Sciatica

Pain That Travels Down the Leg

Pain usually starts in the lower back or buttock and travels below the knee into the leg.

Sharp or Shooting Pain

Many people describe the pain as sharp, burning, electric, or shooting.

Tingling or Pins and Needles

Abnormal sensations may occur in the leg or foot depending on the affected nerve root.

Numbness

Reduced sensation may develop in specific areas of the leg or foot.

Muscle Weakness

Some people notice weakness when lifting the foot, standing on the toes, or climbing stairs.

Pain When Sitting

Symptoms may worsen during prolonged sitting, driving, or bending forward.

Pain During Coughing or Sneezing

Activities that increase pressure within the spine may temporarily increase symptoms.

Difficulty Walking

Severe leg pain or weakness may affect walking tolerance.

Lumbar Disc Herniation

The most common cause of sciatica in younger and middle-aged adults. Disc material may irritate or compress a lumbar nerve root.

Lumbar Spinal Stenosis

Narrowing of the spinal canal or nerve openings may compress nerve roots, particularly in older adults.

Degenerative Changes

Age-related changes in the spine may reduce the space available for nerve roots.

Spondylolisthesis

One vertebra slips forward over another, potentially narrowing the space around a nerve root.

Trauma

Falls or significant injuries can occasionally damage structures around the lumbar spine and affect nerve roots.

Rare Causes

Tumors, infections, inflammatory disorders, or fractures are uncommon but require urgent medical evaluation.

Office Workers

Prolonged sitting may aggravate symptoms in some individuals.

Manual Workers

Frequent lifting, bending, twisting, and heavy physical work.

Drivers

Long periods of sitting and whole-body vibration may contribute to symptoms.

Older Adults

Higher likelihood of lumbar spinal stenosis and degenerative spinal changes.

Smokers

Smoking has been associated with poorer spinal disc health and delayed tissue healing.

Individuals with Previous Episodes

Previous sciatica increases the risk of recurrence.

Clinical Assessment

Medical History

• Where the pain travels
• When symptoms started
• Leg numbness or tingling
• Muscle weakness
• Aggravating activities
• Bladder or bowel symptoms
• Previous episodes
• Occupation and activity level

Physical Examination

• Walking pattern
• Lumbar movement
• Neurological examination
• Muscle strength
• Reflexes
• Sensation testing

Special Tests & Imaging

Special Tests

• Straight Leg Raise (SLR)
• Crossed Straight Leg Raise
• Slump Test
• Neurological examination
• Functional assessment

No single test confirms sciatica. Diagnosis is based on the combination of symptoms, physical examination, and clinical reasoning.

Imaging

Routine MRI is not necessary for most people with uncomplicated sciatica. MRI may be recommended when severe or progressive neurological deficits are present, symptoms persist despite appropriate conservative treatment, surgery is being considered, or serious pathology is suspected.

Education

Understanding sciatica, remaining active within comfortable limits, and avoiding prolonged bed rest are important parts of recovery.

Exercise Therapy

Individualized exercises may help improve movement, reduce pain, and restore function.

Manual Therapy

Manual therapy may help some individuals as part of a comprehensive treatment programme that includes exercise and education.

Activity Modification

Remaining active while temporarily modifying aggravating activities is generally recommended.

Medication

Pain-relieving medication may be appropriate under medical supervision for short-term symptom management.

Epidural Steroid Injection

Some people with persistent, severe nerve root pain may benefit from an epidural steroid injection after specialist evaluation.

Surgery

Surgery may be considered when there is significant or progressive neurological deficit, cauda equina syndrome, or persistent disabling symptoms.

Target: General mobility and function

Duration: Short, frequent walks as tolerated

Target: Lumbar extension mobility

Repetitions: 10 repetitions

Precaution: Appropriate only for individuals whose symptoms improve with extension.

Target: Core activation and lumbar mobility

Repetitions: 10–15 × 2 sets

Target: Neural mobility

Repetitions: 10 gentle repetitions

Precaution: Nerve-gliding exercises should be prescribed after assessment.

Target: Core stability

Repetitions: 8–12 each side

Target: Gluteal muscles and posterior chain

Repetitions: 10–15 × 2 sets

Stay Physically Active

Regular physical activity helps maintain spinal health and overall function.

Lift Safely

Use appropriate lifting techniques and avoid sudden twisting under heavy loads.

Build Core and Hip Strength

Strong trunk and hip muscles support spinal function during daily activities.

Avoid Prolonged Sitting

Take regular movement breaks every 30–60 minutes if your work involves sitting.

Stop Smoking

Smoking is associated with poorer spinal disc health and slower healing.

Progress Exercise Gradually

Increase activity and exercise loads progressively rather than making sudden changes.

Lumbar Disc Herniation

Low Back Pain

Lumbar Spinal Stenosis

Piriformis Syndrome

Spondylolisthesis

Degenerative Disc Disease

Sacroiliac Joint Dysfunction

Cauda Equina Syndrome (Medical Emergency)

Lumbar Radiculopathy

Facet Joint Pain