Sciatica is nerve pain that travels along the sciatic nerve, branching from the lower back through the hips and buttocks down each leg. This radiating pain, often described as burning or an electric shock, usually occurs when a herniated disc or bone spur compresses a nerve root in the lumbar spine. Determining the right medical professional depends on the severity and duration of symptoms. Understanding the roles of doctors involved in spinal care provides a clear path to managing pain and restoring function.
Initial Consultation: Primary Care and Diagnosis
The first step for most people experiencing new sciatica pain is an appointment with a Primary Care Physician (PCP) or General Practitioner (GP). The PCP confirms the diagnosis and rules out other causes of leg pain through an initial assessment. This evaluation includes a physical examination, such as the Straight Leg Raise test, which helps identify characteristic nerve root compression.
Initial treatment focuses on conservative measures, including remaining active rather than resting in bed, coupled with first-line pharmacologic therapy. This often involves non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. If symptoms persist beyond a few weeks or are severe, the PCP determines if advanced diagnostic imaging, such as an MRI, is necessary before a specialist referral.
Non-Surgical Specialists for Pain Management
If conservative treatments fail after several weeks, a referral to a non-surgical specialist is the next step. Physiatrists, doctors of Physical Medicine and Rehabilitation (PM&R), specialize in restoring function and managing nerve-related problems without surgery. They create comprehensive, non-operative treatment plans that may include targeted medications, physical therapy, and precise diagnostic testing. Physiatrists are also skilled in performing interventional procedures, such as image-guided epidural steroid injections, to deliver anti-inflammatory medication directly to the compressed nerve root.
Pain Management Specialists, often anesthesiologists, focus on using advanced techniques to control chronic pain. Their expertise lies in procedures like nerve blocks and spinal injections, providing a focused approach to pain relief. The Physical Therapist (PT) plays a primary role in rehabilitation, working alongside these specialists. The PT develops a program of specific exercises, stretches, and posture corrections aimed at decompressing the nerve and strengthening core muscles.
Advanced Care: Surgical Experts and Criteria for Referral
A referral to a surgical specialist is warranted when sciatica symptoms persist for six to twelve weeks despite non-surgical treatments, or if neurological function is significantly impaired. Two types of surgeons commonly treat spinal conditions: Orthopedic Spine Surgeons and Neurosurgeons. Orthopedic Surgeons focus on the musculoskeletal system and correct structural issues, such as degenerative disc disease.
Neurosurgeons specialize in the central and peripheral nervous system, including the spinal cord and nerve roots. Their focus involves procedures that directly decompress the affected nerve, such as a microdiscectomy to remove the part of a herniated disc pressing on the sciatic nerve. A referral initiates a consultation to assess structural problems that conservative care cannot fix. Surgery is typically reserved for cases where pain is debilitating or when a neurological deficit, like severe leg weakness or foot drop, is present.
When Sciatica Requires Immediate Emergency Attention
While most sciatica cases resolve with time and conservative care, certain “red flag” symptoms require immediate emergency evaluation. These symptoms indicate potentially severe compression of the spinal cord’s nerve bundle, known as Cauda Equina Syndrome (CES). The most urgent sign is any sudden loss of bowel or bladder control, such as an inability to urinate or accidental incontinence.
Other symptoms include rapidly progressive weakness or numbness in one or both legs, making it difficult to walk or stand. Numbness in the “saddle area”—the groin, inner thighs, and buttocks—is also a serious indicator. If any of these acute neurological symptoms occur, immediate emergency medical attention is necessary to prevent permanent nerve damage.