Pain that starts in the lower back or buttock and "shoots" down the leg, sometimes all the way to the foot, can make sitting, walking and sleeping really difficult. Many people immediately call it sciatica and search online for a quick way to deal with it. But before you turn to advice from forums, it is worth understanding what sciatica is, what causes it and - above all - when it requires urgent medical care. In this article we describe the typical symptoms and causes of sciatica, the red-flag symptoms that must not be ignored, how a doctor diagnoses and treats it, and general principles of everyday activity and ergonomics. You will not find any "miracle cures" here - instead, reliable information to help you prepare for a conversation with your doctor.
This article is for informational purposes only and does not replace medical advice. If you have symptoms, consult a doctor.
What is sciatica?
Sciatica (in medical terms often described as radicular pain or lumbosacral radiculopathy) is a set of symptoms resulting from irritation or compression of the nerve roots that form the sciatic nerve. It is the thickest and longest nerve in the human body. It is made up of fibers coming from the lower part of the spine - the lumbar spine and the sacrum. The nerve runs through the buttock and the back of the thigh, and above the knee it divides into branches that supply the lower leg and foot.
One thing worth remembering: sciatica is not a separate disease but a symptom. It means that something is irritating the nerve roots or the nerve itself, and it is the doctor's job to determine exactly what. Further management depends on that. This is why two people with very similar leg pain may receive completely different recommendations.
Sciatica vs. ordinary lower back pain
Not every pain in the lower back or buttock is sciatica. Local pain, related for example to overloaded muscles, facet joints or the sacroiliac joint, often radiates to the buttock and thigh, but it usually does not go below the knee and is not accompanied by sensory changes or muscle weakness. In sciatica, leg pain is often stronger than back pain, feels "piercing", "burning" or "electric" and usually runs along a specific strip of the leg. Similar symptoms can also be caused by other problems, such as hip joint or blood vessel conditions - hence the need for a medical examination.
What are the symptoms of sciatica?
Sciatica symptoms vary depending on which nerve root is irritated and how severely. They most often appear on one side of the body. The typical picture includes:
- radiating pain from the lower back or buttock along the back or side of the thigh, often below the knee, sometimes all the way to the foot,
- tingling, numbness or "pins and needles" in the leg or foot,
- a feeling of leg weakness, e.g. difficulty lifting the foot or standing on your toes,
- pain that gets worse when coughing, sneezing, straining or sitting for a long time,
- difficulty finding a comfortable position, pain when getting up from a chair or out of bed.
| Symptom | What it may look like | What to do |
|---|---|---|
| Pain radiating to the leg | From the buttock through the thigh to the calf or foot, usually on one side | Make an appointment with a doctor, especially if the pain is severe or persistent |
| Tingling, numbness | In a specific area of the leg or foot, e.g. on the top of the foot or around the heel | Describe to your doctor exactly where it occurs |
| Leg weakness | Foot drop, tripping, difficulty walking on your heels or toes | Urgent medical consultation, especially if the weakness is getting worse |
| Symptoms in both legs | Pain, numbness or weakness on both sides | Urgent medical consultation |
| Sensory changes in the groin area | Numbness around the groin, buttocks and inner thighs ("like after anesthesia") | Go to the ER immediately or call the emergency number 112 |
| Bladder or bowel problems | Difficulty urinating, urinary retention, loss of bladder or bowel control | Go to the ER immediately or call the emergency number 112 |
What causes sciatica?
Sciatica is most often caused by changes in the lower spine that reduce the space for the nerve roots or irritate them. The most commonly cited causes include:
- Herniated disc (often called a "slipped disc") - a fragment of the disc shifts and may compress a nerve root. This is one of the most common causes of sciatica, especially in middle-aged people.
- Degenerative spine changes - with age the discs lose height, and bone spurs (osteophytes) may form in the joints and along the edges of the vertebrae.
- Narrowing (stenosis) of the spinal canal or the intervertebral foramina - more common in older people; symptoms typically get worse when walking and ease when you sit down or lean forward.
- Spondylolisthesis - one vertebra slipping relative to another.
- Nerve compression outside the spine, e.g. in the buttock area. In this context, piriformis syndrome is sometimes mentioned, although it is a debated diagnosis made after other causes have been ruled out.
- Less common causes: injuries, infections, tumors, hematomas. This is exactly why the red-flag symptoms described below are so important.
Risk factors
The risk of sciatica is associated with, among other things, age (degenerative changes), physical work that involves frequent lifting, bending and twisting, prolonged sitting and generally low activity, excess body weight, smoking and some chronic conditions, such as diabetes. Similar symptoms also occur during pregnancy, when posture and the load on the pelvis change - in that case, it is worth discussing any new symptom with the doctor managing your pregnancy.
When does sciatica require urgent medical care?
