Overview
Sciatica isn't a diagnosis on its own — it's a symptom. It describes pain that radiates along the path of the sciatic nerve, from the lower back through the buttock and down the leg, caused by irritation or compression of a nerve root in the lumbar spine.
The most common underlying causes are a herniated disc pressing on a nerve root or spinal stenosis narrowing the space around it. The reassuring news is that most episodes of sciatica settle on their own or with non-surgical care, without ever requiring an operation.
Dr. Erik Gerlach's approach starts with identifying the underlying cause, then choosing the least invasive treatment that fits your situation — surgery is considered only when it's clearly needed.
Symptoms
Sciatica symptoms typically start in the low back or buttock and travel down one leg. Common symptoms include:
- Pain radiating from the buttock down the back or side of the leg, often below the knee
- Pain that worsens with sitting or bending forward
- Tingling or numbness in the leg or foot
- Leg or foot weakness — new or worsening weakness, including foot drop, needs to be seen quickly
- New bowel or bladder dysfunction, numbness in the saddle or groin area, or rapidly worsening foot drop or leg weakness are emergency signs — go to the emergency department rather than waiting for an appointment.
Treatment Options
Most sciatica is treated non-surgically at first. This typically means a short period of activity modification (not prolonged bed rest), anti-inflammatory medication, and physical therapy to build strength and mobility around the spine. Epidural steroid injections can also help calm inflammation around an irritated nerve root while the underlying issue settles.
When leg pain from a disc herniation is persistent or nerve symptoms are progressing despite non-surgical care, a microdiscectomy — a minimally invasive procedure to remove the portion of disc material pressing on the nerve — can relieve pressure and speed recovery. Surgery is reserved for cases where conservative treatment hasn't worked or where nerve function is at risk.
Frequently Asked Questions
How long does sciatica last?
Most people improve substantially within 6 to 12 weeks with non-surgical care. Timelines vary depending on the underlying cause and how the nerve responds to treatment.
Should I rest in bed?
Only brief rest is recommended. Prolonged bed rest tends to slow recovery — early, gentle activity generally leads to better outcomes than staying still.
When do I need to be seen quickly?
New leg or foot weakness, foot drop, or any change in bowel or bladder control are signs to be evaluated promptly rather than waiting to see if symptoms improve on their own.