The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.Sciatica (pronounced sigh-at-ih-kah) is a symptom of an underlying medical condition – it is not a medical diagnosis in and of itself.

Sciatica Nerve Pain

Sciatica Nerve Pain

Sciatica is often characterized by one or more of the following symptoms:

  • Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
  • Pain that is worse when sitting
  • Burning or tingling down the leg (vs. a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A sharp pain that may make it difficult to stand up or to walk

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Specific sciatica symptoms also vary widely in type, location and severity, depending upon the condition causing the sciatica. While symptoms can be very painful, it is rare that permanent sciatic nerve damage (tissue damage) will result.

The Sciatic Nerve and Sciatica

The Sciatic Nerve and Sciatica

Sciatica symptoms occur when the large sciatic nerve is irritated. Thesciatic nerve is the largest single nerve in the body and is composed of individual nerve roots that start by branching out from the spine in the lower back and combine to form the “sciatic nerve”.

  • The sciatic nerve starts in the lower back at lumbar segment 3 (L3).
  • At each level of the lower spine a nerve root exits from the inside of the spine and then comes together to make up the large sciatic nerve.
  • The sciatic nerve runs from the lower back, down the back of each leg
  • Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg – e.g. the buttock, thigh, calf, foot, toes.

The sciatica symptoms (e.g., leg pain, numbness, tingling, weakness, possibly foot pain) are different depending on where the nerve is pinched. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle (foot drop(See diagram of the sciatic nerve).

The Course of Sciatica Pain

The Course of Sciatica Pain

The incidence of sciatica increases in middle age. Rarely occurring before age 20, the probability of experiencing sciatic pain peaks in the 50s and then declines.1

Often, a particular event or injury does not cause sciatica, but rather the sciatic nerve pain tends to develop over time.

The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with non-surgical treatment. For others, however, sciatica pain from a pinched sciatic nerve can be severe and debilitating.

There are a few symptoms that may require immediate medical, and possibly surgical, intervention, such as progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction.

Because sciatica pain is caused by an underlying medical condition, treatment is focused on relieving the underlying causes of symptoms. Treatment is usually self-care and/or non-surgical treatment, but for severe or intractable cases surgery may be an option.


  • Frymoyer J, “Lumbar Disc Disease: Epidemiology,” Instructional Course Lectures, 1992:41:217-23.

Sciatica refers to a set of symptoms caused by a problem in the lower back called a radiculopathy – a condition in which a nerve root that connects to the sciatic nerve is pinched, compressed or irritated.

6 Most Common Causes of Sciatica

6 Most Common Causes of Sciatica

When discussing sciatica it is important to understand the underlying medical cause of the sciatica symptoms. There are 6 lower back problems that are the most common causes of sciatica:

Lumbar herniated disc

A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) of the disc and irritates the contiguous nerve root as it exits the spine. In general, it is thought that a sudden twisting motion or injury can lead to an eventual disc herniation and sciatica. However, most discs weaken over time due to repetitive stress, eventually resulting in herniation. A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve, and sciatica is the most common symptom of a lumbar herniated disc.

See Lumbar Herniated Disc.

Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Spinal stenosis. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots as they exit the spine, causing sciatica pain.

See Lumbar Spinal Stenosis: A Definitive Guide.

Degenerative disc disease
While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the area (including the nerve roots). This is truly not a disease despite its name, it is part of the natural aging process.

See Lumbar Degenerative Disc Disease.

Isthmic spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another vertebral body (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched as it exits the spine and cause sciatica.

See Isthmic Spondylolisthesis.

Piriformis syndrome
The sciatic nerve can also get irritated as it runs under the piriformis muscle in the rear. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.

See What is Piriformis Syndrome?

Sacroiliac joint dysfunction
Irritation of the sacroiliac joint – located at the bottom of the spine – can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain. The leg pain can feel the same as sciatica caused by a nerve irritation.

See Sacroiliac Joint Dysfunction (SI Joint Pain).

