Sciatica
Also known as: sciatic nerve pain
Pain, and sometimes tingling, numbness or weakness, in one leg when the sciatic nerve is irritated or compressed.
When to seek care
Call 999 or go to A&E for sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or problems controlling the bladder or bowels; the NHS advises against driving yourself. Versus Arthritis advises seeing a GP if back pain does not improve after a few weeks or is getting worse.
Overview
Sciatica describes symptoms that arise when the sciatic nerve, which runs from the lower back to the feet, is irritated or compressed. The NHS lists pain, tingling, numbness or weakness in one leg. A slipped disc is the most common cause. The NHS says it usually gets better in a few weeks to a few months but can last longer. Numbness around the genitals or bottom, or problems controlling the bladder or bowels, need an emergency response: call 999 or go to A&E.
Causes
- Slipped (herniated) disc pressing on a nerve root, the most common cause
- Spinal stenosis, a narrowing of the spaces in the spine
- Spondylolisthesis, where a bone in the spine slips out of position
- Back injury
Risk factors
- Regular lifting and other physical stress on the spine
- Smoking
- Obesity
- Whole-body vibration at work, particularly alongside obesity
Symptoms
What a clinician may find
- Pain in the bottom and back of one leg, sometimes reaching the foot and toes
- Tingling or numbness in one leg
- Weakness in the affected leg
Complications
- Symptoms that take a number of months to settle or last longer
- Cauda equina syndrome, a rare but serious emergency involving the nerves at the base of the spine
- Persistent symptoms that lead to referral for injections or surgery
Diagnosis
Sciatica is mainly diagnosed from the person's history and a physical examination. One review calls careful history-taking and examination key to the diagnosis, and says clinicians should always look for red flag features, which prompt a wider search for other causes such as infection or cancer. NICE advises against routinely offering imaging in a non-specialist setting and suggests considering imaging in specialist settings only if the result is likely to change management.
Treatment
The NHS lists exercises, painkillers and physiotherapy as the main treatments. NICE says people should be given advice and information to support self-management at every stage of treatment. In severe cases that treatments have not helped, the NHS says people may be referred to a hospital specialist, and options include epidural injections or decompression surgery.
Prevention
A review of risk factors notes that most reported risk factors, such as smoking, obesity and occupational factors, are modifiable.
Key facts
| Fact | Detail |
|---|---|
| What it is | Irritation or compression of the sciatic nerve, which runs from the lower back to the feet |
| Typical symptoms | Pain, tingling, numbness or weakness in one leg |
| Most common cause | A slipped disc |
| Usually diagnosed by | History and physical examination; scans are not routinely offered in non-specialist settings |
| Usual recovery | A few weeks to a few months, sometimes longer |
| Main treatments | Exercises, painkillers and physiotherapy; injections or surgery in severe cases |
| Emergency signs | Sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, bladder or bowel problems: call 999 or go to A&E |
What is sciatica and what does it feel like?
Sciatica is the name given to symptoms that arise when the sciatic nerve is irritated or compressed. This nerve runs from the lower back down to the feet. The NHS describes the symptoms as pain, tingling, numbness or weakness in one leg, usually affecting the bottom and the back of the leg and often including the foot and toes.
One NHS musculoskeletal service says irritation of the nerve roots can cause pain in the buttock, thigh, calf and foot. Versus Arthritis describes pain travelling down the leg as sciatica or referred leg pain, and says gentle exercise started early is likely to help. The NHS also says a person probably does not have sciatica if they have only back pain.
What causes sciatica?
The NHS says a slipped disc is the most common cause of sciatica. Versus Arthritis explains that in this case a disc in the back bulges and presses on a nearby nerve. Other causes listed by the NHS are spinal stenosis, spondylolisthesis and an injury to the back. Spinal stenosis is a narrowing of the spaces in the spine, and spondylolisthesis is when one bone in the spine slips out of position.
Research on risk factors points to modifiable influences. In cohort studies, current smoking, obesity and frequent lifting or carrying of heavy objects were linked with hospital admission for sciatica, and whole-body vibration raised the risk among people with obesity. Reviews also note that sciatica is related to age and is rarely seen before 20.
How is sciatica diagnosed?
Sciatica is mainly diagnosed from the person's history and a physical examination. One review calls careful history-taking and examination key to the diagnosis. The straight leg raise is described as the most commonly used test, although on its own it does not reliably tell sciatica from other problems. Clinicians look for red flag features, which prompt a wider search for other causes such as infection or cancer. The review says immediate referral is indicated for suspected cauda equina syndrome.
