Sciatica is a painful collection of symptoms involving the sciatic nerves—the body’s largest nerves.

These nerves, which can be as wide as a finger, are formed from spinal nerve roots in the lower back and run from the lower spine through the hip, buttock, and leg to the back of the knee, where they branch and extend to the foot. The sciatic nerves control leg movement and sensation, so when they become compressed, inflamed, or damaged, they can cause pain and abnormal sensations, such as tingling or numbness.

Sciatica is a common condition in the United States, affecting around 40 percent of the population at some point in their lives, with around 10 percent of those with lower back pain specifically having sciatica.

The first sign of sciatica is usually pain that starts in the lower back or buttocks and radiates along the sciatic nerve’s path down one leg. Although it feels like the pain is coming from the sciatic nerve in the buttock, it most often stems from an irritated nerve in the lower spine.

Primary Symptoms

Sciatica symptoms can vary widely in intensity and presentation, but they most often follow a recognizable pattern. Below are the most common signs people experience:

• Pain: Typically affects one side of the body and can range from mild tingling or a dull ache to sharp, burning pain or electric shock-like jolts


• Numbness: Occurs in the leg, calf, or sole of the foot


• Muscle weakness: Appears in the affected leg


• Abnormal sensations: Includes tingling, pins and needles, or intense hot or cold sensations


• Muscle spasms: Occur in the lower back or leg

Pain Triggers and Aggravating Factors

Sciatica pain may worsen with:

• Sitting for long periods


• Standing for extended periods


• Sneezing, coughing, or laughing


• Bending backward


• Walking long distances


• Climbing stairs


• Straining during bowel movements

In severe cases, the pain can be so intense that it limits movement or causes the foot to drag while walking. If the cauda equina—a bundle of nerves at the base of the spinal cord—is affected as well, it can lead to a loss of bladder and bowel control.

Below are some warning signs that may require immediate medical attention:

• Severe numbness in the genital area


• Difficulty urinating or loss of bladder and bowel control


• Progressive muscle weakness


• Foot dragging while walking

Sciatica is best understood as a grouping of symptoms rather than a specific injury or disease. It can stem from various underlying causes, as any condition that structurally affects or puts pressure on the sciatic nerve can lead to sciatica symptoms. Common causes include:

1. Herniated disc: A herniated disc occurs when a spinal disc becomes damaged and its soft inner gel bulges or leaks through a tear in the outer layer, pressing on nearby nerve roots and causing inflammation.


2. Spinal stenosis: Spinal stenosis involves narrowing of the spaces within the spine, which puts pressure on the spinal cord or exiting nerves—often due to age-related degeneration.


3. Degenerative disc disease: Degenerative disc disease results from the natural aging process, during which spinal discs lose hydration, become thinner and less flexible, and may irritate nearby nerve roots.


4. Piriformis syndrome: Piriformis syndrome develops when the piriformis muscle in the buttock irritates or compresses the nearby sciatic nerve, often due to tightness, inflammation, or spasm.


5. Bone or muscle injuries: Bone or muscle injuries include trauma such as pelvic fractures or dislocations that cause inflammation, swelling, or direct injury to the sciatic nerve.


6. Spondylolisthesis: Spondylolisthesis happens when a vertebra slips out of place, narrowing the spinal nerve openings or compressing nearby nerve roots in the lower back.


7. Pregnancy: Physical and hormonal changes in late pregnancy can shift the center of gravity and loosen ligaments, potentially affecting the sciatic nerve.

Sciatica can also arise from causes beyond disc herniation, including spinal masses, surgical complications, joint issues, nerve damage from diabetes, bone spurs, and, in many instances, an unknown origin.

Risk factors for sciatica:

• Age-related factors: Wear and tear over time increases the risk of sciatica, especially in those 40 or older.


• Sex-related factors: Men between the ages of 30 and 50 have a higher risk of sciatica.


• Physical factors: Tall height and excess body weight may place extra strain on the spine.


• Lifestyle factors: Habits such as smoking or chronic stress may contribute to inflammation or poor spinal health.


• Occupational factors: Jobs that involve heavy lifting, prolonged sitting, driving, or contact sports may raise the risk of sciatica.


• Health-related factors: Poor general health, a history of back surgery, or chronic lower back pain may increase vulnerability.


