Sciatica describes pain that radiates along the path of the sciatic nerve, extending from the lower back through the hips and buttocks into one leg. This sensation is a symptom of an underlying issue, most often the compression or irritation of a spinal nerve root in the lower back. The pain is frequently described as a severe burning, shooting, or electric shock-like feeling, often accompanied by numbness or weakness in the affected limb. Treating sciatica involves a coordinated effort across several medical and therapeutic specialists due to the varied causes.
The Starting Point Primary Care Physicians
The initial point of contact for most patients experiencing radiating leg pain is a primary care physician (PCP), such as a family medicine or internal medicine doctor. These practitioners perform the first physical examination and history assessment to differentiate sciatica from other causes of leg pain. They focus on identifying urgent symptoms, often called “red flags,” which indicate a medical emergency.
The most concerning red flag is cauda equina syndrome, signaled by symptoms like progressive weakness in both legs, saddle anesthesia, or loss of bowel or bladder control. If these symptoms are present, the PCP facilitates an immediate referral to a surgeon. For the vast majority of non-emergency cases, the PCP prescribes initial conservative management, typically involving non-steroidal anti-inflammatory drugs (NSAIDs) and advice to remain active. If symptoms persist beyond four to six weeks, the PCP coordinates a referral to a specialist for further non-surgical intervention.
Specialized Medical Management for Non-Surgical Treatment
When initial conservative care fails to provide relief, specialized medical doctors step in to refine the diagnosis and offer advanced non-surgical treatments. Physiatrists, who specialize in physical medicine and rehabilitation (PM&R), are experts in musculoskeletal and nerve conditions. They focus on accurately diagnosing the specific source of nerve irritation and developing comprehensive, non-operative treatment plans. Physiatrists often lead the rehabilitation team, coordinating medication management, physical therapy, and interventional procedures.
Pain management specialists focus on advanced pain relief techniques. Their most common intervention for sciatica is the epidural steroid injection (ESI), which uses X-ray guidance to deliver a potent anti-inflammatory corticosteroid and a local anesthetic directly into the epidural space near the irritated nerve root. This localized treatment aims to reduce inflammation, providing pain relief that can last several weeks to months, creating a window for successful physical therapy. Neurologists may be consulted when the nature of the nerve damage is unclear or a deeper neurological condition is suspected. They perform diagnostic tests, such as Electromyography (EMG) and Nerve Conduction Studies (NCS), which measure the electrical activity of muscles and the speed of nerve signals.
Rehabilitative and Movement Therapies
Rehabilitative practitioners play an integral role in active recovery and long-term symptom management, working alongside the medical specialists. Physical therapists (PTs) are often considered the cornerstone of non-surgical sciatica recovery. They design personalized programs focused on strengthening the deep core and gluteal muscles to provide better support for the lumbar spine and relieve pressure on the sciatic nerve.
Specific PT techniques include nerve gliding exercises, which gently mobilize the sciatic nerve to reduce irritation and improve its movement within surrounding tissues. They also instruct on posture correction and body mechanics to prevent recurrence during daily activities. Other practitioners include chiropractors, who focus on spinal adjustments and manipulation to restore alignment and joint mobility in the lower back. Osteopaths (Doctors of Osteopathic Medicine or DOs) use a hands-on approach called Osteopathic Manipulative Treatment (OMT), incorporating soft tissue massage and joint mobilization to address muscle tension and structural imbalances.
When Surgical Intervention Is Necessary
Surgical consultation is reserved for a small percentage of patients, primarily those who have failed an aggressive course of non-surgical treatment lasting six to twelve weeks, or those presenting with emergency symptoms. The two types of surgeons most commonly involved are orthopedic spine surgeons and neurosurgeons. Both are highly qualified to perform spine surgery, often completing specialized fellowship training.
The decision to operate is usually based on persistent, debilitating pain that has not responded to conservative care, or the presence of progressive neurological deficits like worsening leg weakness. The most common procedure for sciatica caused by a herniated disc is a microdiscectomy, a minimally invasive surgery that removes the small fragment of the disc that is compressing the nerve root. For cases involving spinal stenosis, which is a narrowing of the spinal canal, a laminectomy may be performed to remove a portion of the bone and ligament to create more space for the nerves.