Sciatica

Sciatica is pain from irritation or compression of the sciatic nerve — the nerve that runs from the lower back through the buttock and down the back of each leg. Pain typically shoots from the low back or buttock down one leg. Most cases settle within 6 weeks with simple care. A small number need further investigation or treatment.

Symptoms

• Sharp, electric, burning, or shooting pain down one leg (rarely both).
• Pain worse on sitting, bending forward, sneezing, or coughing.
• Numbness, tingling, or weakness along the nerve's path.
• Back pain may or may not be prominent.

Red flags — dial 112 or go to hospital

• Numbness around the anus / genitals; bladder or bowel control problems; progressive leg weakness — possible cauda equina; emergency.
• Severe pain with fever — possible infection.
• History of cancer or recent significant infection with new sciatica.
• Severe injury before onset.

Common causes

• Herniated (slipped) disc — most common.
• Spinal stenosis — narrowed canal.
• Piriformis syndrome — tight muscle compressing the nerve.
• Spondylolisthesis — one vertebra slips over another.
• Pregnancy-related — baby's position can irritate nerve.
• Rarely: tumours, infections (spinal TB should be on the list in Indian settings), or nerve-root cysts.

What helps

• Keep moving — gentle walking, light stretching. Prolonged bed rest actually slows recovery.
• Heat/cold packs.
• NSAIDs short-term (with food) for pain.
• Simple pain relievers.
• Physiotherapy — core strengthening, nerve-glide exercises, posture; one of the most effective long-term approaches.
• Don't sit for prolonged stretches — stand and stretch every 30-45 minutes.
• Lose weight if overweight; stop smoking — both help disc health.
• Avoid heavy lifting and twisting during flares.
• Most episodes improve substantially in 4-6 weeks.

When to consider further treatment

• Severe, persistent pain beyond 6 weeks.
• Significant weakness or numbness.
• Epidural steroid injection — for carefully selected cases.
• Surgery (microdiscectomy, laminectomy) — for persistent significant nerve compression with weakness, cauda equina, or pain not responding. Very effective when the indication is right.
• Be cautious about aggressive unproven spinal manipulations and unregulated "pain kill" injections from roadside practitioners — they have caused real harm in India.