• Mechanical factors: Improper movement or posture during daily activities—such as lifting heavy objects or prolonged sitting—may aggravate the sciatic nerve and increase risk.

There are several different ways to classify sciatica, depending on how long it lasts, which areas it affects, and where the pain is most concentrated.

By Duration

Sciatica can be categorized by how long symptoms persist. Some cases resolve quickly, while others become long-term and require more ongoing management.

Acute sciatica: A short-term condition with sudden onset, lasting from a few days to several weeks, often triggered by an injury or strain.

Chronic sciatica: A long-lasting condition that persists for more than three months and typically requires more comprehensive treatment.

By Affected Area

The condition can also be described based on where the pain occurs. While most people experience sciatica in one leg, other patterns are possible.

• Unilateral sciatica: Affects one leg and is the most common form


• Bilateral sciatica: Affects both legs simultaneously; a rare form that may indicate a serious condition


• Alternating sciatica: Involves pain that switches between legs; an uncommon form often associated with sacroiliac joint dysfunction

By Pain Pattern

Sciatica may also be classified based on where the pain is most prominent—either in the lower back or the buttocks.

Back-predominant: Pain is centered primarily in the lower back

Buttock-predominant: Pain is felt mostly in the buttock region

If sciatica symptoms do not improve with rest, ice therapy, or other self-care measures, the patient may benefit from consulting a physician or spine specialist.

Physical Examination Tests

Diagnosing sciatica mainly involves a thorough medical history and physical exam, during which a doctor evaluates the patient’s symptoms—especially the type and location of their leg pain.

During the physical exam, the following tests may be used:

• Straight leg raising test: A common physical exam used to assess sciatica, particularly when a herniated disc is suspected. While the patient lies flat on the back with legs extended, the doctor lifts the affected leg without bending the knee. The test is considered positive if it reproduces pain or abnormal sensations, especially when the leg is elevated to less than 70 degrees and the discomfort radiates below the knee. This may indicate nerve root irritation or compression.


• Crossed straight leg raise: A variation of the straight leg test used to support the diagnosis of a herniated disc. While the patient lies flat on their back, the doctor lifts the unaffected leg while keeping it straight. A positive result occurs when this movement triggers pain that radiates down the opposite, affected leg.


• Femoral stretch test: A physical exam used to identify nerve root irritation higher in the spine. With the patient lying face down, the doctor bends the knee of the affected leg to a 90-degree angle and gently lifts the thigh off the table. Pain in the front of the thigh during this maneuver may suggest a herniated disc.

If symptoms are severe, especially concerning, or persist for more than a few weeks, a doctor may recommend additional tests:

Imaging Tests

Diagnostic imaging is most useful when it may affect treatment decisions. It is typically considered for patients with severe symptoms that do not improve after about six weeks of conservative care, or if weakness or numbness is present. Imaging can help determine whether a herniated disc with nerve root compression exists—possibly indicating the need for surgical intervention. Techniques may include:

• X-rays: Used to detect bone-related issues such as osteoarthritis or spinal fractures


• Magnetic resonance imaging: Provides detailed images of soft tissues, including nerves, tumors, and spinal damage


• Computed tomography scans: Offer 3D views of the spine and can detect structural abnormalities

If imaging tests are inconclusive or further clarity is needed, a doctor may order electrodiagnostic tests.

Electrodiagnostic tests: Electrodiagnostic tests include electromyography (EMG) and nerve conduction studies, which assess nerve and muscle function. EMG uses small needles inserted into muscles to measure electrical activity, while nerve conduction studies use electrodes on the skin to evaluate how well nerves transmit signals. Together, these tests help determine whether nerve damage is present, pinpoint the exact location of the injury, identify the affected spinal nerve root, and assess the severity of the damage.

A range of natural remedies, self-care strategies, and lifestyle modifications can play an important role in managing sciatica symptoms.

Exercise

Pilates and strength exercises may help improve pain and function with chronic lower back pain, including sciatica. Many health care providers recommend performing these exercises under the supervision of a trained physical therapist. Light activities—such as walking, swimming, or aqua therapy—along with gentle stretching of the lower back and hamstrings, can aid recovery. Specific exercises may be recommended based on the underlying cause of sciatica.