More Causes of Sciatica

More Causes of Sciatica

  • Pregnancy. The changes that the body goes through during pregnancy, including weight gain, a shift on one’s center of gravity, and hormonal changes, can cause sciatica during pregnancy.
  • Scar tissue. If scar tissue compresses the nerve root, it can cause sciatica.
  • Muscle strain. In some cases, inflammation related to a muscle strain can put pressure on a nerve root and cause sciatica.
  • Spinal tumor. In rare cases, a spinal tumor can impinge on a nerve root in the lower back and cause sciatica symptoms.
  • Infection. While rare, an infection that occurs in the low back can affect the nerve root and cause sciatica.

It is important to know the underlying clinical diagnosis of the cause of sciatica, as treatments will often differ depending on the cause. For example, specific sciatica exercises, which are almost always a part of a sciatica treatment program, will be different depending on the underlying cause of the sciatica symptoms.

For some people, sciatica pain can be severe and debilitating. For others, the sciatica symptoms might be infrequent and irritating, but have the potential to get worse.

Usually, sciatica only affects one side of the lower body and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg.

Low back pain may be present along with the leg pain, but typically the leg pain is markedly more severe than the low back pain.

Common Sciatica Symptoms

Common Sciatica Symptoms

  • Lower back pain, if experienced at all, is not as severe as leg pain
  • Constant pain in only one side of the buttock or leg, but rarely both the right and left sides
  • Pain that originates in the low back or buttock and continues along the path of the sciatic nerve – down the back of the thigh and into the lower leg and foot
  • Pain that feels better when patients lie down or are walking, but worsens when standing or sitting
  • Sciatic pain that is typically described as sharp or searing, rather than dull
  • Some experience a “pins-and-needles” sensation, numbness or weakness, or a prickling sensation down the leg
  • Weakness or numbness when moving the leg or foot
  • Severe or shooting pain in one leg that may make it difficult to stand up or walk
  • Depending on where the sciatic nerve is affected, the pain and other sciatica symptoms may also include foot pain or pain in the toes.

Sciatica Symptoms for each Sciatic Nerve Root

Sciatica Symptoms for each Sciatic Nerve Root

There are two sciatic nerve roots that exit the lumbar spine (L4 and L5) and three that exit the sacral segment (S1, S2 and S3). All five nerves bundle together to form the sciatic nerve, and then branch out again within the leg to deliver motor and sensory functions to specific destinations in the leg and foot.

Sciatica symptoms vary based on where the compressed nerve root is located. For example:

  • L4 nerve root sciatica symptoms usually affect the thigh. Patients may feel weakness in straightening the leg, and may have a diminished knee-jerk reflex.
  • L5 nerve root sciatica symptoms may extend to the big toe and ankle (called foot drop). Patients may feel pain or numbness on top of the foot, particularly on the “web” of skin between the big toe and second toe.
  • S1 nerve root sciatica affects the outer part of the foot, which may radiate to the little toe or toes. Patients may experience weakness when raising the heal off the ground or trying to stand on tiptoes. The ankle-jerk reflex may also be reduced.

Since more than one nerve root may be compressed, patients may experience a combination of the above symptoms.

Sciatica Symptoms that Require Immediate Attention

Sciatica Symptoms that Require Immediate Attention

Rarely, sciatica symptoms that worsen quickly may require immediate surgery. The following symptoms indicate a need for immediate medical care:
  • Sciatica symptoms that continue to get worse rather than improve, which may indicate possible nerve damage, especially if the progressive symptoms are neurological (such as weakness)
  • Symptoms that occur in both legs (called bilateral sciatica) and cause either bladder or bowel incontinence or dysfunction, which may indicate cauda equina syndrome. Cauda equina syndrome is an acute compression of one or several nerve roots that occurs relatively rarely, e.g. in 2% of herniated lumbar disc cases.2

Patients should seek immediate medical attention if they experience any of the above symptoms.


