Sciatica: Causes, Symptoms, Diagnosis and Treatment

Pain that travels from your lower back into your buttock and leg can make walking, sitting, working, or sleeping uncomfortable. When this pain follows the pathway of the sciatic nerve, doctors may call it sciatica.

Sciatica develops when a nerve root contributing to the sciatic nerve becomes irritated or compressed. A slipped disc is the most common cause, but spinal stenosis, spondylolisthesis, injuries, and other conditions can also produce sciatic symptoms.

Importantly, sciatica is not a disease of the sciatic nerve alone. It describes a pattern of nerve-related symptoms, usually affecting one side of the body.

Fortunately, many cases improve with conservative treatment. However, severe weakness or bladder and bowel problems require urgent medical attention.

At Jyoti Hospital, Gurugram, our orthopaedic team evaluates the cause of sciatica before recommending treatment.

What Is Sciatica?

The sciatic nerve is formed by nerve roots in the lower spine. It travels through the buttock and down the back of the leg.

When one of these nerve roots becomes irritated or compressed, you may develop:

• Shooting leg pain
• Burning pain
• Tingling
• Numbness
• Muscle weakness

Sciatica typically affects one side.

The pain can range from mild discomfort to severe, disabling pain.

What Causes Sciatica?

A number of conditions can irritate the nerves that contribute to the sciatic nerve.

1. Slipped Disc: A herniated disc can press against a spinal nerve and cause sciatica.
   • This is one of the most common causes of the condition.
2. Spinal Stenosis: Spinal stenosis occurs when the space available for spinal nerves becomes narrower.
   • As a result, nerves can become compressed, particularly during standing or walking.
3. Spondylolisthesis: It occurs when one vertebra moves forward relative to another.
   • This can narrow the space around the nerves and produce sciatic symptoms.
4. Back Injury: Certain injuries can irritate or compress spinal nerves and produce sciatica.

Therefore, persistent leg pain after an injury deserves proper assessment.

What Does Sciatica Feel Like?

Sciatica can feel different from ordinary muscular back pain.

You may experience:

• Shooting pain: Pain may travel from the lower back or buttock down the leg.
• Burning pain: Some people describe the sensation as burning or hot.
• Tingling: You may feel pins and needles along part of the leg or foot.
• Numbness: The affected area may feel less sensitive.
• Weakness: Significant nerve compression can affect muscle strength.

Because nerve symptoms can vary, a physical examination helps determine their severity and likely cause.

Where Does Sciatica Pain Travel?

Sciatic pain can travel from:

Lower back → Buttock → Back of thigh → Calf → Foot

However, not everyone experiences pain throughout the entire pathway.

The exact distribution depends on which nerve root is affected.

Sciatica vs Normal Back Pain

Sciatica involves nerve-related symptoms, whereas ordinary mechanical back pain often remains localised to the lower back.

Sciatica	Mechanical back pain
Often travels into the buttock and leg	Usually remains around the back
May cause tingling or numbness	Usually does not cause nerve symptoms
May cause muscle weakness	Weakness is less typical
Usually affects one side	Can affect either or both sides
Often results from nerve irritation	Often results from muscles, joints, or other structures

Therefore, pain travelling down the leg with numbness, tingling, or weakness deserves a different assessment from uncomplicated back pain.

How Is Sciatica Diagnosed?

Doctors usually begin with your symptoms and a physical examination.

Our orthopaedic specialist may assess:

• Pain distribution
• Muscle strength
• Sensation
• Reflexes
• Walking
• Leg movement
• Nerve tension signs

A straight-leg raise test may help identify nerve irritation in appropriate patients.

The examination helps determine whether your symptoms are consistent with sciatica and whether further investigation is necessary.

Do You Need an MRI for Sciatica?

Not everyone with sciatica needs an MRI.

NICE recommends against routine imaging in non-specialist settings when the result is unlikely to change management. Imaging may be considered in specialist settings when the findings are likely to influence treatment.

