Symptoms, causes and treatment of sciatica
Sciatica is pain caused by irritation or pressure on one or more of the nerves in the lower back that travel into the leg.
It commonly causes pain in the buttock and leg and may also cause tingling, numbness or weakness.
Most people with sciatica get better without surgery. If your symptoms are severe, are not improving or are affecting your everyday life, specialist assessment can help identify the cause and explain your treatment options.
At Integrity Spine Care, Honorary Professor Tony Bateman, Consultant Spine Surgeon, provides specialist assessment and treatment for sciatica and other spinal conditions in Derby, Lincoln, Nottingham and the East Midlands.
What Is Sciatica?
Sciatica describes symptoms caused by irritation or compression of a nerve in the lower part of the spine.
The nerves in your lower back join together to form the sciatic nerve. When one of these nerves becomes irritated, pain can travel from the lower back or buttock into the leg.
Sciatica is therefore a symptom rather than a diagnosis in itself. The important question is what is causing the nerve irritation.
A slipped or herniated disc is one of the most common causes. Other causes include narrowing around the nerves, known as spinal stenosis.
What Does Sciatica Feel Like?
Sciatica can feel different from person to person.
Symptoms may include:
- Pain in the buttock
- Pain travelling down the back, side or front of the leg
- Pain extending into the calf, ankle or foot
- Tingling or pins and needles
- Numbness
- Burning or electric-shock-like pain
- Weakness in the leg or foot
You may have some lower back pain as well, but the leg pain is often more troublesome than the back pain.
Symptoms usually affect one leg, although occasionally both legs can be affected.
The exact location of the symptoms can provide clues about which nerve is irritated.
What Causes Sciatica?
Several conditions can cause sciatica.
Slipped or Herniated Disc
Between the bones of your spine are soft structures called discs.
A disc can sometimes bulge or herniate. This is commonly called a slipped disc, although the disc does not actually slip out of position.
Disc material can irritate or press against a spinal nerve and cause sciatica.
Many disc prolapses naturally shrink with time, which is one reason why sciatica often improves without surgery.
Learn more about slipped discs →
Lumbar Spinal Stenosis
Spinal stenosis means narrowing of the space available for the nerves.
It becomes more common as we get older and can cause pain, numbness or heaviness in the legs.
Symptoms may be worse when standing or walking and improve when sitting or leaning forwards.
Learn about lumbar spinal stenosis →
Spondylolisthesis
Spondylolisthesis occurs when one vertebra moves relative to another.
This can sometimes narrow the space around a spinal nerve and cause sciatica.
Learn about spondylolisthesis →
Will Sciatica Get Better on Its Own?
Often, yes.
Many episodes of sciatica improve naturally over a period of weeks to a few months.
A slipped disc can look quite dramatic on an MRI scan but may shrink naturally over time. For this reason, an MRI finding alone does not determine whether someone needs surgery.
If your symptoms are manageable and there is no significant weakness or other worrying feature, allowing time for natural recovery is often appropriate.
Keeping gently active is generally preferable to prolonged bed rest.
When Should I See a Specialist About Sciatica?
You may wish to seek specialist advice if:
- Your pain is severe
- Your symptoms are not improving
- Pain is affecting your sleep
- You are struggling to work or carry out normal activities
- You have persistent numbness or tingling
- You notice weakness in your leg or foot
- Symptoms keep returning
- You have already tried treatment without sufficient improvement
- You have had an MRI scan and would like help understanding the findings
- You would like to discuss whether an injection or surgery may be appropriate
Seeing a spinal surgeon does not mean that you will be advised to have surgery.
A specialist consultation can also help confirm that non-surgical treatment remains the best option.
Book a consultation with Honorary Professor Tony Bateman →
How Is Sciatica Diagnosed?
Diagnosis starts with understanding your symptoms.
During your consultation, Professor Bateman will usually ask:
- Where your pain starts and where it travels
- How long you have had your symptoms
- Whether you have numbness or tingling
- Whether you have noticed weakness
- What makes the symptoms better or worse
- How they affect walking, sleeping, working and everyday activities
- What treatments you have already tried
A clinical examination can assess your nerves, including muscle strength, sensation and reflexes.
