Sciatica: Causes, Diagnosis, and Effective Treatment Options Based on the Latest Evidence

What Is Sciatica?

Sciatica is not a diagnosis in itself but a symptom of an underlying medical condition. It refers to pain that radiates along the sciatic nerve, the longest nerve in the body. Typically, this pain originates in the lower spine and travels through the buttock and down the back of one leg.

Common Causes of Sciatica

• Herniated or bulged disc (most common)

• Spinal stenosis (narrowing of the spinal canal)

• Degenerative disc disease

• Spondylolisthesis (a vertebra slipping out of position)

• Piriformis syndrome (compression of the sciatic nerve by the piriformis muscle)

Symptoms of Sciatica

• Sharp, shooting pain on one side of the lower body

• Numbness or tingling in the leg or foot

• Muscle weakness in the affected leg

• Pain that worsens when sitting, coughing, or sneezing

How Is Sciatica Diagnosed?

Diagnosis begins with a comprehensive medical history and physical examination. A healthcare provider will assess:

• Pain pattern

• Muscle strength and reflexes

• Range of motion

• Special tests

Imaging Tests

• MRI (Magnetic Resonance Imaging): Gold standard for identifying disc herniations and nerve root compression.

• CT scan: Useful if MRI is contraindicated.

• X-rays: May detect bone-related issues but not soft tissue.

Evidence-Based Treatment Options for Sciatica

Most cases of sciatica resolve without surgical intervention. Here are the leading evidence-based treatment options:

1. Conservative Management

Physiotherapy

• Core-strengthening exercises

• Stretching programs

• McKenzie method or directional preference exercises

Evidence: Studies show structured physiotherapy reduces pain and improves function in acute and chronic sciatica.

Medications

• NSAIDs (e.g., ibuprofen or naproxen) for inflammation

• Oral corticosteroids (short-term use in acute inflammation)

• Muscle relaxants (limited evidence)

• Neuropathic pain agents (e.g., gabapentin) – mixed evidence, not first-line

Activity Modification

• Staying active and avoiding prolonged bed rest

• Ergonomic changes in the workplace

2. Invasive Interventions

Epidural Steroid Injections

• Can provide short-term relief

• Best for patients with severe leg pain not responding to conservative care

Evidence: Cochrane reviews suggest modest benefits in the short term but limited long-term effects.

Surgical Options

• Discectomy or microdiscectomy for herniated discs

• Laminectomy for spinal stenosis

When to Consider Surgery:

• Severe pain lasting more than 6-12 weeks despite conservative treatment

• Progressive neurological deficits (e.g., foot drop)

• Loss of bladder or bowel control (medical emergency—cauda equina syndrome)

3. Complementary Therapies

• Acupuncture: Some patients report pain relief; evidence is mixed.

• Manual therapy: Effective in some acute cases, particularly with spinal manipulation.

Prevention and Long-Term Management

Preventing sciatica involves maintaining a healthy spine:

• Regular exercise focusing on flexibility and core strength

• Maintaining a healthy weight

• Proper posture while sitting and lifting

• Avoiding prolonged sedentary behavior

When to See a Doctor

Seek immediate medical attention if you experience:

• Sudden, severe pain in your lower back or leg

• Numbness or muscle weakness

• Loss of bladder or bowel function

Conclusion

Sciatica is a painful condition but usually resolves with evidence-based conservative treatments. Accurate diagnosis and early intervention can prevent chronic symptoms and improve quality of life. If conservative methods fail, minimally invasive surgical options have excellent success rates for the right candidates.

Although we recommend you discuss your symptoms with a health professional if you are looking for some sciatica stretching options? This video may be helpful:

References

1. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015;372(13):1240-1248. doi:10.1056/NEJMra1410151

2. van Tulder MW, et al. Conservative treatment of sciatica: a systematic review. Spine. 1997;22(17):2123-2133.

3. Foster NE, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383.

4. Kreiner DS, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191.

5. Pinto RZ, et al. Epidural corticosteroid injections for sciatica. Cochrane Database Syst Rev. 2012;2012(8):CD009940.

6. Qaseem A, Wilt TJ, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline. Ann Intern Med. 2017;166(7):514–530.

7. Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245–2256.