Sciatica is a condition characterized by pain radiating along the path of the sciatic nerve,
which extends from the lower back through the hips and buttocks and down each leg. It is
not a disease itself, but a symptom of an underlying medical condition affecting the sciatic
nerve.
Anatomy Overview
The sciatic nerve is the longest and thickest nerve in the body. It arises from the lumbosacral
plexus, specifically from L4 to S3 nerve roots, and passes through the greater sciatic foramen,
beneath the piriformis muscle, into the gluteal region and down the posterior thigh. It eventually
branches into:
Tibial nerve
Common fibular (peroneal) nerve
What is Sciatica?
Sciatica refers to pain, numbness, tingling, or weakness that starts in the lower back and travels
along the path of the sciatic nerve. It typically affects one side of the body.
Causes of Sciatica
1. Herniated (slipped) disc
o Most common cause.
o A bulging disc compresses one or more of the lumbar or sacral nerve roots.
2. Degenerative disc disease
o Age-related wear and tear can irritate or compress nerves.
3. Spinal stenosis
o Narrowing of the spinal canal compresses the nerve roots.
4. Spondylolisthesis
o A vertebra slips over another, narrowing the exit path for the nerve.
5. Piriformis syndrome
o The piriformis muscle irritates the sciatic nerve as it passes underneath or through
it.
6. Trauma
o Pelvic fractures or dislocations affecting nerve paths.
7. Tumors or infections (rare)
o Growths pressing on the nerve or inflammatory conditions.
8. Pregnancy
o Increased pressure on the spine and hormonal changes may contribute.
Symptoms of Sciatica
Sharp, shooting, or burning pain from the lower back or buttock down the leg
Pain that worsens with movement, sneezing, coughing, or prolonged sitting
Numbness or tingling along the back of the leg
Weakness in the affected leg or foot
Difficulty walking or standing up due to pain
Pain usually follows a dermatomal pattern, depending on which spinal root is compressed
(e.g., L5 or S1).
Diagnosis of Sciatica
1. History and physical exam
o Evaluate symptoms and neurological signs (reflexes, strength, sensation)
2. Straight leg raise (SLR) test
o Reproduces sciatic pain when the leg is lifted while lying down
3. Imaging tests (if needed)
o X-ray: Shows bone structure
o MRI: Best for visualizing soft tissue (discs, nerves)
o CT scan with myelogram: In some complex cases
o Electromyography (EMG): To check nerve function
Treatment of Sciatica
Conservative Management (Most Cases)
Rest and activity modification (avoid sitting for long periods)
NSAIDs: Ibuprofen, naproxen for inflammation and pain
Muscle relaxants or oral steroids
Cold/heat therapy
Physical therapy:
o Stretching and strengthening
o Core stabilization exercises
o Posture training
Interventional Options
Epidural steroid injections
o Reduce inflammation around compressed nerves
Nerve root blocks
Surgical Treatment
Reserved for severe or unresponsive cases:
Microdiscectomy: Removal of herniated disc material
Laminectomy: Widening the spinal canal in spinal stenosis
Indications for surgery include:
Progressive motor weakness
Severe unrelenting pain
Bowel or bladder dysfunction (suggests cauda equina syndrome, a medical
emergency)
Prognosis
Most cases improve within a few weeks to 3 months.
Some patients may experience chronic or recurrent symptoms.
Addressing the underlying cause is key to full recovery.
Prevention Tips
Maintain proper posture, especially when sitting or lifting
Exercise regularly to strengthen back and core muscles
Avoid prolonged sitting or driving without breaks
Use proper techniques when lifting heavy objects
Key Difference: Sciatica vs. General Back Pain
Sciatica Back Pain
Radiates down the leg Localized to back
Numbness/tingling in leg Usually none
Sciatica Back Pain
Often caused by disc/herniation Can be muscular or disc-related
May involve weakness Rarely involves weakness