Our doctor may consider MRI when:

• Symptoms persist
• Significant weakness develops
• The diagnosis is uncertain
• Severe nerve compression is suspected
• Surgery is being considered

An MRI should therefore support the clinical assessment rather than replace it.

Treatment for Sciatica

Most people improve without surgery.

Treatment depends on the underlying cause and severity of symptoms.

1. Stay Active

Prolonged bed rest is generally not recommended.

Instead, gradually maintain normal activities as your symptoms allow. Walking and other gentle movement may support recovery.

2. Physiotherapy

Physiotherapy can help improve:

• Strength
• Flexibility
• Movement
• Core control
• Functional ability

Our physiotherapist can tailor exercises according to your symptoms.

As your condition improves, the programme can gradually progress towards normal activity.

3. Pain Management

Our doctors recommend appropriate medicines depending on your symptoms and medical history.

However, not every painkiller is suitable for every patient.

Therefore, discuss prolonged or repeated use of pain medicines with a healthcare professional.

4. Activity Modification

Temporarily modify activities that significantly aggravate your symptoms.

For example, you may need to reduce:

• Heavy lifting
• Repeated bending
• Forceful twisting
• High-impact exercise
• Prolonged sitting

Then, as symptoms settle, gradually resume normal activity.

Can an Epidural Injection Help Sciatica?

For selected patients with acute and severe sciatica, NICE recommends considering an epidural injection containing local anaesthetic and steroid.

The injection aims to reduce inflammation and nerve-related pain.

However, it does not repair the underlying disc or permanently remove the cause of compression.

Our doctor will determine whether an injection is appropriate for your condition.

When Is Surgery Considered?

Most patients do not need surgery.

However, a specialist may consider surgery when:

• Severe symptoms continue despite appropriate non-surgical treatment
• Pain significantly limits daily function
• Imaging confirms nerve compression matching the symptoms
• Progressive neurological weakness develops

For appropriate patients with persistent sciatica, spinal decompression may relieve pressure on the affected nerve. NICE recommends considering decompression when non-surgical treatment has not improved pain or function and imaging findings correspond with the symptoms.

What Is Spinal Decompression?

Spinal decompression surgery aims to create more space for a compressed nerve.

Depending on the underlying problem, the surgeon may remove:

• A portion of a herniated disc
• Small amounts of bone
• Other tissue causing nerve compression

The exact procedure depends on the cause of sciatica.

For example, a patient with disc-related sciatica may undergo a discectomy, while another patient with spinal stenosis may require a different decompression procedure.

How Long Does Sciatica Last?

Sciatica often improves over several weeks, although some cases can last longer.

Recovery depends on:

• Underlying cause
• Degree of nerve irritation
• Duration of symptoms
• Severity
• General health
• Response to treatment

If symptoms continue or worsen, reassessment can help determine whether the diagnosis or treatment plan needs to change.

Can You Walk With Sciatica?

In many cases, yes.

Gentle walking can help you remain active without placing excessive stress on the spine.

However, if walking significantly increases your symptoms, causes weakness, or produces new neurological symptoms, seek medical advice.

Can Exercise Help Sciatica?

Appropriate exercise can support recovery.

Depending on your condition, your programme may include:

• Walking
• Gentle mobility exercises
• Core strengthening
• Hip strengthening
• Flexibility exercises
• Gradual aerobic activity

There is no single exercise that works for every patient. Your programme should match the underlying cause and your current symptoms.

What Should You Avoid During Sciatica?

During a painful episode, avoid movements that clearly worsen your symptoms.

These may include:

• Heavy lifting
• Repeated bending
• Forceful twisting
• High-impact exercise
• Prolonged bed rest
• Sudden return to intense gym training

Instead, gradually increase your activity as symptoms improve.

How Can You Reduce the Risk of Sciatica Returning?

Although recurrence cannot always be prevented, healthy habits may reduce risk.

