Sciatica

Sciatica is pain that runs along the path of the sciatic nerve, starting in your lower back, traveling through your buttock, and shooting down the leg, sometimes all the way to the foot. It is a description of the pain, not a diagnosis on its own: something has to be irritating the nerve. The most common cause is a lumbar disc herniation, a soft spinal disc bulging out and pressing on one of the nerve roots in your lower back. Other causes include narrowing of the spinal canal (lumbar stenosis), one vertebra slipping forward on another (spondylolisthesis), tightness in the muscle the nerve passes under (piriformis syndrome), or, rarely, a tumor or blood clot pressing on the nerve.

Patients usually describe it as burning, electric, or shooting, distinct from the dull ache of muscle pain. It typically gets worse with prolonged sitting, bending, and coughing. The good news: the vast majority of cases settle down without surgery.

• Shooting, burning, or electric pain running from your lower back or buttock down the back or outside of one leg, sometimes all the way to the foot
• Numbness or tingling along the same path, often in the calf or sole of the foot
• Weakness in the leg or foot, a foot that slaps the ground when you walk, or difficulty pushing up on your toes
• Pain that worsens with prolonged sitting, bending forward, coughing, or sneezing
• Relief when walking or lying flat compared to sitting
• Symptoms almost always affect one side; bilateral sciatica is uncommon and warrants urgent evaluation

Diagnosis starts with a focused physical exam of the back and legs, which can point to a disc pressing on a nerve root before any imaging is ordered. An MRI is the definitive test: it shows the disc, the nerve, and exactly where the pinch is happening. Nerve-conduction studies (EMG/NCS) can pinpoint which nerve is compressed and give some sense of how much damage there is.

The reassuring part of sciatica is that the vast majority of cases settle down without surgery. The treatments below are listed in the order we usually introduce them. The goal is to take pressure off the irritated nerve root and give the inflammation time to calm down.

If Conservative Care Is Not Enough

When the conservative steps above have not settled the leg pain, an interventional treatment such as a spinal injection (for example, an epidural steroid injection placed around the irritated nerve root) is often the next step. OSI does not perform spinal injections. When that step is appropriate, OSI directs you to a pain management specialist who provides interventional treatment, and your evaluation and conservative care stay with us.

Surgery helps only a small minority of spine patients, usually those with a specific structural problem plus a nerve issue that isn’t getting better with a structured non-operative trial. When that step is genuinely warranted, it falls outside the care OSI provides, so we refer you to a spine surgeon. OSI does not perform or coordinate spine surgery; your non-operative care stays with us.

Emergency. Bilateral leg weakness, saddle numbness, or loss of bladder or bowel control is a surgical emergency. Go to the nearest emergency department rather than waiting for a clinic appointment.

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language