A pinched nerve can have big consequences when it’s the longest, widest nerve in your body. That’s why compression of your sciatic nerve — sciatica — is such a challenge.
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“Most people describe sciatica as pain radiating down one leg, especially below the knee,” says Santhosh Thomas, DO, MBA, Medical Director of the Center for Spine Health.
“In more severe cases, numbness and/or weakness can develop in the any part of the leg, including the hip, thigh, knee or ankle.”
Common causes of sciatica include a herniated disk, lumbar spine stenosis and spondylolisthesis.
Why sciatica develops
Your sciatic nerve starts out as small nerves that branch out from both sides of the lower spinal cord. These join together, then quickly split in two to run down (and bring movement and sensation to) each hip, buttock and leg.
Compression at any point along the nerve causes symptoms, usually on the affected side. Burning or shooting pains make walking, sitting and standing up — or even coughing and sneezing — difficult.
Sciatica usually lasts for a couple of weeks, but may persist for a couple of months or even longer.
The good news? “Nearly 90 percent of sciatica patients do not require surgery. Most people simply need time, medication and physical therapy,” says Dr. Thomas.
How sciatica is diagnosed
Doctors start with a physical exam but also order imaging tests. X-rays can show bony detail. MRIs can reveal a bulging disk, cyst, or spine opening narrowed by arthritis.
Electromyography (EMG) can isolate the nerve involved. “It can tell us if an injury is new or old, and whether it is mild, moderate or severe,” he says.
The two-part test reveals which level of the spine is involved and whether a problem like foot drop is caused by a peripheral or a spinal nerve.
Conservative care should be tried first, Dr. Thomas says. Physical therapy is helpful to improve body mechanics, especially with progressive arthritis of the spine.
If conservative care doesn’t help, “we would consider spinal injections. Once the nerve root or the source is identified, we can proceed. We typically use anesthetic and steroids for injections,” he explains.
Red flags for surgery
Surgery is a usually a last resort, but bowel or bladder problems signal the need for aggressive treatment.
“We also consider surgery if pain worsens, if weakness becomes noticeable, if you’re falling or if you can’t clear your foot (in other words, catch your toe on sidewalk),” says Dr. Thomas. “Don’t wait to seek help.”
Getting care for sciatica can ease your pain and help you regain your mobility.