Sciatica is a symptom, not a diagnosis, characterized by pain that radiates along the path of the sciatic nerve. This discomfort typically originates in the lower back or buttock and travels down the back of one leg, often feeling sharp, burning, or like an electric shock. The radiating pain is commonly caused by an underlying condition that compresses or irritates the nerve roots that form the sciatic nerve, with a herniated disc being the most frequent culprit. Other common causes include spinal stenosis (a narrowing of the spinal canal) or bone spurs that press on the nerve tissue. Fortunately, the vast majority of sciatica cases (estimated between 80% and 90%) improve significantly or resolve entirely with conservative, non-surgical treatments within a few weeks to months.
The Initial Step: Primary Care and Diagnosis
The first professional to consult for new-onset sciatica pain is typically a primary care physician (PCP), such as a family doctor or general practitioner. The PCP performs a thorough physical examination and takes a detailed medical history to confirm the symptoms are sciatica and rule out other serious conditions. During this visit, the doctor assesses reflexes and muscle strength, often using a straight-leg raise test, to pinpoint affected nerve roots.
Initial management focuses on conservative strategies, including advice to remain active and avoid prolonged bed rest, which can actually worsen outcomes. The doctor may prescribe over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce inflammation and pain. A short course of muscle relaxants may also be recommended to ease muscle spasms that frequently accompany sciatica.
A diagnosis is generally made based solely on the patient’s symptoms and the physical exam; expensive imaging is usually not necessary early on. The PCP typically orders advanced diagnostic tests, like an X-ray or Magnetic Resonance Imaging (MRI), only if the pain is severe, persists beyond six to eight weeks of initial care, or if “red flag” symptoms are present. This initial consultation establishes the baseline for your recovery and determines the appropriate next steps, often involving a referral to non-surgical specialists.
Non-Surgical Specialists for Management and Rehabilitation
When initial pain management provides insufficient relief, a referral to a non-surgical specialist is the standard pathway toward recovery.
Physical Therapy
Physical therapy (PT) is central to this conservative approach, with a physical therapist designing a customized exercise program to improve mobility and reduce nerve compression. Therapists focus on exercises that strengthen the core and lower back muscles to support the spine and stabilize the irritated area. They also use specific stretching techniques, manual therapy, and posture correction to relieve pressure on the sciatic nerve. The goal is not just short-term relief but teaching the patient mechanical strategies for long-term self-management and prevention of future episodes.
Physiatrists
A physiatrist, a doctor of physical medicine and rehabilitation (PM&R), specializes in diagnosing and treating pain non-surgically. Physiatrists coordinate the rehabilitation process and are experts in targeted treatments, such as administering epidural steroid injections (ESIs). These injections deliver a potent anti-inflammatory corticosteroid directly near the irritated nerve root, providing localized relief that enhances the effectiveness of physical therapy.
Chiropractic Care
Chiropractors are also frequently consulted for sciatica, focusing on manual adjustments and spinal manipulation to improve alignment and restore proper motion to the spine. They operate on the principle that mechanical issues in the spine contribute to nerve irritation. For some patients, this approach can offer significant relief by addressing joint dysfunction or subtle misalignments contributing to the compression of the sciatic nerve.
Advanced Care and Surgical Consultation
If persistent, disabling pain continues despite several months of comprehensive non-surgical management, advanced specialists may be consulted. Pain management specialists, often fellowship-trained physiatrists or anesthesiologists, offer sophisticated, minimally invasive procedures. These interventions include nerve blocks, which temporarily interrupt pain signals from specific nerves using a local anesthetic and a steroid.
For chronic pain unresponsive to injections, radiofrequency ablation may be used, which involves heating a small area of nerve tissue to stop pain signaling. These advanced techniques manage pain and improve function when conservative measures have reached their limit. The decision to move to this level of care is typically made in consultation with the referring PCP or physiatrist.
Surgical consultation is reserved for a small subset of patients with a confirmed structural issue causing severe, unrelenting pain or progressive neurological deficits. The specialists involved are neurosurgeons or orthopedic spine surgeons, both of whom are trained to operate on the spine. Surgery is considered if conservative treatment has failed for six to twelve weeks and the patient continues to experience debilitating symptoms.
The most common procedure for sciatica caused by a herniated disc is a microdiscectomy, a minimally invasive surgery to remove the portion of the disc pressing on the nerve. For significant spinal stenosis, a laminectomy may be performed to decompress the nerves by removing a small part of the vertebral bone called the lamina. These surgical options mechanically relieve nerve pressure but are generally considered only after all non-surgical avenues have been exhausted.
When Sciatica Pain Requires Emergency Attention
While most sciatica is manageable, certain symptoms signal a severe medical condition requiring immediate emergency room evaluation, bypassing all other steps. The most concerning sign is the sudden onset of progressive weakness in the lower extremities, especially if it affects both legs and impacts the ability to walk. This can indicate significant and potentially irreversible nerve damage.
A medical emergency known as Cauda Equina Syndrome results from massive compression of the nerve roots at the base of the spinal cord. Serious signs include new-onset difficulty controlling the bladder or bowels, such as inability to urinate or accidental leakage. This condition is often accompanied by numbness in the “saddle area,” including the groin, buttocks, and inner thighs. Recognizing these specific “red flag” symptoms and seeking immediate care is necessary to prevent permanent neurological impairment.