Do I Need an MRI Scan for Sciatica?
Not everyone with sciatica needs an MRI scan.
If symptoms are improving and there are no concerning features, a scan may not change the treatment.
An MRI scan may be helpful when symptoms are persistent or severe, when weakness is present, or when treatments such as an injection or surgery are being considered.
MRI can show the discs, spinal nerves and other structures within the spine.
Importantly, MRI scans often show changes that are not causing symptoms. The scan therefore needs to be considered alongside your symptoms and examination rather than interpreted on its own.
If you already have an MRI scan, this can be reviewed as part of your consultation.
How Is Sciatica Treated?
Treatment depends on the cause of the sciatica, how severe the symptoms are and how they are affecting you.
Most treatment begins without surgery.
Staying Active
Although movement can sometimes be uncomfortable, prolonged bed rest is generally not recommended.
Gentle activity and gradually returning to normal activities can help recovery.
You may need to temporarily modify activities that significantly aggravate your symptoms.
Pain Relief
Medication may sometimes help control symptoms while the nerve recovers.
The most appropriate medication depends on your individual circumstances and should be discussed with your GP, pharmacist or treating clinician.
Physiotherapy and Exercise
Exercise and physiotherapy can help some people remain active and return gradually to normal function.
There is no single exercise programme that is right for everyone with sciatica. Treatment should take account of your symptoms, general health and stage of recovery.
Spinal or Nerve Root Injection
A targeted injection around an irritated spinal nerve may be considered for some patients with severe or persistent sciatica.
The aim is usually to reduce inflammation and pain around the nerve.
The benefit varies between individuals and the benefits of an injection can sometimes wear off.
Learn about nerve root injections →
Surgery
Only a minority of people with sciatica require an operation.
Surgery may be considered when nerve compression has been identified and symptoms remain severe despite appropriate non-surgical treatment.
It may also be considered sooner when there is significant or progressive weakness or certain emergency symptoms.
When Is Surgery Considered for Sciatica?
The decision to consider surgery is individual.
It usually depends on several factors:
- How severe your leg pain is
- How long symptoms have been present
- Whether symptoms are improving
- Whether you have weakness or numbness
- How much symptoms affect your quality of life
- Whether an MRI shows nerve compression that matches your symptoms
- Whether non-surgical treatment has provided sufficient relief
- Your own preferences after understanding the alternatives, benefits and risks
The main purpose of surgery for a disc prolapse is usually to relieve pressure on the affected nerve and improve leg pain.
Surgery is generally more predictable for nerve-related leg pain than for non-specific lower back pain.
Microdiscectomy for Sciatica
A microdiscectomy is an established operation used to treat sciatica caused by a herniated or slipped disc.
A small incision is made in the lower back and the part of the disc pressing on the nerve is removed.
The aim is to create enough space for the nerve and relieve the leg symptoms.
Learn about lumbar microdiscectomy →
Endoscopic Discectomy for Sciatica
Some disc prolapses can be treated using endoscopic spine surgery.
An endoscope is a narrow camera that allows the surgeon to see and operate through a small incision.
In appropriately selected patients, an endoscopic discectomy can remove the disc material pressing on the nerve using a minimally invasive approach.
Not every disc prolapse is suitable for endoscopic surgery. The choice between an endoscopic procedure, conventional microdiscectomy and continued non-surgical treatment depends on your symptoms, examination and MRI findings.
Learn about endoscopic discectomy →
Microdiscectomy or Endoscopic Discectomy?
Both operations aim to achieve the same fundamental goal:
to relieve pressure on the spinal nerve.
The most appropriate approach depends on factors including the position and size of the disc prolapse, your anatomy, previous spinal surgery and the surgeon's assessment.
Rather than choosing an operation before consultation, the first step is establishing whether surgery is appropriate at all.
If it is, the advantages and disadvantages of the available approaches can then be discussed with you.
How Successful Is Surgery for Sciatica?
For appropriately selected patients with sciatica caused by nerve compression, surgery can provide substantial relief from leg pain.
