Sciatica is a nerve type pain that is felt down the leg. It is often described as a sharp, burning or shooting pain, and may be accompanied by pins and needles, numbness or weakness in the leg or foot. The pain follows the path of an irritated spinal nerve, which is why it can travel from the lower back all the way down towards the foot.
Although sciatica can be very uncomfortable and at times debilitating, it is reassuring to know that in most cases it is self-limiting – meaning it tends to settle on its own over a period of weeks to a few months.
Yes. Most people associate sciatica with pain down the back of the leg, and this is the most common pattern. However, depending on which spinal nerve is affected, the pain can also be felt down the front or side of the thigh and leg. This often causes worry, because it does not fit what people expect sciatica to feel like – but pain down the front of the leg can still be coming from an irritated nerve in the spine.
Which part of the leg is affected depends on the particular nerve involved. Different nerves supply sensation to different areas, so pinching of one nerve may cause pain at the back of the leg, while another may cause pain at the front of the thigh or shin. This is one of the reasons a careful clinical examination is so valuable – the pattern of pain helps to identify exactly which nerve is affected, and where.
Sciatica is usually caused by pinching or irritation of the spinal nerves in the lower back. The most common causes are:
In each case, the underlying problem is that one of the nerves leaving the spine is being compressed or irritated, which produces pain along the course of that nerve.
Diagnosis begins with your clinical history and a thorough examination, which can often identify which nerve is affected and the likely cause. An MRI scan may be needed depending on your clinical history and examination findings, particularly if symptoms are severe, persistent, or if surgery is being considered. The scan helps confirm the cause and pinpoint exactly where the nerve is being compressed.
Because sciatica is self-limiting in the majority of cases, initial treatment is usually conservative. This includes staying as active as comfort allows, appropriate pain relief, and physiotherapy. Many people find their symptoms improve steadily over a number of weeks without any need for surgery.
Where pain is severe or slow to settle, a targeted nerve root injection can sometimes help to reduce inflammation around the affected nerve. Surgery to relieve the pressure on the nerve (for example a microdiscectomy, where the portion of disc pressing on the nerve is removed) is considered when symptoms are severe, when there is significant or progressive weakness, or when pain has not responded to conservative treatment over a reasonable period. The results of surgery for relieving leg pain in carefully selected patients are generally very good.
You should seek a specialist opinion if your sciatica is severe, is not improving after several weeks, or is associated with weakness in the leg or foot. You should seek urgent medical attention if you develop difficulty controlling your bladder or bowels, numbness around the back passage or inner thighs, or worsening weakness in both legs, as these can rarely indicate a more serious problem requiring prompt treatment.
As a Consultant Neurosurgeon in Cambridge, Mr Dan Brown is able to assess the cause of your leg pain, explain clearly what is happening, and recommend the most appropriate treatment. In most cases this will be conservative, but where surgery is needed to relieve pressure on a nerve, his specialist training ensures it is carried out with precision and care. You can read more about his spinal surgery in Cambridge.
Yes. Although sciatica is most commonly felt down the back of the leg, it can also be felt down the front or side of the thigh and leg, depending on which spinal nerve is irritated. Pain down the front of the leg can still be coming from a nerve in the spine, which is why a proper assessment is helpful in identifying the cause.
In most cases, yes. Sciatica is self-limiting for the majority of people and tends to settle over a period of weeks to a few months with conservative treatment such as staying active, pain relief and physiotherapy.
Usually not. Surgery is reserved for cases where pain is severe, where there is significant or progressing weakness, or where symptoms have not improved with conservative treatment over a reasonable period. Where it is needed, results for relieving leg pain are generally very good.
It is a procedure to remove the small portion of a spinal disc that is pressing on a nerve, relieving the pressure causing the leg pain. It is one of the more common procedures used to treat sciatica that has not settled on its own.
If your symptoms are mild and improving, conservative treatment is usually appropriate first. If pain is severe, persistent, or accompanied by weakness, it is sensible to seek a specialist opinion sooner. Any loss of bladder or bowel control needs urgent medical attention.