NICE advises against routinely offering imaging in a non-specialist setting. It suggests considering imaging in specialist settings only if the result is likely to change management. Cauda equina syndrome is diagnosed clinically, usually with imaging support from an MRI scan.
How is sciatica treated?
The NHS lists exercises, painkillers and physiotherapy as the main treatments. A medical review describes initial care as focused on pain management and maintaining function, with reassurance that symptoms usually diminish over time. NICE says people should be given advice and information to support self-management at every stage of treatment. Versus Arthritis notes that a physiotherapist can help oversee an exercise programme and recommend specific exercises.
NHS advice says paracetamol is unlikely to help and that it is unclear how much anti-inflammatory painkillers such as ibuprofen help. NICE does not recommend gabapentinoids for low back pain, and its evidence review found they did not improve sciatica symptoms. NICE advises against opioids for chronic sciatica, and against traction for low back pain with or without sciatica.
How long does sciatica last, and what if it does not settle?
The NHS says sciatica usually gets better in a few weeks to a few months but can last longer. The NHS suggests staying active, starting gentle exercise and using heat packs on the painful area. Versus Arthritis says most people recover fairly quickly, although in some cases it can take a number of months.
In severe cases that treatments have not helped, the NHS says people may be referred to a hospital specialist for options such as epidural injections or decompression surgery. Versus Arthritis says injections are sometimes used for severe sciatica when other treatments have not worked, and that an operation is sometimes needed to free the nerve. A review of management strategies says discectomy is supported for carefully selected patients whose sciatica from a disc prolapse does not resolve with conservative management. A Cochrane review of placebo-controlled trials found that the benefits of epidural steroid injections were small, mainly short term, and may not be clinically important to patients.
When is sciatica an emergency?
The NHS says sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, and bladder or bowel control problems could be symptoms of a serious back problem that needs hospital treatment as soon as possible. The NHS route is a call to 999 or a visit to A&E, and it advises against driving yourself. Hospital patient information describes cauda equina syndrome as a rare but serious condition in which the nerves at the base of the spine are compressed. Warning signs include pain in both legs with weakness or numbness, numbness in the saddle area, and changes in bladder or bowel control. An Oxford University Hospitals leaflet links early surgery with better outcomes.
Leg pain that is not improving is a different situation, and Versus Arthritis advises seeing a GP if pain does not improve after a few weeks or is getting worse.
Frequently asked questions
How long does sciatica take to get better?
The NHS says sciatica usually gets better in a few weeks to a few months but can last longer. Exercises, painkillers and physiotherapy are listed as the main treatments. Versus Arthritis advises seeing a GP if pain does not improve after a few weeks or is getting worse, and the NHS says severe cases may be referred to a hospital specialist for options such as epidural injections or decompression surgery.
Is sciatica the same as a slipped disc?
They are linked but not identical. Sciatica describes the symptoms of an irritated or compressed sciatic nerve, and the NHS says a slipped disc is the most common cause. Versus Arthritis describes a slipped disc as a disc in the back that bulges and presses on a nearby nerve. Other causes include spinal stenosis, spondylolisthesis and back injury.
Is it better to rest or stay active with sciatica?
The NHS suggests staying active, starting gentle exercise and using heat packs on the painful area. Versus Arthritis calls staying active the most important way people can help themselves with back pain. A physiotherapist can help oversee an exercise programme and recommend specific exercises.
Do I need an MRI scan for sciatica?
Sciatica is mainly diagnosed from a person's history and a physical examination. NICE advises against routinely offering imaging in a non-specialist setting and suggests imaging in specialist settings only when the result is likely to change management. Suspected cauda equina syndrome is different: it is diagnosed clinically, usually with imaging support from an MRI scan.
When is sciatica an emergency?
The NHS says sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, and bladder or bowel control problems need a call to 999 or a visit to A&E. It advises against driving yourself. Hospital patient information describes cauda equina syndrome, which has similar warning signs, as rare but serious.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Sciatica.
Conditions
- Herniated (slipped) disc Protrusion of the soft nucleus of an intervertebral disc through its fibrous outer ring, most often at the lower lumbar levels.
Symptoms
- Back pain Pain in the spine or the muscles beside it, most often the lower back.
- Numbness Reduced or absent feeling in part of the body.
- Tingling (pins and needles) Prickling, buzzing or crawling sensations without an outside cause, produced when sensory nerves fire abnormally.
Imaging
- MRI scan Magnetic resonance imaging uses a strong magnet and radio waves, not radiation, to produce detailed pictures of soft tissue: the brain, spinal cord.