What is sciatica?
The sciatic nerve is the longest nerve in the body. It forms in the lower back, runs through the buttock, and travels down the back of each leg to the foot. Sciatica (sometimes called a trapped nerve or lumbar radiculopathy) is the pain, numbness, or weakness you feel when something presses on or irritates this nerve where it leaves the spine.
Importantly, sciatica is a symptom rather than a diagnosis in itself. The pain is felt in the leg, but the source is almost always in the lower back. It usually affects only one side, and the pattern of pain often points to exactly which nerve is involved.
The reassuring part: most sciatica settles without surgery. Our role is to confirm what is actually pressing on the nerve and guide you to the least invasive treatment that gives a durable result.
Symptoms to look for
Sciatica has a recognizable pattern, though its intensity varies from person to person:
- Radiating leg pain - often sharp, burning, or electric, traveling from the lower back or buttock down the leg, sometimes past the knee to the foot.
- Numbness or tingling along the path of the nerve, such as pins and needles in the calf or foot.
- Weakness in the leg or foot - for example a foot that drags or feels heavy.
- Pain that worsens with sitting, bending, coughing, sneezing, or straining, and may ease when you move or lie down.
Usually only one leg is affected. A careful examination - not the scan alone - is what tells us which nerve is involved and how much it is being compressed.
CAUTION
New loss of bladder or bowel control, numbness around the groin, buttocks, or inner thighs, or rapidly worsening weakness in one or both legs can signal serious nerve compression. Treat these as an emergency and seek immediate medical attention.
What causes sciatica?
The most common cause is a herniated disc in the lower back pressing on a nerve root. Sciatica can also come from spinal stenosis (narrowing of the spinal canal), bone spurs from wear-and-tear arthritis, or a vertebra that has slipped out of line (spondylolisthesis). Less often, muscle tightness deep in the buttock irritates the nerve.
Risk rises with age as discs and joints lose flexibility, and it is most common between 30 and 60. Long hours seated at a desk, heavy or repetitive lifting, carrying extra weight, and smoking can all make sciatica more likely.
How we diagnose it
Diagnosis begins with your history and a focused neurological examination - checking strength, reflexes, sensation, and movements such as raising a straight leg - to map exactly which nerve is involved. Where imaging is needed, an MRI shows the disc and nerve most clearly, and in some cases nerve conduction studies (EMG) help confirm the picture or rule out other causes.
Just as important, we match the imaging to your symptoms. Scans in healthy, pain-free people often show disc changes, so we treat the person - not the picture. Your assessment is led by a US board-certified neurosurgeon.
Treatment - least invasive first
We follow a measured, surgery-last approach. For most people that means starting with non-surgical care and escalating only if the evidence calls for it.
- Non-surgical care (first line for most). Staying gently active, physiotherapy, and anti-inflammatory medication give the irritated nerve time to settle - most people improve within about six weeks.
- Targeted injections. If radiating pain persists, an image-guided epidural steroid injection can calm nerve inflammation and support recovery without surgery.
- Minimally invasive surgery (when it is warranted). If severe leg pain lasts beyond six weeks, weakness is progressing, or a red flag is present, removing the fragment pressing on the nerve can relieve the pain, often quickly. Where suitable, we use endoscopic discectomy - a small camera through a tiny, muscle-sparing incision, frequently as a day case. Microdiscectomy remains a reliable, well-established option, and the right choice depends on the size and position of the problem.
If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.
What to expect
With non-surgical care, expect gradual improvement over several weeks rather than an overnight change - many people are noticeably better within six weeks. A steroid injection may take a couple of weeks to reach its full effect and can give relief lasting weeks to months. If you do have endoscopic surgery, the incision is small, many patients go home the same day, and a guided return to activity follows over the following weeks. Your surgeon will explain the timeline and any precautions for your specific case, and the plan is built around you.
Common questions
How long does sciatica take to heal?
Most cases of sciatica ease within four to six weeks, and the majority settle within about three months with the right non-surgical care. The timeline depends on what is pressing on the nerve and your general health - your specialist can give you a realistic estimate once your symptoms and any imaging are reviewed.
Does sciatica go away on its own?
Often, yes. Most sciatica improves without surgery as nerve inflammation settles, helped by staying gently active, physiotherapy, and - if needed - a targeted injection. Pain that lasts beyond six weeks is less likely to resolve on its own and is worth having assessed so the source can be confirmed and treated.
Do I need surgery for sciatica?
Usually not. Surgery is generally considered only when leg pain has not responded to six or more weeks of non-surgical care, when muscle weakness is getting worse, or when red-flag symptoms appear. If an operation has already been recommended to you, an independent second opinion can confirm whether a less invasive path is possible.
What is the difference between sciatica and a herniated disc?
Sciatica describes the symptom - pain traveling along the sciatic nerve into the leg - rather than a diagnosis in itself. A herniated disc is one of the most common causes of it, but stenosis, bone spurs, or a slipped vertebra can irritate the same nerve. Identifying the true cause guides the right treatment.
What makes sciatica worse?
Prolonged sitting, bending forward, coughing, sneezing, or straining often increase sciatic pain because they add pressure on the affected nerve. Long periods without movement can also stiffen the area. Gentle, regular activity within comfort usually helps more than strict bed rest, which can slow recovery.
What warning signs should I not ignore?
Seek urgent medical care if you develop new loss of bladder or bowel control, numbness around the groin, buttocks, or inner thighs, or rapidly worsening weakness in one or both legs. These can signal serious nerve compression that needs prompt assessment rather than watchful waiting.