Health A to Z
Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve.
The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.
The pain of sciatica is usually felt in the buttocks and legs.
Most people find it goes away naturally within a few weeks, although some cases can last for a year or more.
This topic covers:
When the sciatic nerve is compressed or irritated, it can cause:
The pain can range from being mild to very painful, and may be made worse by sneezing, coughing or sitting for a long period of time.
While people with sciatica can also have general back pain, the pain associated with sciatica usually affects the buttocks and legs much more than the back.
See your GP if your symptoms are severe, persistent or getting worse over time.
Your GP can usually confirm a diagnosis of sciatica based on your symptoms and recommend appropriate treatment. Sometimes they may refer you to a specialist doctor or a physiotherapist for further help.
A simple test, known as the passive straight leg raise test, can also help your GP identify whether you have sciatica.
This test involves lying flat on your back with your legs straight, and lifting one leg at a time. If lifting one of your legs causes pain or makes your symptoms worse, this usually suggests sciatica.
You should immediately call 999 for an ambulance if you experience all of the following:
Although it's rare, these symptoms can be a sign of a serious condition called cauda equina syndrome.
In the vast majority of cases sciatica is caused by a slipped disc. A slipped disc occurs when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.
It's not always clear what causes the damage, although as you get older your discs become less flexible and more likely to rupture.
Less common causes include:
Most cases of sciatica pass in around six weeks without the need for treatment.
A combination of things you can do at home – such as taking anti-inflammatory painkillers for any back pain, staying active and exercising, and using hot or cold packs – may help reduce the symptoms until the condition improves.
Further treatment may be needed in some cases, such as:
In rare cases surgery may be needed to correct the problem in your spine.
Read more about treating sciatica.
You can minimise your risk of a further episode of sciatica by:
While sleeping, your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.
If your mattress is too soft, place a firm board under the mattress. Support your head with a pillow, but make sure your neck isn't forced up at a steep angle.
Treatment for sciatica isn't always necessary, as the condition often improves naturally within around six weeks.
If your symptoms are severe or persistent, your GP may recommend self-help measures and treatments such as medication and physiotherapy.
However, it's not clear exactly how effective many of these treatments are at treating sciatica.
In a small number of cases, surgery may be recommended to correct the spinal problem thought to be causing your symptoms.
There are a number of things you can do yourself to help reduce troublesome sciatica symptoms.
It's important for you to remain as physically active as possible if you have sciatica.
Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back.
While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful.
If you've had to take time off work because of sciatica, you should aim to return to work as soon as possible.
Read more about exercises for sciatica.
Some people find that using either hot or cold compression packs on painful areas can help to reduce the pain.
You can make your own cold compression pack by wrapping a pack of frozen peas in a towel. Hot compression packs are usually available from pharmacies.
You may find it effective to use one type of pack followed by the other.
If you have persistent or troublesome sciatic pain, there are a number of stronger medications available on prescription that may help.
These medications aren't suitable for everyone, particularly when used in the long term, so it's important to discuss all available options with your GP. Some of these medications can also cause significant side effects in some people.
If the painkilling medications your GP prescribes don't help, you may be referred to a specialist pain clinic for further treatment.
This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of your spine.
Spinal injections are very effective at releasing the pressure on your sciatic nerve and temporarily reducing your pain for a few months.
In some cases, your GP may recommend a suitable exercise plan for you, or they may refer you to a physiotherapist.
A physiotherapist can teach you a range of exercises that strengthen the muscles that support your back and improve the flexibility of your spine.
They can also teach you how to improve your posture and reduce any future strain on your back.
Your GP may also suggest taking part in a group exercise class led by a physiotherapist.
Read more about physiotherapy.
Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.
Manual therapy can help reduce sciatica pain, but it shouldn't be used on its own. It should only be used alongside other measures such as exercise.
Your GP may suggest psychological therapy as part of your treatment plan, in addition to other treatments such as exercise and manual therapy.
Therapies such as cognitive behavioural therapy (CBT) can help you manage your pain better by changing how you think about your condition.
While the pain in your back is very real, how you think and feel about your condition can make it worse.
If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain may be offered.
Surgery is rarely needed for sciatica.
But a type of surgery called lumbar decompression surgery may be considered if:
Decompression surgery can involve several different techniques, such as:
Many people have a positive result from surgery but, as with all surgical procedures, spinal surgery carries some risks.
Potential complications range from the relatively minor, such as an infection at the operation site, to the more serious, such as permanent damage to the spinal nerves.
Before choosing spinal surgery, your surgeon will discuss the relative risks and benefits with you.