Sciatica

Key takeaways

• Typical pattern: pain below the knee, often with tingling or numbness
• Most cases: improve over weeks to months without surgery
• Most useful single change: Keep moving within tolerance rather than resting.
• Commonest mistake: Prolonged bed rest.
• See a doctor if any of the signs under "When to get help" below apply to you.

Why it matters

Most cases improve without surgery, and the important skill is recognizing the small number that need urgent action.

The numbers, in one place

Published figures for Sciatica

Measure	Figure
Typical pattern	pain below the knee, often with tingling or numbness
Most cases	improve over weeks to months without surgery
Imaging	only if it would change management
Physical therapy	commonly used to guide a graded return to activity

What helps

• Keep moving within tolerance rather than resting
• Ask about a structured exercise program or physical therapy
• Use over-the-counter pain relievers as advised to enable movement
• Expect gradual improvement over weeks

What to avoid

• Prolonged bed rest
• Assuming a scan is needed to start treatment
• Ignoring progressive weakness in the leg

In depth

Sciatica describes pain that travels along the path of the sciatic nerve, from the lower back or buttock down the back of the leg, often below the knee and sometimes into the foot. The sciatic nerve is formed from several nerve roots that leave the lower spine. When one of these roots is compressed or inflamed, it can cause pain, tingling, numbness or weakness in the area that nerve supplies.

The most common cause in adults under about 60 is a herniated disc, where the soft inner part of a spinal disc pushes out and presses on or inflames a nearby nerve root. Chemical irritation from the disc material plays a significant role, not only physical pressure. In older adults, narrowing of the spinal canal or the openings where nerves exit, known as spinal stenosis, is a more common cause.

The leg pain of sciatica is often worse than the back pain and can be intense, burning or electric. The good news is that the body can reabsorb herniated disc material over time, and most people improve over weeks to months with conservative care. Knowing this helps people tolerate a difficult few weeks while focusing on staying as active as possible.

Signs and symptoms

• Pain spreading from the buttock down the back or side of the leg
• Tingling, pins and needles, or numbness in the leg or foot
• Pain that worsens with sitting, coughing or sneezing
• Weakness in the leg or foot, such as difficulty lifting the toes
• Pain usually affecting one side

Causes and risk factors

• A herniated or bulging disc pressing on a nerve root
• Spinal stenosis narrowing the space around the nerves
• Spondylolisthesis, where one vertebra slips forward on another
• Age-related changes in discs and joints
• Jobs involving heavy lifting, prolonged sitting or vibration
• Rarely, infection, tumor or injury affecting the nerve

How it is checked

Sciatica is usually diagnosed from the history and examination. Your doctor will check where the pain and numbness are, test muscle strength and reflexes in your legs, and may perform a straight leg raise test, in which lifting your straightened leg reproduces the pain. The pattern of findings can suggest which nerve root is affected.

Imaging such as MRI is not needed at first if there are no warning signs. It is used if symptoms persist despite several weeks of treatment and an injection or surgery is being considered, or if there are signs of serious nerve compression. Nerve conduction studies or electromyography (EMG) may be used when the diagnosis is unclear.

Related topics

• Back Pain: What Published Guidance Supports (Bone and Joint)
• The Evidence on Neuropathic Pain, Without the Hype (Chronic Pain)
• Sensitive Teeth: What the Evidence Actually Says (Oral Health)
• What the Guidance Really Says About Circulation and the Feet (Foot Health)

Where to go next

• Sciatica: What to Do, in Order
• Myths About Sciatica, Checked Against the Guidance
• Back and Posture: The Complete Guide
• Neck Pain: What the Evidence Actually Says
• Workstation Setup: Sorting the Evidence From the Noise

When to get help

Go to the emergency room for numbness around the genitals, buttocks or inner thighs, difficulty passing or controlling urine, loss of bowel control, or weakness in both legs, and call 911 if you cannot get there safely. See your doctor urgently for progressive weakness in one leg, a foot that drags, or sciatica with fever or unexplained weight loss.

Where this comes from

• MedlinePlus — Sciatica
• National Institute of Neurological Disorders and Stroke — Low Back Pain

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.