Sciatica Explained: Causes, Symptoms, and Modern Treatment Options

What Is Sciatica?

Sciatica is traditionally a word used in medical nomenclature to describe the sensation of pain radiating down into the leg and foot. While it’s often used as a diagnostic term, sciatica is technically a symptom. Compression or irritation of any of the nerve roots forming the sciatic nerve (L4, L5, S1, S2, and S3), as well as compression of the nerve itself, can cause symptoms. Compression can also occur in the buttock region, as well as where it branches into the peroneal and tibial nerves in the the back of the knee,  Typically one side is involved, although in rare cases it may involve both sides. 

Understanding what causes sciatica and how it’s treated can help you take the right steps toward lasting relief.

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Common Symptoms of Sciatica

Sciatica symptoms can vary in intensity and duration. Common signs include:

• Sharp, burning, or shooting pain in the lower back, buttocks, hip or leg

• Tingling or “pins and needles” sensations

• Numbness in the leg or foot

• Muscle weakness in the affected leg

• Pain that worsens with sitting, standing, or walking

If symptoms persist or worsen, a medical evaluation is important to identify the underlying cause.

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What Causes Sciatic Nerve Pain?

Several spine-related conditions can compress or irritate the sciatic nerve, including:

Herniated or Bulging Discs

Disc material can press on the nerve roots that form the sciatic nerve.

Spinal Stenosis

Narrowing of the spinal canal can place pressure on nerves, especially during walking or standing.

Degenerative Disc Disease

Age-related changes can reduce disc height and alter spinal alignment.

Bone Spurs or Arthritis

Arthritic changes may narrow nerve pathways.

Piriformis Syndrome

A tight or inflamed muscle in the buttocks (the Piriformis Muscle) can irritate the sciatic nerve outside the spine.

Baker’s Cyst

An abnormal fluid filled sac, caused typically by inflammation from osteoarthritis, in the back of the knee (Popliteal fossa). In rare cases this can cause compression of the peroneal and tibial nerves and result in weakness (foot drop), numbness/tingling, calf muscle wasting, and pain/tightness behind the knee radiating into the calf.

Tumor

In very rare circumstances, a tumor can compress the sciatic nerve, its originating nerve roots, or its branches. A tumor compressing the sciatic nerve causes sciatica-like symptoms (pain, numbness, weakness down the leg) but often presents with distinct signs like night pain, unexplained weight loss, or neurological deficits, and can stem from nerve sheath tumors (like benign schwannomas) or growths in the pelvis/spine.

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How Sciatica Is Diagnosed

Diagnosis begins with a detailed medical history and physical exam. Imaging studies such as Ultrasound, MRI or CT scans may be used to confirm nerve compression and guide treatment decisions.

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Modern Treatment Options for Sciatica

Modern sciatica treatment options focus on identifying the source of nerve irritation and using a stepwise, non-surgical approach tailored to each patient’s condition.

Conservative Treatments

• Physical therapy

• Activity modification

• Anti-inflammatory medications

• Guided stretching and strengthening

  
  

Interventional Pain Management Options

When conservative care is not enough, minimally invasive treatments may help:

• Epidural Steroid Injections to reduce nerve inflammation

• Selective Nerve Root Blocks for targeted pain relief

• Radiofrequency Ablation (RFA) for longer-lasting relief in certain cases

• Spinal Cord Stimulation (SCS) for chronic, treatment-resistant nerve pain

  
  

These procedures are performed with image guidance and are designed to minimize downtime.

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When to See a Spine Specialist for Sciatica

You should seek medical evaluation if you experience:

• Persistent pain lasting more than a few weeks

• Increasing numbness or weakness

• Pain that interferes with daily activities or sleep

• Symptoms that do not improve with rest or therapy

  
  

Early evaluation can help prevent progression and identify the most effective treatment plan.

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Relief Starts With the Right Diagnosis

Sciatica can be painful and frustrating, but effective treatment options are available. Identifying the root cause is the key to choosing the right therapy and avoiding unnecessary procedures.

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References

1. Cleveland Clinic. (n.d.). Sciatica. https://my.clevelandclinic.org/health/diseases/12792-sciatica

2. Mayo Clinic. (n.d.). Sciatica – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

3. American Academy of Orthopaedic Surgeons (AAOS). (n.d.). Sciatica. https://orthoinfo.aaos.org/en/diseases--conditions/sciatica/

4. Johns Hopkins Medicine. (n.d.). Sciatica. https://www.hopkinsmedicine.org/health/conditions-and-diseases/sciatica

5. Spine-health. (n.d.). Sciatica symptoms and causes. https://www.spine-health.com/conditions/sciatica

6. National Institutes of Health. (n.d.). Herniated disc. https://www.ncbi.nlm.nih.gov/books/NBK441822/