Sciatica

What is sciatica?

Sciatica is pain caused by irritation or compression of the sciatic nerve, the longest and thickest nerve in the body. The sciatic nerve starts in the lower spine and runs through the buttock and down the back of the leg to the foot.

Sciatica is not a diagnosis itself, but a set of symptoms caused by an underlying spinal or nerve condition.

Where is sciatic pain felt?

Symptoms can occur in:

  • Lower back

  • Buttock

  • Back or side of the thigh

  • Calf

  • Foot and toes

Pain usually affects one side of the body.

Common symptoms

  • Sharp, burning, or electric-shock–like pain

  • Pain that radiates down the leg

  • Pins and needles (tingling)

  • Numbness

  • Muscle weakness in the leg or foot

  • Pain worsened by coughing, sneezing, bending, or sitting

     

⚠️ Red flag symptoms (urgent medical review required):

  • Loss of bladder or bowel control

  • Progressive leg weakness

  • Severe numbness in the groin or saddle area

     

Types of sciatica

  1. True sciatica

    • Direct compression or irritation of the sciatic nerve

  2. Sciatica-like pain

    • Symptoms mimic sciatica but originate from nearby nerves or structures

In clinical practice, both are commonly referred to as “sciatica.”

Common causes

  • Slipped (herniated) disc

  • Degenerative disc disease

  • Spinal or foraminal stenosis

  • Spondylolisthesis

  • Osteoarthritis

  • Trauma or injury

  • Pregnancy

  • Tumours or cysts (rare)

  • Cauda equina or conus medullaris syndrome (emergency)

     

Risk factors

  • Poor posture and lifting technique

  • Prolonged sitting or inactivity

  • Weak core muscles

  • Excess body weight

  • Heavy manual work

  • Smoking

  • Diabetes

  • Age-related spinal changes

     

How is sciatica diagnosed?

  • Clinical assessment (history + physical examination)

  • Gait observation

  • Straight leg raise test

  • Neurological examination (strength, reflexes, sensation)

     

MRI scan is indicated if:

  • Symptoms persist

  • Severe pain or weakness is present

  • Multiple nerve roots are suspected

  • Red flags are identified

     

Treatment options

Self-management (mild cases)

  • Ice (first 48–72 hours)

  • Heat thereafter

  • NSAIDs (if appropriate)

  • Gentle mobility and stretching

  • Staying active (avoid prolonged bed rest)

     

Conservative treatment

  • Physiotherapy (exercise-based rehab)

  • Prescription pain relief or nerve medications

  • Spinal injections (short-term relief)

  • Acupuncture, chiropractic care, massage (adjuncts)

     

Surgery (only if needed)

Considered when:

  • Severe or worsening neurological symptoms

  • Persistent pain beyond 6–8 weeks

  • Failure of conservative treatment

     

Common procedures:

  • Discectomy

  • Laminectomy

     

Prognosis

  • Most people recover fully

  • Some may develop chronic pain

  • Rarely, permanent nerve damage can occur if untreated

     

Can sciatica be prevented?

Risk can be reduced by:

  • Maintaining good posture

  • Regular exercise and core strengthening

  • Healthy body weight

  • Safe lifting techniques

  • Staying physically active

Physiotherapy Exercises for Acute Sciatica: 3-4 weeks