  1. Winters ME, Kluetz P, Zilberstein J, “Back Pain Emergencies,” Medical Clinics of North America, 2006:90:505–23.

For severe or ongoing flare-ups of sciatic nerve pain, the condition may need to be treated so that it does not get worse over time.

  • For most, readily available nonsurgical remedies and regular exercise will go a long way to relieving their pain.
  • For others, when the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may offer the best approach to finding pain relief and preventing or minimizing future flare-ups of sciatica.

This page addresses nonsurgical treatment for sciatica. For more treatment options, see also Physical Therapy Exercises and Sciatica Surgery (links below).

Non-Surgical Treatment for Sciatica

Non-Surgical Treatment for Sciatica

Non-surgical sciatica treatments encompass a broad range of options, with the goal of relieving pain caused by compressed nerve roots. One or some combination of the treatments below are usually recommended in conjunction with a specific exercise program.

For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

See also Heat Therapy Cold Therapy.

Sciatica Pain Medications
Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can be helpful in reducing the inflammation that is usually a contributing factor in causing sciatica pain.

See also NSAIDsOral Steroids.

Epidural Steroid Injections for Sciatica
If the sciatica pain is severe, an epidural steroid injection can be performed to reduce the inflammation. An epidural injection is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), and it does not work for everyone, an epidural steroid injection can be effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.

See also Lumbar Epidural Steroid Injections for Low Back Pain and Sciatica and Epidural Steroid Injection Video

Alternative Sciatica Treatment

Alternative Sciatica Treatment

In addition to standard medical treatments, several alternative treatments have also been shown to provide effective sciatica pain relief for many patients. Three of the more common forms of alternative care for sciatica include chiropractic manipulation, acupuncture, and massage therapy.

Chiropractic/Manual Manipulation
Spinal adjustments and manual manipulation performed by appropriately trained health professionals (such as chiropractors, osteopathic physicians, physical therapists) are focused on providing better spinal column alignment, which in turn should help to address a number of underlying conditions that can cause sciatic nerve pain. Manual manipulation done to address the right indications by appropriately trained health professionals can create a better healing environment and should not be painful.

See also Chiropractic Treatments for Back Pain.

The practice is centered on the philosophy of achieving or maintaining well being through the open flow of energy via specific pathways in the body. Hair-thin needles (that are usually not felt) are inserted into the skin near the area of pain. Acupuncture has been approved by the U.S. FDA as a treatment for back pain, and the National Institutes of Health recognized acupuncture as effective in relieving back pain, including sciatica.

See also Acupuncture: An Ancient Treatment for a Current Problem.

Massage Therapy
Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers).

See also Massage Therapy for Lower Back Pain.

For most people, the good news is that sciatica usually will get better on its own, and the healing process for most will only take a few days or weeks. Overall, the vast majority of episodes of sciatica pain heal within a six to twelve week time span. Following initial pain relief, a program of sciatica physical therapy and exercise should usually be pursued in order to alleviate pain and prevent or minimize any ongoing sciatic pain.

There are a number of types of non-surgical spine care professionals who specialize in treating sciatica symptoms, including chiropractors, physiatrists (physical medicine and rehabilitation specialists), pain medicine specialists, and physical therapists, all of whom have specialized training to provide pain relief and to help prevent future recurrences of sciatica. It is always advisable to have a qualified medical professional oversee any type of sciatica treatment.

Physical therapy exercises – incorporating strengthening, stretching and aerobic conditioning – are a central component of almost any sciatica treatment plan.

When patients engage in a regular program of gentle strengthening, stretching and aerobic exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of sciatica.

Sciatica exercises usually focus on three key areas:

  • Strengthening exercises
    Many exercises can help strengthen the spinal column and the supporting muscles, ligaments and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttocks) and hip muscles. Taken together, these strong ‘core’ muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.
  • Stretching exercises
    Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible. Hamstring stretching is almost always an important part of a sciatica exercise program. See Hamstring Stretching.
  • Low impact aerobic exercise
    Some form of low impact cardiovascular exercise, such as walking, swimming or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment. Aerobic conditioning has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.