• Stay active: Regular physical activity supports strength and mobility.
• Maintain a healthy weight: Weight management can reduce mechanical stress on the spine.
• Use safe lifting techniques: Avoid lifting heavy objects with poor technique.
• Improve your sitting posture: If you work at a desk, maintain a comfortable workstation and take regular movement breaks.
• Avoid smoking: Smoking can increase the risk of back and spinal problems.

Sciatica in Office Workers

Long periods of sitting can aggravate existing back symptoms.

If you work at a desk:

• Keep your monitor at a comfortable height
• Support your lower back
• Keep your feet supported
• Avoid sitting continuously for long periods
• Take regular movement breaks
• Change position throughout the day

Good ergonomics cannot guarantee that you will never develop sciatica, but they can support healthier movement habits.

Sciatica in Gym-Goers

Strength training can improve overall physical fitness. However, sudden increases in training loads or poor lifting technique can strain the back.

To reduce injury risk:

• Warm up before training
• Use appropriate lifting technique
• Increase weights gradually
• Maintain adequate recovery
• Avoid training through significant nerve pain

If a particular movement repeatedly triggers shooting leg pain, stop the activity and seek professional assessment.

Emergency Warning Signs

Most cases of sciatica are not emergencies. However, certain symptoms require immediate assessment.

Seek urgent medical attention if you develop:

• Numbness around the genitals or anus
• Difficulty starting urination
• Inability to urinate
• Loss of bladder control
• Loss of bowel control
• Severe weakness in both legs
• Numbness affecting both legs

These symptoms can indicate cauda equina syndrome, a serious condition requiring urgent treatment.

When Should You See an Orthopaedic Doctor?

Consult an orthopaedic specialist if:

• Sciatica persists for several weeks
• Pain interferes with daily activities
• Symptoms are getting worse
• You develop persistent numbness
• You notice weakness
• Symptoms repeatedly return
• Treatment has not provided sufficient improvement

Early assessment can help identify the underlying cause and guide appropriate treatment.

How Jyoti Hospital Can Help

At Jyoti Hospital, Gurugram, our orthopaedic team evaluates sciatica through clinical assessment and appropriate investigations.

Depending on your symptoms, the evaluation may include:

• Medical history
• Neurological examination
• Assessment of muscle strength and sensation
• X-rays when appropriate
• MRI when clinically indicated
• Functional assessment

Treatment may include:

• Activity modification
• Medicines
• Physiotherapy
• Rehabilitation
• Selected epidural injections
• Surgical evaluation when appropriate

The aim is to identify why the nerve is being irritated and treat the underlying cause rather than simply treating the pain.

Final Thoughts

Sciatica occurs when nerves contributing to the sciatic nerve become irritated or compressed. A slipped disc is a common cause, but spinal stenosis, spondylolisthesis, injuries, and other conditions can also produce similar symptoms.

Fortunately, many people improve with non-surgical treatment, physical activity, physiotherapy, and appropriate symptom management. However, progressive weakness, significant numbness, or bladder and bowel problems require urgent medical assessment.

If you experience persistent pain travelling from your lower back into your leg, numbness, tingling, or weakness, consult the Orthopaedics team at Jyoti Hospital, Gurugram for a detailed evaluation and personalised treatment plan.

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FAQs

1. Is sciatica the same as a slipped disc?
   • No. Sciatica describes a pattern of nerve-related symptoms, while a slipped disc is one possible structural cause. Other conditions, including spinal stenosis and spondylolisthesis, can also cause sciatica.
2. Does sciatica always affect one leg?
   • Sciatica commonly affects one side. Symptoms affecting both legs, particularly when associated with weakness or bladder and bowel problems, require urgent assessment.
3. Should I stay in bed if I have sciatica?
   • Usually, no. Prolonged bed rest is generally not recommended. Gradually maintaining normal activity is usually preferable when symptoms allow.
4. Can physiotherapy help sciatica?
   • Yes. Appropriate physiotherapy can improve strength, movement, flexibility, and functional recovery.
5. When does sciatica require surgery?
   • Surgery may be considered when symptoms remain disabling despite appropriate non-surgical treatment or when significant neurological problems develop.