> Skip repeated content

Sciatica

If you develop a pain that starts in your lower back or buttock and radiates down your leg, your problem may be sciatica.

 

What is sciatica?

Sciatica is an irritation of the sciatic nerve, which is the largest nerve in the human body. Sciatic nerves originate from several nerves in your lower back. These nerves branch outward from the spine and then come together at each buttock to form the sciatic nerve, which then radiates down each leg. Sciatic nerve pain radiates along the same path.

What are the symptoms of sciatica?

The typical first symptom is lower back pain that travels down one leg. Generally, symptoms include:

  • Dull, aching, shooting or "burning" pain that starts in your lower back and/or buttock and radiates down one of your legs. Back pain accompanied by leg pain is the key symptom that suggests you have sciatica rather than another type of back pain.
  • Neuropathies such as numbness or a “pins and needles” tingling sensation.
  • Feelings of muscle weakness or altered reflexes.

Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.

What causes sciatica?

Irritation of the sciatic nerve is caused by nerve root entrapment (also known as nerve compression, pinched nerve or entrapment neuropathy). This particular form of entrapment is called lumbar radiculopathy, since the damaged nerves roots are located in the lumbar (lower back) portion of the spine. The nerve compression itself may be caused by:

  • A herniated disc – also known as a ruptured or slipped disc – in which the gel-like center of an intervertebral disc of the spine sticks out through a tear in its outer ring (called the annulus). This slippage puts pressure on the nerve roots located just next to the disc. Herniated discs can be brought on by wear-and-tear over time or by an acute back injury.
  • Spinal stenosis – a narrowing of the canal that houses the spinal nerves.
  • Inflammation of nearby anatomical structures caused by:
    • bone or muscle injuries.
    • diseases such as tumors or infections.
    • pregnancy.

Video: sciatica animation

The animation below illustrates the anatomy of the spine and sciatic nerves and the mechanics of sciatic nerve pain and leg pain.

Thumbnail image of a sciatica animation

What should I do if I think I have sciatica?

Mild sciatica can go away on its own. Self-care measures that may help include ceasing all activity that causes pain, performing stretches of your lower back, applying an ice pack intermittently to the area causing pain, and taking NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen.

When should I see a doctor for sciatica?

If rest, icing or other self-care methods have not improved your condition after three days, consult a physiatrist, spine surgeon or your primary care doctor to discuss your symptoms. If you experience severe numbness, tingling or problems urinating, see a doctor as soon as possible.

How is sciatica diagnosed?

The doctor will first perform a history and physical examination, and then X-rays and MRI scans will confirm whether there is a lumbar nerve root compression.

How is sciatica treated?

Nonsurgical treatments may include applying cold packs or heat, medications and/or physical therapy. In some cases, epidural steroid injections may also help you return to full activity. Severe cases may require spinal decompression surgery.

Conservative, nonsurgical treatment

Conservative treatment is aimed at pain reduction. It may include:

Your doctor or physical therapist may give you instruction about proper bending and lifting to avoid aggravating your condition. In some cases, epidural steroid injections may also help you return to full activity. Most people with sciatica get relief from their symptoms within several months.

Surgical treatment

For those patients who do not respond conservative care and experience persistent, disabling sciatica, surgery may be warranted. Your doctor will determine whether you are a candidate for surgery based on the duration and severity of symptoms. If your condition is causing cauda equina syndrome (which includes symptoms such as bladder dysfunction, incontinence or severe numbness in the buttocks) may be an indication that you should have immediate surgery.

The surgical treatment for sciatica is spinal decompression surgery. The goal is to remove any disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. There are several different decompression surgeries, dependent on which nerve roots are affected. They include:

  • laminectomy
  • laminoplasty
  • laminotomy
  • microdiscectomy (also known as spinal microdecompression)

In general, more than 90% of sciatica surgery patients have successful outcomes.

Additional information about sciatica

Learn more from the articles and other content below, or find the best sciatica doctor or surgeon at HSS for your particular condition and insurance.

Overview articles

Get more information about sciatica and other conditions that cause back pain.

Sciatica diagnosis articles

These articles discuss different methods physicians use to diagnose sciatica and other spine-related conditions.

Sciatica treatment articles

Learn more about treatments for sciatica.

Topics related to sciatica

Read articles about conditions and issues related to sciatica.

Back in the Game patient stories

In-person and virtual
physician appointments

Urgent Ortho Care

Same-day in-person or virtual appointments

Specialized Centers, Departments and Services: