Sciatica: Causes, Symptoms and Treatment

Pain that travels from the lower back or buttock down the leg is commonly called sciatica. It can range from a mild ache or tingling sensation to severe, electric or burning pain that makes sitting, standing, walking, or sleeping difficult.

Sciatica is not actually a diagnosis by itself. It is a symptom caused by irritation or compression of a nerve in the lower spine.

The good news is that many cases improve without surgery. The first step is determining which nerve is irritated and what is causing the pressure.

Watch: Why Does Sciatica Shoot Down Your Leg?

The Spine Minute with Domingo Molina IV, MD, FAAOS

In this short video, Dr. Molina explains why a problem in the lower back can cause pain all the way down the leg and when sciatica should be evaluated by a spine specialist.

What Does Sciatica Feel Like?

Sciatica usually affects one side of the body and may cause:

• Shooting or electric pain from the buttock into the leg

• Burning pain down the thigh or calf

• Numbness or tingling

• Pins-and-needles sensations

• Pain extending into the ankle or foot

• Leg or foot weakness

• Difficulty standing or walking

• Pain that worsens with sitting, coughing, sneezing, or certain movements

Some patients have significant leg pain with very little back pain.

The location of the symptoms can often provide clues about which nerve in the lower back is being affected.

What Causes Sciatica?

Several spinal conditions can irritate or compress the nerves that travel into the leg.

Herniated Disc

A herniated disc is one of the most common causes of sciatica.

The discs between the vertebrae act as cushions. If material from inside a disc pushes outward, it can irritate or compress a nearby spinal nerve.

This can produce sudden pain traveling from the back or buttock into the leg.

Lumbar Spinal Stenosis

Spinal stenosis occurs when the space available for the spinal nerves becomes narrowed.

Patients may experience:

• Leg pain

• Numbness or tingling

• Heaviness in the legs

• Weakness

• Difficulty walking longer distances

Symptoms are often worse when standing or walking and may improve when sitting or bending forward.

Foraminal Stenosis

Each spinal nerve exits the spine through an opening called the foramen.

Arthritis, disc degeneration, bone spurs, or loss of disc height can narrow this opening and place pressure on the exiting nerve.

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips relative to another.

That change in alignment can narrow the spinal canal or neural foramen and compress the nerves traveling into the leg.

Is Sciatica the Same as a Pinched Nerve?

In many cases, yes.

Patients frequently use the term pinched nerve to describe lumbar radiculopathy.

Lumbar radiculopathy occurs when a spinal nerve becomes irritated or compressed and produces symptoms along the course of that nerve.

Sciatica is commonly used to describe this type of radiating leg pain.

Does Sciatica Require an MRI?

Not everyone with new sciatica needs an immediate MRI.

Many episodes improve with time and conservative treatment.

An MRI may be appropriate when symptoms:

• Are severe or persistent

• Fail to improve with treatment

• Are associated with significant numbness

• Cause muscle weakness

• Suggest substantial nerve compression

MRI imaging can show whether a herniated disc, spinal stenosis, or another condition is placing pressure on a nerve.

Does Sciatica Go Away on Its Own?

Many cases do.

Inflammation around an irritated nerve can gradually decrease, and some disc herniations can shrink over time.

Initial treatment may include:

• Remaining active as tolerated

• Temporary activity modification

• Anti-inflammatory medication when medically appropriate

• Physical therapy

• Home exercises

• Time

The appropriate treatment depends on the cause and severity of the symptoms.

Can an Epidural Injection Help Sciatica?

For some patients, an epidural steroid injection can reduce inflammation surrounding an irritated spinal nerve.

An injection does not physically remove a disc herniation or spinal stenosis, but reducing inflammation can sometimes provide enough relief for the nerve to recover and allow the patient to participate more comfortably in rehabilitation.

The response to an injection can also provide useful information about which nerve is causing the symptoms.

When Does Sciatica Need Surgery?

Most people with sciatica do not require surgery.

Surgery may be considered when:

• Severe leg pain persists despite appropriate nonsurgical treatment

• Symptoms significantly interfere with daily life

• Imaging identifies nerve compression that matches the patient's symptoms

• Significant or progressive weakness develops

The goal of surgery is typically to decompress the affected nerve.

The exact procedure depends on what is causing the compression.

Minimally Invasive and Endoscopic Spine Surgery for Sciatica

Certain causes of sciatica can be treated using minimally invasive or endoscopic spine surgery.

Endoscopic techniques allow a surgeon to access and decompress a spinal nerve through a small incision using a specialized camera and instruments.

For appropriately selected patients, this can minimize disruption of surrounding muscles and normal spinal anatomy.

Not every patient or spinal condition is appropriate for an endoscopic procedure. The decision depends on the patient's symptoms, physical examination, imaging, and the location of the nerve compression.

When Should You See a Spine Specialist?

You should consider an evaluation if sciatica:

• Persists despite initial treatment

• Frequently returns

• Prevents you from working or exercising

• Makes walking or standing difficult

• Causes persistent numbness

• Is associated with leg or foot weakness

A spine evaluation can help determine whether the symptoms are coming from a herniated disc, spinal stenosis, or another source.

When Is Sciatica an Emergency?

Seek urgent medical evaluation if you develop:

• Rapidly progressive leg weakness

• New loss of bowel or bladder control

• Difficulty urinating

• Numbness involving the groin or saddle region

• Severe symptoms involving both legs

These symptoms can rarely indicate significant compression of the nerves at the bottom of the spinal canal and require prompt evaluation.

Sciatica Treatment in Springfield and Southwest Ohio

Domingo Molina IV, MD, FAAOS is a fellowship-trained orthopedic spine surgeon providing evaluation and treatment for conditions including:

• Sciatica

• Lumbar radiculopathy

• Herniated discs

• Lumbar spinal stenosis

• Foraminal stenosis

• Spondylolisthesis

Treatment is individualized and may include nonsurgical care, spine injections, minimally invasive surgery, or endoscopic spine surgery when appropriate.

Having Pain Shooting Down Your Leg?

You don't have to determine the cause on your own.

A spine evaluation can help identify which nerve is being affected and what treatment options may be appropriate.

Frequently Asked Questions About Sciatica

Can sciatica happen without back pain?

Yes. Some patients experience significant buttock or leg pain while having little or no lower-back pain.

How long does sciatica last?

The duration varies depending on the cause. Many acute episodes improve over several weeks, while persistent nerve compression may produce longer-lasting symptoms.

Can a herniated disc cause sciatica?

Yes. A lumbar disc herniation is one of the most common causes of sciatica.

Can spinal stenosis cause sciatica?

Yes. Spinal stenosis can compress the nerves in the lower back and cause pain, numbness, tingling, or weakness in the legs.

Does numbness mean I need surgery?

Not necessarily. Persistent or progressive numbness should be evaluated, but treatment depends on the severity of the symptoms, physical examination, imaging findings, and response to nonsurgical care.

Can weakness from sciatica be serious?

Yes. New or progressive muscle weakness deserves prompt evaluation because it can indicate more substantial nerve compression.