Condition
Sciatica
Pain radiating from the low back down the leg, sometimes with numbness or weakness. Usually a nerve-root issue at the lumbar spine.
Symptoms
Sciatica is pain that travels from the low back through the buttock and down the back of the leg. It can be sharp, burning, or electric. Some people get numbness, pins-and-needles, or weakness in the leg or foot. Coughing, sneezing, and prolonged sitting often make it worse.
Causes
True sciatica is irritation or compression of a lumbar nerve root, most often from:
- Lumbar disc herniation
- Spinal stenosis (narrowing of the spinal canal)
- Foraminal narrowing from arthritis
Pain in a similar distribution can also come from the piriformis muscle or sacroiliac joint. The pattern of symptoms and a focused neurological exam tell us which.
How we treat it
Assessment identifies the level involved and screens for red flags. Treatment generally combines positions and movements that take pressure off the nerve, manual therapy, progressive exercise, and education on how to move and rest while symptoms settle. Most cases improve over weeks to a few months without surgery. Imaging and surgical referral are reserved for cases with progressive neurological loss or pain that won’t budge with conservative care.
When to seek other care
Progressive leg weakness, loss of bladder or bowel control, or saddle numbness needs emergency medical assessment.