Tai chi and yoga: Both practices have been shown to provide moderate improvements in function and pain intensity for lower back pain, often associated with sciatica.

Massage Therapy

Massage therapy may help relieve sciatica symptoms in several ways, and many people experience some improvement in both pain and function with regular treatment:

• Muscle relaxation: Loosening tight muscles can ease tension around the sciatic nerve and reduce pressure.


• Improved circulation: Increased blood flow may support healing and help reduce inflammation in the affected area. Massage therapy has been shown to enhance circulation by promoting the delivery of oxygen and nutrients to tissues and aiding in the removal of metabolic waste—thereby encouraging recovery.


• Endorphin release: Massage may stimulate the release of endorphins—the body’s natural pain relievers—which can help reduce discomfort. By promoting relaxation and the release of feel-good hormones, massage may also support the body’s detoxification processes and ease pain symptoms.

Cold and Heat Therapy

Cold and heat therapy may provide temporary relief from lower back pain, though effectiveness can vary depending on the underlying cause. Cold therapy, such as applying an ice pack for 20 minutes every two hours, may be most helpful in the early stages of pain. However, some people with sciatica still find brief cold applications useful for reducing inflammation and numbing pain.

Alternatively, superficial heat therapy has shown greater benefit for improving pain and function in those with chronic lower back pain, including sciatica. Heat can help relax tight muscles, improve blood flow, and ease stiffness.

In some cases, alternating between cold and heat therapy may be effective—though individual responses can vary.

Common Herbs

A systematic review of randomized controlled trials suggested that some common herbs and spices may reduce pain associated with sciatica and radiculopathy.

Cayenne pepper: When applied topically, cayenne has shown moderate evidence for short-term pain relief.

Curcumin: Found in turmeric, curcumin may reduce neuroinflammation, oxidative stress, and pain. Preclinical studies suggest it may promote nerve repair and improve disc height. A 2017 study in mice found that curcumin helped reduce sciatica pain caused by a herniated disc for up to two weeks after surgery.

Approximately 95 percent of sciatica cases respond well to nonsurgical treatments and improve within four to six weeks.

Conservative Treatments (First-Line)

Initial treatment for sciatica often focuses on conservative measures aimed at reducing pain, calming inflammation, and improving function without the need for surgery.

Conservative measures include proper exercises, massages, and other approaches outlined in the natural approach section above. They may also include:

Physical therapy

Physical therapy is strongly recommended for managing sciatica, as it helps relieve pressure on the sciatic nerve and reduces pain. A customized approach that includes focused stretching exercises, manual therapy techniques, and strengthening exercises can enhance nerve movement.

Medications

Medications may include over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, or acetaminophen for pain relief. In some cases, a doctor may prescribe muscle relaxants to help reduce spasms.

Activity management

Activity management typically involves a short period of rest—no more than one to two days—preferably on a firm mattress. Afterward, gradually resuming light activity is encouraged to prevent stiffness and promote healing.

Advanced Treatments

1. Injections

For stubborn sciatica pain, doctors may recommend steroid injections around the sciatic nerve. These shots, given by trained specialists, offer short-term relief by reducing inflammation. They’re typically considered when other treatments haven’t worked or if surgery is being delayed or avoided. However, steroid injections don’t prevent the eventual need for surgery and carry some rare risks, such as increased pain.

2. Minimally invasive procedures and surgical options

Minimally invasive procedures—one category of surgical intervention—typically use small incisions, specialized tools, regional spinal anesthesia (which numbs only part of the body), and often a camera to reduce tissue damage during surgery. Procedures used to treat sciatica include lumbar microdiscectomy (small-incision disc removal) and chemonucleolysis (enzyme injection to shrink disc material).

Fewer than 5 percent to 10 percent of patients require surgery for sciatica. It is usually considered a last resort due to its higher risks, such as blood clots and paralysis. Elective surgery may be considered for people with unilateral sciatica who do not improve after at least six weeks of conservative care.

Although many patients experience relief after surgery, 5 percent to 10 percent may see no improvement or may develop worsening symptoms. Surgery may accelerate recovery, but after six to 12 months, outcomes are generally comparable to those who improve without it.