However, no spinal operation can guarantee a particular result.
Recovery varies between individuals, and numbness or weakness may take longer to improve than pain. Some symptoms may persist despite technically successful surgery, particularly when a nerve has been compressed for a long time or has already suffered damage.
The expected benefits, limitations and risks of surgery should therefore be discussed carefully before deciding whether to proceed.
Can Sciatica Come Back?
Yes.
Most people who recover from an episode of sciatica do well, but symptoms can occasionally return.
Following surgery for a disc prolapse, another disc prolapse can occur at the same level. A disc at another level can also cause symptoms in the future.
Recurrent symptoms do not automatically mean that further surgery is required. They should be assessed in the same way as a first episode.
When Is Sciatica an Emergency?
Most sciatica is not an emergency.
However, seek urgent medical assessment if you develop:
- New difficulty passing urine
- Loss of bladder or bowel control
- New numbness around your genitals, anus, buttocks or inner thighs
- Rapidly developing or severe weakness in one or both legs
- Severe symptoms affecting both legs
These can be symptoms of significant compression of the nerves at the bottom of the spinal canal, including cauda equina syndrome.
Cauda equina syndrome is uncommon but requires emergency assessment.
If you develop these symptoms, do not wait for a routine private appointment. Seek urgent medical care.
Frequently Asked Questions About Sciatica
Is sciatica the same as back pain?
No.
Sciatica describes symptoms caused by irritation or compression of a spinal nerve. It typically causes pain travelling into the leg.
You can have sciatica with very little back pain, and you can have significant back pain without sciatica.
Is a slipped disc always the cause of sciatica?
No.
A slipped or herniated disc is a common cause, particularly in younger and middle-aged adults, but other conditions such as spinal stenosis can also irritate or compress a nerve.
Does a slipped disc always need surgery?
No.
Many disc prolapses improve naturally and never require an operation.
Should I rest if I have sciatica?
A short period of modifying activities may be necessary when pain is severe, but prolonged bed rest is generally not recommended.
Try to remain gently active within what you can tolerate.
Do I need an MRI?
Not necessarily.
MRI is particularly useful when symptoms persist, there is weakness or another concerning feature, or an injection or surgery is being considered.
Can an injection cure sciatica?
An injection does not remove a disc prolapse or permanently enlarge the spinal canal.
For selected patients, however, it may reduce pain and inflammation while the underlying problem improves naturally.
When might surgery help?
Surgery may be considered when significant sciatica persists despite appropriate non-surgical treatment and an MRI identifies nerve compression that fits your symptoms.
There are also situations where surgery may need to be considered more urgently, particularly with progressive weakness or symptoms suggesting cauda equina syndrome.
What operation is used for sciatica?
For sciatica caused by a disc prolapse, treatment may involve a microdiscectomy or, in selected patients, an endoscopic discectomy.
For sciatica caused by spinal stenosis, a lumbar decompression may be more appropriate.
The operation depends on the cause of the nerve compression rather than simply the presence of leg pain.
Specialist Assessment for Sciatica
Honorary Professor Tony Bateman
Consultant Spine Surgeon
Honorary Professor Tony Bateman provides specialist assessment and treatment for patients with sciatica, slipped discs and other spinal conditions.
The aim of consultation is to understand:
What is causing your symptoms?
Is it likely to improve without surgery?
Would further investigation help?
What treatment options are appropriate?
Is there anything that requires more urgent treatment?
Where possible, treatment remains non-surgical.
If an operation is appropriate, the available options—including conventional and minimally invasive or endoscopic techniques where suitable—can be discussed so that you can make an informed decision.
About Honorary Professor Tony Bateman →
Arrange a Consultation for Sciatica
If sciatica is affecting your sleep, work, walking, exercise or everyday life, a specialist assessment can help establish the likely cause and explain your options.
You do not need to know whether you need an injection or surgery before arranging an appointment.
Book a consultation with Honorary Professor Tony Bateman
Integrity Spine Care
Consultant-led spinal care in Derby, Lincoln, Nottingham and the East Midlands.
