Sciatica

What is sciatica?

Sciatica is the name for pain that follows the path of the sciatic nerve — the longest nerve in the body. It runs from the lower spine, through the buttock, and down the back of the leg to the foot. Sciatica is a symptom, not a disease itself; it usually means something is irritating or compressing the nerve where it leaves the spine.

Sciatica typically affects one leg rather than both.

Symptoms of sciatica

Sciatica pain varies from person to person, but the following symptoms are common:

• The pain is often sharp, shooting or burning, and travels from the lower back or buttock down the leg.
• Tingling, pins and needles or numbness can be felt in the leg or foot.
• Muscle weakness can develop in the affected leg, although this is less common.
• The pain often gets worse when you cough, sneeze or sit for long periods.

The pain can be severe, but most cases improve with time and conservative treatment.

Causes of sciatica

A slipped (herniated) disc is the most common cause of sciatica. It happens when the soft inner part of a spinal disc bulges out and presses on a nerve root.

Spinal stenosis is a narrowing of the spinal canal, and it is more common in people over 60. Spondylolisthesis happens when one vertebra slips forward on another. Piriformis syndrome occurs when the piriformis muscle in the buttock irritates the nerve, although this cause is less common and its role is debated.

Less often, sciatica is caused by an injury, an infection, or a growth pressing on the nerve.

Managing sciatica at home

Most sciatica resolves without surgery, and there is a lot you can do to help yourself:

• Stay gently active by walking and moving normally as much as you can tolerate, and avoid prolonged bed rest.
• Use pain relief such as paracetamol and ibuprofen; a GP may suggest stronger painkillers for a short time if needed.
• Apply heat or cold to the lower back for comfort.
• Adjust your position, as some people find relief lying on their side with a pillow between their knees.
• Ask about physiotherapy, which uses exercises to improve mobility and reduce nerve irritation; a GP can refer you.

If sciatica affects your job, try to return to work gradually — an occupational health service may be able to help.

When sciatica is an emergency

Cauda equina syndrome is rare but serious. It happens when the nerves at the base of the spine are compressed. Seek emergency help if any of the following happen:

• You lose control of your bladder or bowels, or you cannot pass urine.
• You have numbness in the genitals, buttocks or inner thighs, sometimes called saddle numbness.
• You have severe or progressive weakness in both legs.

These symptoms need immediate hospital assessment and possible surgery.

When to see a GP about sciatica

See a GP if:

• Your pain is not improving after six weeks.
• Your pain is severe and not controlled by painkillers from a pharmacy.
• You have progressive weakness in your leg.
• Your sciatica followed significant trauma.
• You have a fever together with back pain, which could suggest an infection.

A GP can examine you, check how your nerves are working, and arrange MRI scanning or specialist referral if needed.

How sciatica differs from general back pain

Back pain is localised to the back, whereas sciatica radiates into the leg below the knee with nerve-type symptoms such as tingling, shooting pain or numbness. Many people have both at the same time.

Recovering from sciatica and preventing it coming back

Most people recover fully within weeks to months. Keeping your core and back muscles strong through exercise, maintaining a healthy weight, and using good posture when lifting all reduce the risk of sciatica returning.

Common questions about sciatica

What does sciatica pain feel like?

Sciatica typically feels like a sharp, shooting or burning pain that travels from the lower back or buttock down one leg, sometimes as far as the foot. Tingling, numbness or pins and needles are common alongside the pain. Coughing or sneezing may briefly make the pain worse.

What causes sciatica?

Sciatica is most often caused by a bulging or herniated disc in the lower spine pressing on the sciatic nerve root. Less common causes include spinal stenosis (narrowing of the spinal canal), spondylolisthesis and piriformis muscle spasm in the buttock.

How long does sciatica last?

Many people improve significantly within four to six weeks. Some have symptoms for longer. Persistent or worsening pain after six weeks warrants GP assessment and may benefit from physiotherapy or further investigation.

Should I rest in bed with sciatica?

Short rest during severe pain is fine, but prolonged bed rest slows recovery. Gentle walking and normal daily activity as tolerated help most people recover faster than staying still.

Does sciatica need surgery?

Most cases of sciatica do not need surgery. Surgery may be considered if symptoms are severe and persistent despite physiotherapy, or if there is significant nerve compression causing progressive weakness — a specialist decides this.

Sources

• NHS — Sciatica