Sciatica Explained: Causes, Symptoms & Treatment

What is sciatica?

Sciatica is pain that travels along the sciatic nerve pathway. This nerve is the longest in your body, starting in your lower back and running through your buttocks, then branching down each leg. When something presses on or irritates this nerve, it sends pain signals down the affected leg.

The key thing to understand is that sciatica is a symptom, not a diagnosis. It describes what you’re experiencing (nerve pain down the leg), but the underlying cause varies from person to person. The pain is typically one-sided, affecting only one leg. Many people describe it as electrical, burning, shooting, or tingling rather than just a dull ache.

Common causes / why it happens

Herniated disc (most common)

The most frequent cause of sciatica is a herniated, slipped, or bulging disc in the lower spine. The gel inside a spinal disc can leak out and press directly on the nerve root, causing pain and inflammation. This accounts for the majority of sciatica cases and often improves on its own.

Spinal stenosis

Spinal stenosis is the narrowing of the spinal canal, the space where your nerves travel. This narrowing can squeeze the sciatic nerve and nearby roots, leading to sciatica. Stenosis often develops gradually over time and may be related to age-related changes in the spine.

Piriformis syndrome

Your piriformis is a small muscle deep in your buttocks. When this muscle becomes tight or goes into spasm, it can irritate or pinch the sciatic nerve, which runs beneath or through it. Prolonged sitting, sports, or certain movements can trigger piriformis syndrome.

Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips forward out of proper alignment. This displacement can compress the nerve roots, including the sciatic nerve, and trigger pain down the leg. It can happen due to trauma, wear and tear, or structural weakness.

Other causes

Less commonly, sciatica can result from pregnancy-related weight shifts, sitting on an object or wallet for long periods, or direct trauma to the nerve. In rare cases, a tumour or infection near the nerve may be responsible.

Symptoms to watch for

• Shooting or burning pain starting in the lower back or buttocks and radiating down one leg
• Numbness or tingling in the foot, ankle, or toes
• Weakness in the leg or foot, sometimes making it difficult to lift the foot (foot drop)
• Pain that worsens when sitting, coughing, sneezing, or bending forward
• Symptoms that improve with lying down or gentle walking
• Pain that usually affects only one side of the body

The intensity of pain varies widely. Some people experience mild discomfort, while others have severe pain that makes daily activities difficult. The pain may come and go or be constant.

When to see a doctor

Most people recover from sciatica without medical intervention within weeks or a few months. However, you should see a doctor if pain persists beyond 6 weeks, if you cannot manage daily activities, or if your symptoms worsen despite self-care.

Certain warning signs require urgent medical attention. Numbness in the saddle area (the region between your legs), loss of bladder or bowel control, weakness in both legs that is rapidly worsening, or severe pain that is completely unmanageable may indicate cauda equina syndrome. Fever combined with back and leg pain also warrants urgent evaluation. These signs need immediate assessment at A&E or require calling 999.

If sciatica is affecting your daily life, our doctors at Saba Health Clinic can help you find answers and a treatment plan that fits you. Same-day and next-day appointments are available. Book an appointment or contact us today. 

Treatment options

Conservative treatment

Most sciatica improves with conservative care. In the first few weeks, stay active and avoid prolonged sitting, which can aggravate symptoms. Gentle walking is often beneficial. Over-the-counter paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Applying heat or cold, stretching, and maintaining good posture all support recovery. Contrary to older advice, bed rest typically delays improvement.

Medical treatment

If conservative measures do not resolve symptoms after 4-6 weeks, your doctor may recommend nerve pain medication such as gabapentin or pregabalin. These medications specifically target nerve pain and can provide relief when standard painkillers are insufficient. Structured physiotherapy, guided by a trained professional, helps strengthen muscles supporting the spine and improve flexibility.

A qualified healthcare provider may also recommend an epidural steroid injection. This involves injecting anti-inflammatory medication around the nerve root to reduce swelling and alleviate pain. Injections can provide significant relief, particularly when combined with physiotherapy.

Surgical treatment

Surgery is considered only when conservative and medical treatments have failed to resolve symptoms after several months of consistent care. The most common procedure is a microdiscectomy, a minimally invasive keyhole surgery that removes the part of the herniated disc pressing on the nerve. Decompression surgery may also be performed to widen the spinal canal if stenosis is the underlying cause. Your specialist will discuss whether surgery is appropriate for your specific situation.

Recovery and prevention

Most people recover from sciatica within 6-12 weeks when they follow appropriate treatment. The key is staying active and avoiding positions that aggravate symptoms. Maintaining core strength through exercises recommended by a physiotherapist helps prevent recurrence.

To reduce your risk of developing sciatica in the future, maintain good posture, take regular breaks from sitting, and engage in gentle exercise. Lifting heavy objects correctly (bending at the knees, not the back) and managing stress can also help. Maintaining a healthy weight reduces strain on your spine. If you have a previous history of sciatica, regular stretching and strengthening exercises may help prevent flare-ups.