Surgical treatment for sciatica caused by spinal root irritation is referred to as spinal decompression surgery, a category that includes several procedures depending on the location and severity of the nerve compression:

• Laminotomy/Laminectomy: Removal of a portion of bone to relieve pressure on the nerve


• Discectomy: Removal of damaged disc material


• Spinal fusion: Permanent connection of two or more vertebrae to improve spinal stability

Integrative Treatments

Complementary and integrative therapies may offer additional relief for sciatica, especially for people seeking nondrug, nonsurgical options. When used alongside conventional treatment, these approaches may help reduce symptoms, improve function, and support long-term recovery.

Acupuncture

Acupuncture has long been used in traditional Chinese medicine as a treatment for sciatica. A 2015 meta-analysis involving 11 studies found that acupuncture may be more effective than medication alone and may enhance the effects of drug therapy. A 2023 systematic review of 30 studies also concluded that acupuncture is a safe and effective option for sciatica and may serve as a suitable alternative to medication-based therapy. In a 2022 study comparing acupuncture with analgesics, researchers found that acupuncture was significantly more effective and safer for managing sciatica symptoms. All three studies also emphasized the need for future well-designed, rigorous trials to further assess acupuncture’s long-term safety and effectiveness.

Chiropractic care

Chiropractic manipulation is another integrative approach used to manage sciatica, aimed at restoring proper spinal alignment and improving mobility. In a 2006 study of 102 patients with acute back pain and sciatica caused by disc protrusion, participants received either chiropractic manipulation or a simulated version five days a week for six months. The study found that chiropractic care was effective, resulting in a 28 percent pain-free rate for local pain and a 55 percent pain-free rate for radiating pain in patients, along with a significant reduction in pain duration.

Outlook and recovery

Most cases of sciatica improve on their own within four to six weeks and do not result in long-term complications, even without formal medical treatment. Early care can help relieve nerve pressure and prevent more severe symptoms. Recovery is typically good, although more severe cases—especially those involving neurological symptoms—may take longer to resolve.

Factors such as poor body mechanics at work, underlying depression, and socioeconomic challenges may increase the risk of developing chronic or recurrent sciatica.

Mindset plays a crucial role in how people experience and manage sciatica. It can influence both the intensity of sciatica symptoms and the effectiveness of treatment.

A negative mindset—marked by fear, anxiety, or catastrophizing—can heighten the perception of pain and increase muscle tension, which may worsen symptoms. This mental state may also lead to avoidance of movement, reduced physical activity, and a slower recovery. In some cases, having a negative mindset may increase the risk of chronic pain.

Conversely, a positive and proactive mindset can support better outcomes. People who remain optimistic, follow treatment plans, and stay active are often better equipped to manage symptoms and recover more quickly.

Prevention largely depends on the underlying cause, but several general strategies can help reduce the risk of sciatica.

Prolonged Pressure

One key factor is avoiding prolonged pressure on the buttocks—such as sitting or lying down for extended periods. Maintaining strong back and abdominal muscles becomes especially important with age to support the spine and reduce strain on the sciatic nerve.

Exercise

Regular exercise can help prevent sciatica by improving overall fitness, maintaining a healthy weight, and strengthening core muscles. Aerobic activities such as walking or swimming enhance general strength, while specific exercises—like pelvic tilts, abdominal curls, and knee-to-chest stretches—help stabilize the spine and reduce strain on discs and ligaments. However, stretching should be done with caution, as it can worsen pain in some people.

Posture

Good posture also plays a role in prevention. Slouching should be avoided, and chairs should be adjusted so that feet rest flat on the floor, knees remain slightly bent, and the lower back is supported—using a small pillow if needed. It’s best to sit with feet flat rather than crossed and to avoid staying in one position for too long.

Proper Lifting Techniques

Using proper lifting techniques is key to preventing back injuries. It’s important to keep the hips aligned with the shoulders and avoid twisting. Instead of bending at the waist with straight legs, one should bend at the hips and knees to lift objects safely.

While most cases of sciatica resolve without long-term issues, complications can occur depending on the underlying cause. Potential complications include:

• Lasting numbness or weakness in the affected leg


• Abnormal sensations, such as tingling or “pins and needles”


• Progressive worsening of pain over time


• Reduced motor strength in the affected leg


• Loss of bladder or bowel control


• Permanent nerve damage


• Recurring or worsening herniated discs