Sciatica
Sciatica is pain caused by irritation or compression of the sciatic nerve, the largest nerve in the body.
The pain usually starts in the lower back or buttock and travels down the back of the thigh and leg.
Common Symptoms
Sharp, burning, or shooting pain in one leg
Low back pain with leg pain
Tingling or “pins and needles”
Numbness in the leg or foot
Weakness in the leg
Pain increases while:
Sitting long periods
Coughing/sneezing
Bending forward
Common Causes
1. Lumbar Disc Herniation (most common)
A slipped disc presses on a nerve root.
2. Spinal Canal Narrowing (Lumbar Stenosis)
Common in older adults.
3. Piriformis Syndrome
Tight buttock muscle compresses the sciatic nerve.
4. Spondylolisthesis
One vertebra slips over another.
5. Trauma or Tumor (less common)
Commonly Affected Nerve Roots
L4
L5
S1 (most common)
Typical Patterns
| Nerve Root | Pain/Numbness Area | Weakness |
|---|---|---|
| L4 | Front thigh/knee | Knee extension |
| L5 | Outer leg/top of foot | Big toe lifting |
| S1 | Back of calf/lateral foot | Plantar flexion |
Diagnosis
Clinical Examination
Straight Leg Raise (SLR) test
Neurological examination
Reflex testing
Imaging
X-ray (alignment)
MRI lumbar spine (best investigation)
CT scan if MRI not possible
Treatment
Conservative Treatment (most improve within 6–12 weeks)
Rest for short duration
Avoid heavy lifting
Physiotherapy
Core strengthening
Stretching exercises
Hot fomentation
Anti-inflammatory medicines
Helpful Exercises
McKenzie extension exercises
Hamstring stretching
Piriformis stretching
Core strengthening
Red Flag Symptoms — Seek Immediate Medical Attention
Loss of bladder or bowel control
Severe weakness in leg
Saddle anesthesia
Fever with back pain
History of cancer or trauma
Progressive neurological deficit
When Surgery May Be Needed
Persistent severe pain despite treatment
Progressive weakness
Cauda equina syndrome
Large disc prolapse compressing nerve
Common Surgeries
Microdiscectomy
Endoscopic discectomy
Laminectomy
Keywords
