Sciatica: What It Is, Why It Happens and How to Feel Better

Most sciatica gets better on its own within a few weeks, and very few people ever need surgery. As a spinal surgeon, that is the first thing I tell patients who come to clinic worried about leg pain.

What Is Sciatica?

Sciatica is not a diagnosis in itself. It describes pain caused by irritation or pressure on the sciatic nerve — the longest nerve in the body. It starts from nerve roots in your lower back, runs through the buttock and travels down the back of each leg to the foot.

When one of those nerve roots is squeezed or inflamed, you feel pain along the path of the nerve. That is why a problem in your back can cause pain in your calf or foot.

Common Symptoms

Sciatica usually affects one leg. Patients describe it in many ways, but the most common are: pain that spreads from the buttock down the back of the leg, often below the knee; sharp, burning or shooting pain, sometimes like an electric shock; numbness, tingling or pins and needles in the leg or foot; weakness in the leg or foot; and pain that is worse when sitting, coughing, sneezing or bending.

The leg pain is often worse than any back pain. That pattern helps us tell sciatica apart from ordinary back strain.

What Causes It?

The most common cause is a slipped (herniated) disc. The discs between your vertebrae act as cushions. If the soft centre bulges out, it can press on a nearby nerve root and inflame it.

Other causes include spinal stenosis (narrowing of the spinal canal, more common after age 60), spondylolisthesis (one vertebra slipping forward over the one below), wear and tear in the joints and discs of the spine, and rarely, an infection, injury or growth pressing on the nerve.

Risk factors include age, heavy lifting, long periods of sitting, smoking and carrying extra weight. Often, though, there is no single trigger.

What You Can Do at Home

The best thing you can do is keep moving, gently. Bed rest used to be advised, but we now know it slows recovery.

Stay active — short, regular walks are better than lying down for long periods. Keep working if you can, adjusting tasks that make the pain worse. Use heat or cold: a warm pack or a wrapped ice pack on the lower back can ease pain. Try gentle stretches, especially for the lower back and hamstrings. Take simple pain relief as advised by your pharmacist or GP. Change position often and avoid sitting for long stretches.

Most people notice steady improvement within four to six weeks. Some take longer, which does not mean something is wrong.

Treatments We May Offer

If symptoms are severe or not settling, treatment is stepped up gradually. Most patients never reach the final step.

Physiotherapy: a tailored exercise programme to strengthen your core, improve flexibility and get you moving with confidence.

Medication review: your GP may adjust pain relief. NICE no longer recommends several nerve-pain medicines for sciatica (see below), so always discuss options with your doctor.

Spinal injection: an epidural steroid injection can calm an inflamed nerve and reduce severe pain, giving you a window to rehabilitate.

Surgery: considered when severe leg pain persists despite other treatment, or when there is worsening weakness. The most common operation is a microdiscectomy. Through a small incision, we remove the part of the disc pressing on the nerve. Most patients notice leg pain easing soon after surgery and go home the same or next day. Like any operation it carries risks, which we would discuss with you in detail.

An MRI scan is not usually needed early on. We arrange one if symptoms persist, are severe, or if surgery or an injection is being considered.

What NHS and NICE Guidelines Say

My advice follows the NHS and the NICE guideline on low back pain and sciatica (NG59), which sets the standard for care in England and Wales.

NHS advice for patients: sciatica usually gets better in 4 to 6 weeks, but it can last longer. Carry on with your normal activities as much as possible and do regular back stretches. Symptoms are often worse when moving, sneezing or coughing, and leg pain is usually worse than back pain.

NICE recommendations (NG59):

Self-care

Advice to keep active and support to manage the condition yourself.

Exercise

Consider a group exercise programme, such as aerobic, strengthening or mind–body exercise.

Scans

Do not routinely offer imaging outside specialist care; scan only if the result is likely to change treatment.

Medicines

Do not offer gabapentinoids (such as gabapentin or pregabalin), other antiepileptics, oral steroids or benzodiazepines for sciatica; do not offer opioids for long-term (chronic) sciatica.

Injections

Consider an epidural injection of local anaesthetic and steroid for acute and severe sciatica.

Surgery

Consider spinal decompression when non-surgical treatment has not improved pain or function.

Not recommended

Belts or corsets, ultrasound, TENS machines and acupuncture.

When to Seek Urgent Help

Rarely, severe nerve compression causes a condition called cauda equina syndrome. It is an emergency and needs surgery quickly to prevent permanent damage.

Go to A&E or call 999 straight away if you have back pain or sciatica with any of these: numbness or tingling between your legs, around your genitals or back passage (saddle area); new difficulty passing urine, or not knowing when your bladder is full; loss of control of your bladder or bowels; sciatica in both legs; leg weakness that is getting worse, or difficulty walking; new problems with sexual function; altered feeling when using toilet paper to wipe yourself.

Also see a doctor promptly if you have sciatica with a fever, unexplained weight loss, a history of cancer, or after a significant fall or injury.

Looking After Your Back for the Future

You cannot prevent every episode, but you can lower your risk: exercise regularly, including core-strengthening work such as Pilates; lift with your knees bent and the load close to your body; take breaks from sitting and set up your workstation well; stop smoking, which affects the health of your spinal discs; keep to a healthy weight.

The Bottom Line

Sciatica can be very painful and frightening, but the outlook is good. Most people recover with time, movement and simple measures. If your pain is not improving after six weeks, is getting worse, or you are worried, book a review. We will assess you properly and agree a plan together.

This article is general information and is not a substitute for a personal medical assessment.

Sources

NICE NG59: Low back pain and sciatica in over 16s: assessment and management — nice.org.uk/guidance/ng59

NICE NG59 overview (last reviewed December 2020) — nice.org.uk/guidance/ng59

NHS 111 Wales: Sciatica — 111.wales.nhs.uk/encyclopaedia/s/article/sciatica

King's College Hospital NHS Foundation Trust: Cauda equina syndrome patient information — kch.nhs.uk