What To Know and Do About Sciatic Nerve Pain
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Medically reviewed by Amy Kwan, PT
Sciatic nerve pain (also called sciatica or lumbar radiculopathy) affects your lower back and can radiate to the thighs and legs. The pain occurs due to compression at the root of the sciatic nerve—a large, paired nerve that travels from the lower (lumbar) spine down the back of each leg. This can cause chronic pain, significantly affect your quality of life, and damage the sciatic nerve.
Several conditions cause sciatic nerve pain, including bulging, slipped disc (herniated disc), spinal stenosis, and tumor growth. Since it’s a common cause of pain and disability, it’s important to understand why sciatica occurs, the signs you need help, and how healthcare providers treat the pain.
Symptoms of Sciatic Nerve Pain
The severity of sciatic nerve pain depends on what's causing your pain. Most people with this type of pain experience sharp and electrical pain in the lower back, buttocks, or hip. The pain generally occurs on either the left or right side. You might also feel persistent cramps or shooting pain in the legs.
In more severe cases, sciatic nerve pain can cause additional symptoms, such as:
Tingling or numbness in the hip, lower back, or buttocks
The sensation of pins and needles down the leg and foot
Loss of bladder control
Sexual dysfunction
Symptoms of sciatic nerve pain can range in severity (from mild to advanced) and may often come and go. Some people experience worsening symptoms when they cough, sneeze, or make certain movements.
Potential Causes of Sciatic Nerve Pain
Sciatic nerve pain can develop when the sciatic nerve becomes compressed or damaged. A wide range of conditions can cause this compression to occur.
Herniated Lumbar Disc
A herniated disc occurs when the disc (the round, flat cartilage that separates the bones of the spine) slides out of position or bulges, sometimes leaking fluid. This increases pressure on the sciatic nerve, and the fluid can irritate it.
The lower lumbar and upper sacral nerve roots branch out from the spinal cord and combine to form the sciatic nerve. Herniated disc symptoms result from inflammation, or irritation, at the lower lumbar nerve root.
If you develop a herniated disc, it's likely the result of wear and tear, or disc degeneration. Several factors increase your risk of this condition:
Being assigned male at birth
Being between the ages of 20 and 50
Having an improper lifting technique
Living a sedentary (non-active) lifestyle
Carrying excess weight or living with obesity
Doing activities that require repetitive movements like pulling or twisting
Spinal Stenosis
Spinal stenosis is a narrowing of the spaces surrounding the spinal cord and nerve roots. When this happens to lumbar (lower back) vertebrae, the resulting compression causes sciatica. Your chances of developing spinal stenosis rise as you age, and several conditions can cause it, including:
Piriformis Syndrome
The piriformis muscle connects the sacrum (the part of the spine below the lower back and above the tailbone) to the top of the femur (thigh bone). Inflammation or injury to this muscle can compress the sciatic nerve. Additional symptoms include difficulty climbing stairs, loss of range of motion in the hip, and pain with pressure on the muscle.
Since the piriformis muscle is involved in hip and leg motion, piriformis syndrome often occurs due to overuse. Athletes, especially runners, are at greater risk of this condition.
Spondylolisthesis
Spondylolisthesis is when vertebrae slide out of alignment from each other. In the lumbar region, this can pinch the sciatic nerve, leading to pain and other symptoms. Natural wear and tear of the spine and spinal injury are common causes of this condition.
Pott Disease
Pott disease occurs when tuberculosis (TB), a bacterial infection, spreads to the spine and inflames the nerve roots. Discs and vertebrae start to degrade, leading to spinal cord damage. Alongside sciatica symptoms, Pott disease causes loss of sensation or function in the legs and incontinence (loss of bladder control). Risk factors for this condition include prolonged exposure to people with TB, a weakened immune system due to chronic disease, and substance use.
Weight Changes
Excess weight puts more pressure on the joints and bones, raising the risk of sciatic nerve pain. Studies have found obesity and being overweight to be linked with low back pain and sciatica. The weight gain caused by pregnancy can also lead to increased pressure in the sciatic nerve.
Other Causes
Several other conditions also cause sciatic nerve pain, though many of these are less common causes. These include:
Tumor: Cancerous tumors in the lower back, hip, or pelvis
Bone spurs: Abnormal bone growths
Injury or infection: Injury to the lower back or pelvis and inflammation around the sciatic nerve
Cysts or abscesses: Cysts (irregular growths) and abscesses (pockets of pus or fluid) on or near the spine
When to Contact a Healthcare Provider
If your symptoms are significantly affecting your daily life, don’t seem to be going away, or are getting worse, it's a good idea to see a healthcare provider. The characteristic signs of sciatica, such as lower back pain spreading to the legs and feet, tingling, or weakness all prompt a visit.