The specific sciatica exercises will depend on the underlying medical condition causing the sciatica pain, as well as a number of other factors, such as the patient’s level of pain and overall conditioning.

For information and illustrations on exercises for different causes of sciatica, see:

When sciatica pain is at its most severe, patients may find the pain hard to bear and may need to rest for a day or two. However, resting for more than one or two days is usually not advisable, as prolonged rest or inactivity can make the sciatic pain worse and will lead to deconditioning. Regular movement is important to provide healing nutrients to the injured structures that are causing the pain.

There are a number of types of health professionals who specialize in providing appropriate physical therapy and exercise programs and instruction, including physical therapists, chiropractors, physiatrists (also called physical medicine and rehabilitation physicians), and qualified certified athletic trainers. See more in Sciatica Exercises for Sciatica Pain Relief.

If the sciatica pain is severe and has not gotten better within six to twelve weeks, it is generally reasonable to consider lower back surgery. Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered:

  • A microdiscectomy (or small open surgery)
  • An open decompression (lumbar laminectomy)

Microdiscectomy (Microdecompression) for Sciatica

Microdiscectomy (Microdecompression) for Sciatica

In cases where the sciatica pain is due to a disc herniation, a microdiscectomy or small open surgery with magnification may be considered. In this surgery, the portion of the herniated disc that is pinching the nerve is removed.

This surgery is generally considered after 4 to 6 weeks if the severe pain is not relieved by non-surgical means. If the patient’s pain and disability is severe, surgery may be considered sooner than 4 to 6 weeks.

As a general rule, approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.

Lumbar Laminectomy for Sciatica

Lumbar Laminectomy for Sciatica

In cases where the sciatica pain is due to lumbar spinal stenosis, a lumbar laminectomy may be recommended. In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed.

Laminectomy surgery may be offered as an option if the spinal stenosis causes the patient’s activity tolerance to fall to an unacceptable level. The patient’s general health may also be a consideration in whether or not to have surgery or continue with nonsurgical treatments.

After a lumbar laminectomy (also called an open decompression), approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.

It is the Patient’s Decision

It is the Patient’s Decision

In most cases, sciatica surgery is elective, meaning that it is the patient’s decision whether or not to have surgery. This is true for both microdiscectomy and laminectomy surgery.

The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. The patient’s overall health is a consideration as well.

As a general rule, surgery for sciatica may be considered in the following situations:

  • Severe leg pain that has persisted for 4 to 6 weeks or more
  • Pain relief that is not achieved after a concerted effort at nonsurgical treatments, such as one or a combination of oral steroids, non-steroidal anti-inflammatory medication, manual manipulation, injections, and/or physical therapy
  • The condition is limiting the patient’s ability to participate in everyday activities

Urgent surgery is typically only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control.

Additional Sciatica Surgery Considerations

Additional Sciatica Surgery Considerations

There are many personal considerations for the patient to take into account when deciding whether or not to have surgery.

  • Some patients may prefer to try as many different non-surgical treatments and remain with non-surgical care for as long as possible, and often they will figure out how to successfully manage their condition and keep painful symptoms at bay. For example, a patient who has intermittent flare-ups of severe sciatica pain may find that a combination of initial rest and an epidural steroid injection followed by a gentle stretching and exercise program is effective in alleviating the pain as needed.
  • Some patients may have a personal preference or a life situation that will benefit from the more immediate pain relief that is usually afforded by surgery. For example, a parent with small children may not have the time to pursue non-surgical remedies and may need immediate pain relief in order to be able to take care of the children and household duties.

The important point is that it is almost always the patient’s decision whether or not to have the surgery, and the surgeon’s role should be to help inform that patient of his or her options to help the patient make the best choice.

Stephen H. Hochschuler, MD. “What You Need to Know About Sciatica.” (2000): n. page. Web.