Sciatica: Understanding Pain That Travels Down Your Leg

Pain that travels from the lower back into the buttock and down the leg is one of the most recognizable symptoms of sciatica (1). While many people experience occasional back pain, radiating leg pain often occurs when the sciatic nerve becomes irritated or compressed (2, 3).

This article explains what sciatica is, its common causes, how healthcare providers evaluate the underlying cause, and the treatment options that may help relieve symptoms.

Sciatica is not a disease, but a symptom caused by an underlying condition that irritates or compresses the nerve roots that form the sciatic nerve or, less commonly, the sciatic nerve itself (4). Although it can be painful, most people improve with appropriate treatment.

What Is Sciatica?

The sciatic nerve is the largest nerve in the body. It is formed by several nerve roots that exit the lower spine and join together before traveling through the buttocks and down the back of each leg to the feet.

Sciatica occurs when the sciatic nerve, or the nerve roots that form it, become irritated or compressed. The pain usually affects one side of the body and may travel from the lower back or buttock down the leg. Depending on the underlying cause, symptoms may develop gradually or occur suddenly (1).

Figure 1. Illustration showing the course of the sciatic nerve and the typical pathway of radiating pain associated with sciatica.

What Causes Sciatica?

Several spinal and musculoskeletal conditions can lead to sciatica by irritating or compressing the nerve roots that form the sciatic nerve or, less commonly, the sciatic nerve itself.

These include

• Herniated disc 

• Lumbar spinal stenosis 

• Piriformis syndrome 

• Sacroiliac (SI) joint dysfunction 

• Spondylolisthesis 

• Bone spurs 

• Spinal injury 

• Less commonly, spinal tumors or infections 

  
  

Although sciatica most commonly results from conditions affecting the lower spine, less common causes, such as piriformis syndrome, can irritate the sciatic nerve outside the spine.

The likelihood of developing these conditions may increase with factors such as increasing age, obesity, smoking, repetitive lifting, prolonged sitting, participation in high-impact sports, diabetes, and a family history of certain spinal disorders. However, the specific risk factors vary depending on the underlying condition.

Common Symptoms

The way sciatica presents varies depending on the underlying cause and the degree of nerve irritation.

• Pain that begins in the lower back or buttock and travels down the back of the thigh and leg 

• Sharp, burning, or shooting pain 

• Pain that worsens with prolonged sitting 

• Pain that may worsen with coughing, sneezing, or certain movements 

• Numbness or tingling in the leg or foot 

• Muscle weakness in the affected leg 

How Is the Underlying Cause Identified?

Evaluation begins with a review of symptoms, medical history, and a physical examination. Healthcare providers assess muscle strength, sensation, reflexes, walking pattern (gait), and signs of nerve involvement. The Straight Leg Raise (SLR) and Crossed Straight Leg Raise tests may also be performed to assess irritation of the lumbosacral nerve roots.

When needed, imaging tests such as MRI, CT, or X-rays, along with electromyography (EMG) and nerve conduction studies (NCS), may be recommended to help identify the underlying condition causing the symptoms and guide appropriate treatment.

Treatment Options

Treatment depends on the underlying condition causing the symptoms. The goals are to relieve pain, improve function, and help individuals return to their normal daily activities. Most people improve without surgery, and treatment usually begins with conservative measures.

Non-surgical Treatment

• Physical therapy 

• Activity modification while remaining active 

• Anti-inflammatory or pain-relieving medications, when appropriate 

• A home exercise or stretching program recommended by a healthcare provider 

• Image-guided spinal injections for selected patients, depending on the underlying cause 

  
  

Surgical Treatment

Surgery may be considered when symptoms persist despite appropriate conservative treatment or when significant nerve compression causes progressive weakness, loss of function, or changes in bowel or bladder control. The type of surgery depends on the underlying condition and aims to relieve pressure on the affected nerve while preserving healthy spinal anatomy whenever possible (5).

Everyday Tips for Managing Symptoms

Many individuals with sciatica continue to lead active and independent lives. During symptom flare-ups, the following strategies may help reduce discomfort:

• Avoid prolonged sitting without changing position regularly. 

• Stay active with gentle exercises, such as walking, as tolerated. 

• Use proper lifting techniques and avoid lifting heavy objects during painful episodes. 

• Maintain good posture during daily activities. 

• Follow the exercise program recommended by your healthcare provider or physical therapist. 

• Seek medical attention if symptoms worsen or significant weakness develops. 

Common Misconception

Myth: Sciatica is a separate disease that can be diagnosed and treated on its own.

Fact: Sciatica is not a separate disease or diagnosis. It is a symptom caused by an underlying condition that irritates or compresses the nerve roots that form the sciatic nerve or, less commonly, the sciatic nerve itself. Treatment focuses on identifying and managing the underlying cause rather than treating sciatica as a standalone condition.

Frequently Asked Questions

1. Can sciatica go away on its own?

• Many people improve within a few weeks with conservative treatment. Recovery depends on the underlying cause and the severity of nerve irritation.

2. Is walking good for sciatica?

• For many individuals, gentle walking may help reduce symptoms and improve mobility. However, activities should be guided by symptoms and the advice of a healthcare provider.

3. Does sciatica always require surgery?

• No. Most individuals improve with non-surgical treatment. Surgery is generally reserved for persistent symptoms that do not respond to conservative care or when significant nerve compression causes progressive weakness or loss of function.

References:

1. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99(4):461–73.

2. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273.

3. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015;372(13):1240–8.

4. Gore S, Nadkarni S. Sciatica: detection and confirmation by new method. Int J Spine Surg. 2014;8.

5. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313–7.