Low back and leg
Sciatica
Sciatica is pain that travels along the path of the sciatic nerve — from the low back or buttock, down the back of the thigh, and often below the knee. It is a symptom rather than a diagnosis. In most cases the nerve is being compressed or irritated close to the spine, where its roots leave the spinal canal, and the purpose of an assessment is to establish which root is involved and what is pressing on it.
Symptoms
The distribution of the pain matters more than its severity, because the distribution is what points to the level involved.
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Pain along one leg
Typically one-sided, running from the low back or buttock into the back of the thigh and frequently past the knee into the calf or foot. It is often described as burning, shooting or electric rather than aching.
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Numbness, tingling or weakness
Each nerve root supplies sensation and power to a defined area, so the pattern of numbness and which movements are weak indicate the level. Difficulty lifting the foot and difficulty pushing off the toes implicate different roots.
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Worse with sitting, bending or straining
Positions that increase pressure on the lumbar discs commonly aggravate root pain. Coughing, sneezing and straining can produce a brief intensification for the same reason.
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Relief with position change
Many people find standing or walking easier than sitting. The positions that ease the pain are themselves informative and are part of what an examination asks about.
Causes and risk factors
Sciatica describes the pain, not its origin. Several distinct problems produce it, and they are not managed the same way.
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Lumbar disc herniation
The most common cause, particularly under the age of about fifty. Disc material displaced toward a nerve root irritates it both mechanically and chemically.
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Spinal stenosis
Age-related narrowing of the canal or of the openings the roots pass through. It more often causes leg symptoms brought on by walking or standing and eased by sitting or leaning forward.
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Spondylolisthesis and degenerative change
One vertebra slipping forward on another, or arthritic change in the facet joints, can narrow the space available to a root.
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Less common causes
Piriformis syndrome, pregnancy, and — rarely — tumour or infection. Their rarity is why a history that does not fit the usual pattern is taken seriously rather than assumed.
Assessment
How the source is identified
Diagnosis begins with the history and a physical examination, and imaging is interpreted in the light of both. This order matters: disc abnormalities are common findings on scans of people with no symptoms at all, so a scan read in isolation frequently identifies something that is not the cause of the pain.
- Examination of strength, reflexes, sensation and nerve tension
- MRI where symptoms persist, are severe, or surgery is being considered
- Electromyography and nerve conduction studies to confirm which root is affected
- Investigation for other causes when the pattern is atypical
Common questions
How long does sciatica usually last?
Most episodes caused by a disc herniation improve substantially within weeks to a few months, though the course varies considerably between individuals and some people experience recurrences. Symptoms that are not improving, or that are worsening, are a reason to be assessed rather than to keep waiting.
Is an MRI always necessary?
No. Imaging is generally reserved for symptoms that persist, that are severe, that involve neurological deficit, or where an intervention is being considered. Because disc abnormalities appear on scans of many people without pain, an MRI is most useful when it is read alongside the examination findings.
Does sciatica mean surgery?
For most people, no. The majority of cases are managed without an operation. Surgery is generally reserved for progressive weakness, for cauda equina syndrome, or for pain that remains disabling despite non-surgical treatment.
Is it caused by the piriformis muscle?
Occasionally. Piriformis syndrome, in which the muscle irritates the sciatic nerve in the buttock, is one recognised cause but a much less common one than a lumbar disc or stenosis. It is diagnosed after the spinal causes have been considered.
Should I rest or keep moving?
Current guidance favours remaining as active as symptoms allow. Extended bed rest has not been shown to improve outcomes and can prolong stiffness and deconditioning.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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