This is the most important part of this article. For most people sciatica is not an emergency, but there are symptoms that may indicate severe compression of the nerves in the lower part of the spinal canal (so-called cauda equina syndrome) or another serious cause. In such situations, time matters. Go to the ER immediately or call 112 if you experience:
- numbness or sensory changes around the groin, anus, buttocks or inner thighs (so-called saddle anesthesia),
- problems urinating - difficulty starting, a weak stream, a feeling of incomplete emptying, urinary retention,
- loss of bladder or bowel control,
- sudden sexual dysfunction, e.g. loss of sensation in the genital area,
- rapidly worsening weakness in one or both legs, e.g. foot drop.
An urgent medical consultation (on the same day) is also needed when sciatica appears:
- after a fall, accident or other injury,
- with fever, chills or a general feeling of being unwell,
- in someone with a history of cancer, unexplained weight loss or a weakened immune system,
- with constant pain that gets worse at night and does not depend on position,
- with symptoms on both sides of the body.
It is also worth seeing your primary care doctor when the symptoms are not red flags, but the pain is very severe, does not ease after a few days, keeps coming back or interferes with work and sleep.
How does a doctor diagnose sciatica?
The diagnosis is based on a conversation and an examination, not an MRI right away. The doctor will ask when and under what circumstances the pain started, where exactly it radiates, what makes it worse and what eases it, whether there is numbness or weakness, and what conditions you have and what medications you take. It is worth preparing for the visit and writing this information down beforehand.
Physical examination
During the examination, the doctor usually assesses spinal mobility, the strength of individual leg muscle groups, skin sensation and reflexes (e.g. knee and ankle reflexes), and performs tension tests such as the Lasègue sign - raising your straightened leg while you lie on your back. This often makes it possible to determine which nerve root is probably affected.
Additional tests
- Magnetic resonance imaging (MRI) - shows the intervertebral discs, nerve roots and spinal canal. It is usually ordered when there are red-flag symptoms, when symptoms do not ease despite treatment or when a procedure is being considered. It is worth knowing that disc changes are often visible on imaging even in people without any symptoms, which is why the result is always interpreted together with the symptoms.
- Computed tomography (CT) - when an MRI is not possible or a detailed assessment of bone structures is needed.
- X-ray - shows bones, but not discs and nerves; it can be useful e.g. when spondylolisthesis is suspected or after an injury.
- Electrodiagnostic testing (EMG) - in selected cases, e.g. when the extent of nerve damage needs to be assessed or sciatica needs to be distinguished from other nerve disorders.
- Blood tests - when an infection or inflammation is suspected.
How is sciatica treated?
The treatment plan is always set by a doctor, taking into account the cause, the severity of symptoms, coexisting conditions and your circumstances. Below we describe in general terms which elements it may include - not as recommendations to follow on your own, but so that you know what to expect.
Conservative treatment
For most people treatment starts with conservative, that is non-surgical, methods. These may include:
- information and education - an explanation of what the condition is, how it may progress and which symptoms require another visit,
- advice to stay active within your pain tolerance, instead of lying down for long periods,
- medication chosen by a doctor - the type, dose and duration are always set by a doctor; do not combine painkillers on your own and do not increase doses yourself,
- physical therapy - a physical therapist assesses your movement, selects exercises and teaches you how to manage day to day.
The course of sciatica varies. In many people symptoms gradually ease over the following weeks, but in some they last longer or come back. That is why follow-up visits and reporting any change in symptoms to your doctor are important.
Procedures and surgery
When conservative treatment does not bring the expected results, a doctor may consider image-guided injections (e.g. epidural) or refer you to a neurosurgeon or orthopedic specialist. Surgery is considered, among other situations, with symptoms of cauda equina syndrome (then urgently), with progressive weakness and with severe pain that persists despite appropriate conservative treatment. The decision is always made by a specialist after reviewing the tests and talking with the patient.
Is it better to rest or keep moving with sciatica?
In the past, several days of bed rest were recommended for radicular pain. Today general guidelines more often emphasize that prolonged bed rest is not beneficial, and returning to normal activities as far as the pain allows is usually a better choice. This does not mean pushing through or "walking off" severe pain. The point is not to immobilize yourself unnecessarily.
In practice, this may look like:
- short, frequent walks instead of one long one - on flat ground, in comfortable shoes,
- changing position every half hour or so - do not sit or lie in one position for too long,
- resting in the position that is most comfortable for you - e.g. on your side with a pillow between your knees, or on your back with your lower legs supported on pillows or a chair,
- a gradual return to work and daily duties, with modifications where possible, e.g. more frequent breaks.
