your spine that moves out of place) or a bone spur (an extra growth of bone).

Yes. Sciatica is very common. At least 4 in every 10 people will experience sciatica at some point in their lives.

Sciatica can affect anyone, but it is most common in people aged 30 to 50. It may also be more likely during pregnancy, in people who sit for long hours, and in those with physically demanding jobs.

Symptoms

Common symptoms

• A sharp or burning pain that starts in the lower back and runs down one leg
• Numbness or a 'pins and needles' feeling in part of the leg or foot
• Weakness in the leg or foot, making it hard to lift the foot or stand on tiptoes
• Pain that gets worse with sitting, standing up, coughing, or sneezing
• A feeling of dull ache or tension in the leg

Symptoms in children

• Sciatica is rare in children, but it can happen after an injury or due to a growth problem in the spine.
• Symptoms may be less specific – a child may not be able to explain the pain well, and may just limp or avoid running.
• If a child has leg pain, numbness, or weakness, they should see a doctor for a proper check.

Symptoms in older adults

• In older adults, sciatica is often caused by wear-and-tear changes in the spine called spinal stenosis (narrowing of the spaces in the spine).
• Symptoms may come on gradually and are often felt as a heavy, aching pain in the legs when walking.
• Older adults may be more at risk of losing mobility or balance, so it is important not to ignore new leg pain.

Causes

Main causes

• Slipped disc (commonly called a herniated disc) – the soft inside of a spinal disc pushes out and presses against the sciatic nerve.
• Bone spurs – rough, extra bone that can grow on the spine and narrow the space where the nerve travels.
• Spinal stenosis – a condition where the spaces in the spine become narrower, putting pressure on nerves.
• Injury – like a car accident, a fall, or lifting something very heavy incorrectly.
• Rarely, infections or tumours in the area of the spine.

Risk factors

• Age – the risk increases as the spine naturally wears over time.
• Being overweight or obese, which puts extra strain on the spine.
• Working in a job that requires heavy lifting, twisting the back, or long periods of sitting.
• Pregnancy – extra weight and hormonal changes can stress the sciatic nerve.
• Diabetes – high blood sugar can damage nerves over time, making them more sensitive to pressure.
• Smoking – it may harm the discs in the spine and speed up wear.

When to see a doctor

See a doctor urgently if:

• If you have sudden loss of bladder or bowel control, call your local emergency number right away.
• If you have weakness in both legs or numbness between your legs, get same-day medical help.
• If your leg gets progressively weaker or your pain becomes unbearable, see a doctor urgently.

Book a routine appointment if:

• If your pain lasts longer than one week and is not improving.
• If the pain is severe enough to interfere with your work, sleep, or daily activities.
• If you have had sciatica before and this episode feels different or worse.
• If you are over 50 or have a history of cancer, and you have new back or leg pain.

Diagnosis

A doctor will first ask about your symptoms, how they started, and what makes them worse. They will then do a physical exam. This often includes checking your muscle strength, reflexes, and how you move. A common test is the straight leg raise: you lie on your back and the doctor lifts one leg straight up. If this causes pain down the leg, it points to sciatica.

Tests that may be done

• No test is needed for most people. The diagnosis is usually clear from your symptoms and the physical exam.
• MRI scan (magnetic resonance imaging) – gives a detailed picture of the spinal discs and nerves, and is used if surgery or a serious cause is considered.
• CT scan or X-ray – may help check the bones of the spine for narrow spaces or fractures.
• Nerve conduction tests – measure how well the sciatic nerve sends signals, but are not always needed.

What to expect at your appointment

Your doctor will explain what is causing your pain and what you can do to help yourself. You may be given advice about which activities to avoid, and which exercises are safe. In most cases, you will not need a scan. If symptoms do not settle after a few weeks, more tests might be arranged.

Treatment

Treatment for sciatica focuses on relieving pain and helping you keep moving. Most people recover with self-care and time. A healthcare team may also offer treatments like physical therapy or, in more stubborn cases, injections or surgery.

Self-care at home

• Keep moving with gentle walking or light stretching, as staying in bed for more than a day can make things worse.
• Use hot or cold packs – for example, a warm compress on the lower back or an ice pack wrapped in a cloth for 15–20 minutes several times a day.
• Sleep in a comfortable position, often on your side with a pillow between your knees.
• Avoid heavy lifting, long sitting, and twisting movements while you recover.
• Take pain relief as advised by your pharmacist or doctor – remember to follow the correct dose and timing.

Medical treatments

Doctors can recommend pain-relieving medicines to help you manage the discomfort. They may also suggest medications that reduce nerve-related pain. In some cases, a short course of muscle relaxants can help with spasms. Your doctor will decide which options are safe for you. Physical therapy is a core treatment – it uses exercises to strengthen your core and improve flexibility. If your pain is severe and ongoing, a specialist may offer a steroid injection near the nerve to calm inflammation.

When is surgery considered?

Surgery is rarely necessary. It may be considered if you have serious weakness, loss of bowel or bladder control, or if the pain is severe and has not improved after 4 to 6 weeks of other treatment. The most common operation removes the part of the disc that is pressing on the nerve. Your doctor or a spinal surgeon will discuss the benefits and risks with you.

Living with this condition

Living with sciatica means learning what makes your symptoms better or worse. Many people find that short, regular walks help more than long periods of rest. Pay attention to your posture when standing and sitting, and try to get up and move every 30 minutes if you work at a desk. Lift objects by bending your knees, keeping your back straight. It is okay to have off days – pace yourself and build up gradually.

Lifestyle tips

• Keep a healthy weight to reduce strain on your spine.
• Stay active with low-impact activities like walking, swimming, or cycling.
• Make your workspace comfortable – adjust your chair and screen so you are not slouching.
• Stop smoking, as it can harm the discs in your spine.
• Sleep on a firm mattress that supports your lower back.

Diet and exercise

Eating a balanced diet with plenty of fruit, vegetables, and whole grains can help you manage your weight and reduce inflammation. Calcium and vitamin D are important for bone health – try to include dairy products, leafy greens, or fortified foods. For exercise, focus on gentle core strengthening, hamstring stretches, and exercises that improve balance. A physical therapist can give you a safe programme tailored to your needs.

Mental health and emotional wellbeing

Living with chronic pain can be exhausting and sometimes worrying. You might feel frustrated, anxious, or low. These feelings are normal and understandable. It can help to talk about your feelings with someone you trust, or to join a pain support group. If you are struggling to cope, let your doctor know – they can offer resources or recommend a counsellor. If you ever have thoughts of self-harm, please reach out for help immediately.

Prevention

It is not always possible to prevent sciatica, especially if it is due to wear-and-tear or an injury. However, you can reduce your risk by keeping a healthy weight, staying physically active, practising good posture, and using safe lifting techniques. Strengthening your core and back muscles can also help protect your spine.

Complications

If left untreated

• Most cases improve on their own, so 'untreated' simply means letting it run its course. But if a nerve stays compressed for a long time, it can lead to permanent numbness or weakness in the leg.
• Cauda equina syndrome – a rare but serious condition where the nerves in the lower spine are severely compressed. It causes loss of bladder or bowel control and weakness in both legs, and needs emergency surgery to prevent permanent damage.
• Loss of balance or mobility, which can lead to falls, especially in older adults.

Long-term outlook

The outlook for sciatica is very good. Around 8 out of 10 people recover within a few weeks without any treatment. Even in cases where symptoms last longer, most people improve with conservative care. Surgery is only needed for a small minority. While it may take time, you can expect your pain to gradually lessen, and you can likely return to your normal activities with some adjustments. There is good hope for recovery.

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