You may need emergency medical help if you’re experiencing more severe symptoms as they may be a sign of cauda equina syndrome. This rare condition causes damaged nerves in the lumbar region and requires emergency surgery. Call 911 or visit an emergency department if you experience any of the following alongside severe pain:
Loss of bowel control
Painful urination or difficulty urinating
Numbness around the anus, genitals, and buttocks
Sexual dysfunction
How Is Sciatic Nerve Pain Diagnosed?
The goal of diagnosis of sciatic nerve pain is to figure out the underlying cause of the issue. Healthcare providers—often orthopedists (specialists in skeletal issues) or neurologists (brain and nervous system specialists)—employ several methods:
Medical history: Your healthcare provider will first ask about your symptoms, including how severe they are and how often you feel them.
Physical exam: Physical tests determine the nerve or nerves involved and assess signs of damage. Your healthcare provider tests your reflexes, ability to make certain movements, and sensitivity to cold, heat, and pain.
Imaging scans: Healthcare providers use X-ray, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) of the pelvis or lower back to screen for any tumors, growths, infections, or problems with the vertebrae.
Nerve conduction studies: Nerve conduction studies and electromyography (EMG) assess how well the sciatic nerve is working. Your provider will insert needles into muscles to check electrical activity, which can identify the origin of the pain.
How Is Sciatic Nerve Pain Treated?
Treatments for sciatic nerve pain depend on the severity of the condition and the underlying cause. Typically, healthcare providers try less-invasive therapies first, only opting for surgeries when other approaches haven’t worked.
At Home Treatments
About 80-90% of the time, sciatica resolves within 4-6 weeks without surgery. At-home remedies are the first-line approach. These include:
Taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen) or Aleve (naproxen)
Applying heat or ice to affected areas for 10 to 20 minutes at a time
Avoiding sitting or standing for long periods
Gently stretching your lower body, based on recommendations from a healthcare professional (like a physical therapist)
Getting in light exercise, such as walking or swimming
Practicing exercises to strengthen your core
Improving your posture
Physical Therapy
Along with at-home treatments, your healthcare provider may recommend physical therapy. This involves working with a physical therapist to learn exercises that manage the condition. You’ll do work at home between sessions to manage symptoms and slowly improve pain.
Prescribed Medications
For more severe pain, your provider may prescribe one of the following medications to help you better manage your symptoms:
Opioids, such as OxyContin (oxycodone) or Vicodin (hydrocodone)
Muscle-relaxing drugs, like Flexeril (cyclobenzaprine) and Soma (carisoprodol)
Anticonvulsant drugs, such as Horizant (gabapentin) or Topamax (topiramate)
Corticosteroid injections on the affected areas
Surgery
Surgery is the last resort for sciatica. Providers use this method only if you’ve had severe symptoms for three months or more. If you do require surgery, a surgeon will likely use one of these two procedures: laminotomy (removal of the lamina, which is the outer portion of a vertebra) and discectomy (removal of all or part of the discs that sit between vertebrae).
Alternative Therapies
Certain alternative therapies may also help with pain alongside other treatments. One such approach is acupuncture, which is a Traditional Chinese Medicine practice that inserts needles into the skin to stimulate specific areas to help relieve pain. But, before you start alternative therapies (such as acupuncture, acupressure, or chiropractic care), ask your healthcare provider if these options are safe for you.
A Quick Review
Sciatic nerve pain, or sciatica, affects the lower back, hips, thighs, and legs. This pain occurs when the sciatic nerve becomes compressed usually due to underlying conditions like a herniated disc, spinal stenosis, or injury and infection in the spine. Everything from at-home treatments to physical therapy and surgeries treat sciatica. If you have chronic pain and discomfort, getting medical support can help treat symptoms and improve your quality of life.
Frequently Asked Questions
Is it better to rest or keep moving with sciatica?
While you don’t want to aggravate any condition that's causing sciatica, in general, you should keep gently moving as you can. Being too sedentary—lying down too much and avoiding activity—can make outcomes worse. Healthcare providers recommend light exercises (such as walking or swimming) and stretching to improve symptoms.
What pain medication is best for sciatica?
Healthcare providers consider over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like Motrin (ibuprofen) or Advil most safe for sciatica because they have fewer side effects. When pain is severe, your provider may consider prescription medication.
Where do you put a heating pad for sciatica?
Heating parts of the body affected by sciatica for 10 to 20 minutes at a time is a standard, at-home therapy. The aim is to spur blood flow to the sciatic nerve and surrounding areas. Apply the pad to the part that hurts: your lower back, hip, buttock, or back of the thigh.
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