Sciatica

What it is

Sciatica is a symptom rather than a diagnosis: irritation or compression of a lumbar nerve root, most often by disc material or by narrowing of the space the nerve travels through. The defining feature is that the pain follows a nerve's distribution and travels below the knee.

The reassuring part is the natural history. Most disc-related sciatica improves substantially over six to twelve weeks, and the disc material itself is often reabsorbed - larger extrusions frequently resorb more completely than small bulges. Surgery speeds up early recovery but the outcomes at one and two years are similar for most people.

What it feels like

• Pain travelling from the low back or buttock down the back of the leg, past the knee
• Sharp, electric or burning rather than the dull ache of ordinary back pain
• Pins and needles or numbness in a specific band of the leg or foot
• Worse with sitting, coughing, sneezing or straining
• Sometimes weakness - a foot that catches, or difficulty rising onto tiptoes

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Disc herniation

Disc material presses on and chemically irritates the nerve root. It is the commonest cause in people under fifty, and it is also the one with the best natural history - the material is often reabsorbed over months.

Spinal stenosis

Age-related narrowing of the canal or the exit foramina compresses the nerve. This is the commoner cause over sixty, and it typically produces leg symptoms brought on by walking and relieved by sitting or bending forward.

Chemical irritation as well as pressure

Disc material is inflammatory in itself. This is why a small herniation can produce severe symptoms and why symptoms can improve substantially before any structural change - the inflammation settles before the anatomy does.

Sustained flexion and sitting

Sitting increases disc pressure and holds the lumbar spine flexed, which is why sitting is so consistently the worst position and why a long drive is a classic aggravator.

Repeated bending and lifting

Loading the spine in flexion repeatedly is the most common mechanical route to disc problems, particularly when combined with rotation.

Deconditioning of the trunk and hips

Weak trunk and hip musculature means the spine absorbs more of every load. It does not cause sciatica directly but it raises the odds and slows the recovery.

Piriformis and deep gluteal irritation

The sciatic nerve passes close to or through the piriformis in the buttock. Irritation here produces a similar-looking leg pain that is a different problem and needs a different treatment - one reason a careful assessment matters.

Smoking

Smoking is consistently associated with disc degeneration and with worse outcomes from sciatica, probably through reduced blood supply to the disc.

Fear and avoidance

Sciatica is frightening, and the natural response is to move as little as possible. That prolongs recovery, and the deconditioning that follows makes recurrence more likely.

Who tends to get it

• Adults between about thirty and fifty for disc-related sciatica; over sixty for stenosis
• Anyone with a job involving repeated bending, lifting or long driving
• People with a history of low back pain
• Smokers
• Anyone who has had sciatica before

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineSciatica & Deep Buttock Relief

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Bowel or bladder change, saddle numbness, or bilateral leg weakness = cauda equina, EMERGENCY; progressive foot drop needs urgent review

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Most disc-related sciatica improves substantially over six to twelve weeks, and the majority never need surgery. Recovery is uneven, with good days and setbacks. Pain that moves out of the leg and back toward the spine is a good sign even if the back hurts more. Progressive leg weakness, numbness in the saddle area, or any change in bladder or bowel control is cauda equina syndrome until proven otherwise and is a same-day emergency, not something to monitor.

Prevalence basis: Population and primary-care studies

Others the same routine covers

These share the Sciatica & Deep Buttock Relief routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.