Sciatica: causes, how long it lasts, and non-surgical treatment

What is sciatica?

Sciatica isn't a diagnosis in itself. It's a description of symptoms caused by irritation or compression of one of the nerve roots that join to form the sciatic nerve, the longest nerve in the body. It runs from your lower back, through your buttock and down the back of each leg to your foot.

When a nerve root in the lower back is irritated, you feel the pain along the path of the nerve, in your leg, even though the problem is in your spine.

Symptoms of sciatica

• Pain spreading from the lower back or buttock down the back or side of one leg, often below the knee and sometimes into the foot
• Leg pain that's often worse than any back pain
• Burning, shooting or electric-shock pain
• Numbness, tingling or "pins and needles" in the leg or foot
• Weakness in the leg or foot
• Pain that's worse when sitting, bending, coughing or sneezing

Sciatica usually affects one leg. Sciatica in both legs can be a warning sign (see below).

What causes sciatica?

• A slipped (herniated) disc is by far the most common cause. Disc material presses on or irritates a nerve root.
• Lumbar spinal stenosis: narrowing of the spinal canal, more common after age 50. It often causes leg pain or heaviness when walking that eases when you sit or bend forward.
• Spondylolisthesis: a vertebra slipping forward and narrowing the space for the nerve.
• Degenerative disc disease, where age-related disc changes narrow the openings the nerves pass through.

Some conditions cause sciatica-like pain without a nerve root being compressed in the spine:

• Piriformis syndrome, where a deep buttock muscle irritates the sciatic nerve
• Sacroiliac joint pain, which can refer pain into the buttock and thigh

Rarely, sciatica is caused by infection or a tumour, which is why red flags matter.

Finding out which of these is behind your pain is the first step in treating it properly.

When sciatica is an emergency

Go to a hospital emergency department straight away if sciatica comes with:

• sciatica in both legs
• numbness around your genitals, inner thighs or bottom
• new difficulty passing urine, or loss of bladder or bowel control
• leg weakness that's getting worse

These can be signs of cauda equina syndrome, a rare but serious condition that needs emergency treatment.

→ Read the full list of red flags

How long does sciatica last?

For most people, the outlook is good.

• Many people with recent sciatica notice clear improvement within the first few weeks.
• A 2024 medical review found that symptoms resolve in 60% to 80% of people with a herniated disc within 6 to 12 weeks, and in 80% to 90% over the long term.

Sciatica that lasts less than three months is usually called acute. Sciatica lasting three months or more is called chronic. Chronic or recurring sciatica is more likely to need a structured treatment plan, and sometimes a surgical opinion.

How sciatica is diagnosed

At your Maana Spine assessment, your physiotherapist asks about your symptoms, checks how your back moves, and tests the nerves in your legs: strength, sensation and reflexes. Specific tests help show whether a nerve root is irritated and at which level.

Do you need an MRI? Not always. Imaging is usually reserved for severe or worsening symptoms, red flags, or sciatica that isn't improving after several weeks. Interestingly, in a major sciatica trial, MRI scans taken a year later couldn't tell apart the people who had recovered from those who hadn't: a disc herniation was still visible in about a third of both groups. How you feel and function matters more than how your scan looks.

→ What happens at your spine assessment

What the research says

Decompression for sciatica from a disc. Sciatica caused by a herniated disc is where the evidence for spinal decompression is strongest. In a 2022 sham-controlled trial, people with a recent disc herniation who received real decompression had less leg pain at two months and better function at two and three months than those who received a sham treatment. A separate 2022 trial found that adding decompression to physiotherapy improved outcomes more than physiotherapy alone in people with nerve pain from the lower back.

Guidelines. The UK's NICE guideline recommends exercise programmes as a core treatment. That's why decompression at Maana Spine is always combined with exercise-based rehabilitation.

Medicines. NICE advises against some medicines often prescribed for sciatica, including gabapentinoids (such as gabapentin and pregabalin), oral steroids and benzodiazepines, and advises against opioids for chronic sciatica. If you're taking any of these, don't stop suddenly: talk to your doctor.

→ Read our full review of the decompression evidence

Sciatica and surgery

Most people with sciatica don't need surgery. In a major randomised trial, early surgery gave faster relief of leg pain, but outcomes at one year were similar to non-surgical care with surgery later if needed. Surgery is usually considered when non-surgical treatment hasn't improved pain or function and an MRI matches the symptoms, or urgently if weakness is severe or worsening.

→ Do I need surgery for a disc problem?

Living with sciatica: practical tips

• Keep gently active. Short walks are usually better than lying in bed.
• Avoid sitting for long periods. Sitting often aggravates sciatica. Stand and move regularly, and break up long car or two-wheeler journeys where you can.
• Find a comfortable sleeping position. Many people find lying on their side with a pillow between the knees, or on their back with a pillow under the knees, easier.
• Don't push through sharp, spreading pain when exercising. Your physiotherapist will show you which movements suit your nerve.

These are general tips, not a substitute for an assessment.

Book a spine assessment

Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.

Book a Spine Assessment · or call +91 99950 09403