Exercises for sciatica
Exercises for sciatica should be selected by a physical therapist or doctor for the specific person and stage of symptoms - what works for one person may make symptoms worse for another. That is why we do not provide a set of "sciatica exercises" here. As general activity, after consulting a specialist, many people do things like gentle walks, gently pulling the knees toward the chest while lying on the back, or a gentle "cat-cow" on all fours. Do every exercise without pain, and if the pain in your leg gets worse during or after it, the numbness spreads or weakness appears, stop and contact your doctor or physical therapist.
We describe general strengthening and stretching exercises, as well as everyday ergonomics, in more detail in our article on caring for the lumbar spine.
How to sit, sleep and work when sciatica flares up?
Ergonomics does not treat sciatica, but a well set-up environment can make daily activities less of a burden. A few principles worth discussing with your doctor or physical therapist:
| Situation | What to pay attention to |
|---|---|
| Sitting at a desk | A chair with lumbar support, feet on the floor, short breaks to stand up and walk around; if possible, alternate between sitting and standing work |
| Driving | Seat set so you do not lean toward the steering wheel, frequent stops on longer trips; if leg weakness makes it hard to use the pedals, do not drive |
| Getting out of bed | Roll onto your side, lower your legs over the edge and push up with your arms, instead of sitting up in one motion from lying down |
| Sleep | The position in which pain is lowest - often on your side with a pillow between your knees or on your back with a pillow under your knees |
| Lifting | Avoid lifting and twisting with a load; if you have to lift something, bend your knees and hold the object close to your body |
| Getting dressed | Put on pants and socks while sitting, use a long-handled shoehorn |
In the long run, overall physical activity, maintaining a healthy body weight and quitting smoking also matter for back health. These are not ways to get rid of symptoms quickly, but things worth taking care of together with your doctor and physical therapist.
Inversion tables and sciatica - what you should know
This article is not a guide to treating sciatica with home equipment. Teeter FitSpine inversion tables are medical devices for home spinal traction with simultaneous stretching of the paraspinal muscles and soft tissues. Consult your doctor before use - inversion has contraindications, including high blood pressure and other cardiovascular conditions, use of anticoagulants, glaucoma, osteoporosis, hernias, pregnancy, recent surgery, and neurological conditions causing unexplained tingling or weakness. Your doctor decides whether inversion is appropriate for you. You will find the full list of contraindications in the manual and in our article on inversion table contraindications.
This is a medical device. Use it in accordance with the instructions for use or the label.
Frequently asked questions
What is sciatica?
It is a set of symptoms resulting from irritation or compression of the nerve roots that form the sciatic nerve. It typically presents as pain radiating from the lower back or buttock down the leg, often below the knee. Sciatica is a symptom, and its cause is determined by a doctor.
What are the first symptoms of sciatica?
Most often pain in the lower back or buttock that starts to radiate to the back or side of the thigh and calf, along with tingling or numbness in the leg. The pain often gets worse when coughing, sneezing and sitting for a long time.
How can you tell sciatica from buttock muscle pain?
In sciatica, the pain usually goes below the knee, runs along a specific strip and may be accompanied by numbness or weakness in the leg. Muscle pain is usually more localized. However, a reliable distinction requires a medical examination.
When should you go to the ER with sciatica?
Immediately if you develop numbness around the groin, problems urinating, loss of bladder or bowel control, or rapidly worsening leg weakness. Sciatica with fever, after an injury or in someone with a history of cancer also requires an urgent consultation.
Do you need an MRI for sciatica?
Not always. The diagnosis is based mainly on the medical history and examination. An MRI is usually ordered with red-flag symptoms, when symptoms do not ease despite treatment or when a procedure is being considered. The decision is made by a doctor.
How long does sciatica last?
It is very individual. In many people symptoms gradually ease over a few weeks, while in some they last longer or come back. If the pain does not ease or new symptoms appear, go back to your doctor.
Can you walk and exercise with sciatica?
General guidelines emphasize that prolonged bed rest is not beneficial, and activity within your pain tolerance, such as short walks, is usually a better choice. Specific exercises should be selected by a physical therapist or doctor. Do every exercise without pain.
Can you use an inversion table with sciatica?
This is for your doctor to decide. Inversion has contraindications listed in the manual, including high blood pressure, glaucoma, osteoporosis, hernias, pregnancy and neurological conditions causing unexplained tingling or weakness. This is a medical device. Use it in accordance with the instructions for use or the label.
Teeter equipment for everyday activity at home
The products below are not a treatment for sciatica. They are exercise and active sitting equipment that should only be used after consulting a doctor or physical therapist.
- Teeter Core Restore - a PVC rubber wedge cushion for sitting with lumbar support, active sitting and balance exercises.
- Teeter FreeStep LT1 - a recumbent cross trainer (seated stepper) for training your arms and legs in a seated position.
- Teeter FreeStep LT3 - the same mechanism as the LT1, with a ComfortSelect seat, SoftStep pedals and SureGrip handles.
