Sciatica is

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

going down the leg from the

lower back Lower may refer to: * ''Lower'' (album), 2025 album by Benjamin Booker *Lower (surname) *Lower Township, New Jersey *Lower Receiver (firearms) *Lower Wick Lower Wick is a small hamlet located in the county of Gloucestershire, England. It is sit ...

. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities such as heavy lifting, though gradual onset may also occur. The pain is often described as shooting. Typically, symptoms are only on one side of the body. Certain causes, however, may result in pain on both sides.

Lower back pain Low back pain or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can var ...

is sometimes present. Weakness or numbness may occur in various parts of the affected leg and foot. About 90% of sciatica is due to a

spinal disc herniation A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, ...

pressing on one of the

lumbar In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm (anatomy), diaphragm and the sacrum. Naming and location The lumbar region is sometimes referred to as the lowe ...

sacral nerve A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into th ...

roots.

Spondylolisthesis Spondylolisthesis is when one spinal vertebra slips out of place compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (o ...

spinal stenosis Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in ...

piriformis syndrome Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle. It is a specific case of deep gluteal syndrome. The largest and most bulky nerve in the human body is the s ...

, pelvic tumors, and

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

are other possible causes of sciatica. The

straight-leg-raising test The straight leg raise is a test that can be performed during a physical examination, with the leg being lifted actively by the patient or passively by the clinician. If the straight leg raise is done actively by the patient, it is a test of fu ...

is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. In most cases

medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...

is not needed. However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

or infection. Conditions that may present similarly are diseases of the hip and infections such as early

shingles Shingles, also known as herpes zoster or zona, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. T ...

(prior to rash formation). Initial treatment typically involves

pain medications An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in so ...

. However, evidence for effectiveness of the pain medication and

muscle relaxant A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeu ...

s is lacking. It is generally recommended that people continue with normal activity to the best of their abilities. Often all that is required for sciatica resolution is time; in about 90% of people symptoms resolve in less than six weeks. If the pain is severe and lasts for more than six weeks, surgery may be an option. While surgery often speeds pain improvement, its long term benefits are unclear. Surgery may be required if complications occur, such as loss of normal bowel or bladder function. Many treatments, including

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

gabapentin Gabapentin, sold under the brand name Neurontin among others, is an anticonvulsant medication primarily used to treat neuropathic pain and also for partial seizures of epilepsy. It is a commonly used medication for the treatment of neuropath ...

pregabalin Pregabalin, sold under the brand name Lyrica among others, is an anticonvulsant, analgesic, and anxiolytic amino acid medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless legs syndrome, opioid withdrawal, generalized anx ...

acupuncture Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientif ...

, heat or ice, and

spinal manipulation Spinal manipulation is an intervention performed on synovial joints of the spine, including the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. It is typically applied w ...

, have limited or poor evidence for their use. Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women. The condition has been known since ancient times. The first known modern use of the word ''sciatica'' dates from 1451, although

Dioscorides Pedanius Dioscorides (, ; 40–90 AD), "the father of pharmacognosy", was a Greek physician, pharmacologist, botanist, and author of (in the original , , both meaning "On Materia medica, Medical Material") , a 5-volume Greek encyclopedic phar ...

(1st-century CE) mentions it in his ''

Materia Medica ''Materia medica'' ( lit.: 'medical material/substance') is a Latin term from the history of pharmacy for the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medications). The term derives f ...

''.

Definition

The term "sciatica" usually describes a

symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

—pain along the

sciatic nerve The sciatic nerve, also called the ischiadic nerve, is a large nerve in humans and other vertebrate animals. It is the largest branch of the sacral plexus and runs alongside the hip joint and down the right lower limb. It is the longest and widest ...

pathway—rather than a specific condition, illness, or disease. Some use it to mean any pain starting in the lower back and going down the leg. The pain is characteristically described as shooting or shock-like, quickly traveling along the course of the affected nerves. Others use the term as a

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

(i.e. an indication of cause and effect) for nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. Pain typically occurs in the distribution of a

dermatome Dermatome may refer to: * Dermatome (anatomy), an area of skin that is supplied by a single pair of dorsal roots * Dermatome (embryology), the portion of the embryonic paraxial mesoderm, the somite, which gives rise to dermis * Dermatome (instrument ...

and goes below the knee to the foot. It may be associated with

neurological Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...

dysfunction, such as weakness and numbness.

Causes

Risk factors

Modifiable risk factors for sciatica include

smoking Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

, occupation, and physical sports where back muscles and heavy weights are involved. Non-modifiable risk factors include increasing age, being male, and having a personal history of

low back pain Low back pain or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can var ...

Spinal disc herniation

Spinal disc herniation A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, ...

pressing on one of the

roots is the most frequent cause of sciatica, being present in about 90% of cases. This is particularly true in those under age 50. Disc herniation most often occurs during heavy lifting. Pain typically increases when bending forward or sitting, and reduces when lying down or walking.

Spinal stenosis

Other compressive spinal causes include

lumbar spinal stenosis Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the nerves and blood vessels at the level of the lumbar vertebrae. Spinal stenosis may also affect the cervical or thoracic region, in which case ...

, a condition in which the

spinal canal In human anatomy, the spinal canal, vertebral canal or spinal cavity is an elongated body cavity enclosed within the dorsal bony arches of the vertebral column, which contains the spinal cord, spinal roots and dorsal root ganglia. It is a pro ...

, the space the spinal cord runs through, narrows and compresses the spinal cord,

cauda equina The cauda equina () is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enl ...

, or sciatic nerve roots. This narrowing can be caused by

bone spurs An exostosis, also known as a osteochondroma, is a benign chondrogenic lesions derived from aberrant cartilage from the perichondral ring. Exostoses can cause chronic pain ranging from mild to moderate, but rarely severe, depending on the shape, s ...

spondylolisthesis Spondylolisthesis is when one spinal vertebra slips out of place compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (o ...

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

, or a

herniated disc A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, ...

, which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that become the sciatic nerve. This is the most frequent cause after age 50. Sciatic pain due to spinal stenosis is most commonly brought on by standing, walking, or sitting for extended periods of time, and reduces when bending forward. However, pain can arise with any position or activity in severe cases. The pain is most commonly relieved by rest.

Piriformis syndrome

Piriformis syndrome is a condition that, depending on the analysis, varies from a "very rare" cause to contributing up to 8% of low back or buttock pain. In 17% of people, the sciatic nerve runs through the

piriformis muscle The piriformis muscle () is a flat, pyramidally-shaped muscle in the buttock, gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group. The piriformis muscle has its origin upon the front surface of the sacrum, ...

rather than beneath it. When the piriformis shortens or spasms due to trauma or overuse, it is posited that this causes compression of the sciatic nerve. Piriformis syndrome has colloquially been referred to as "wallet sciatica" since a

wallet A wallet is a flat case or pouch, often used to carry small personal items such as physical currency, debit cards, and credit cards; identification documents such as driving licence, identification card, club card; photographs, transit pass, b ...

carried in a rear hip pocket compresses the buttock muscles and sciatic nerve when the bearer sits down. Piriformis syndrome may be suspected as a cause of sciatica when the spinal nerve roots contributing to the sciatic nerve are normal and no herniation of a spinal disc is apparent.

Deep gluteal syndrome

Deep gluteal syndrome is non-discogenic, extrapelvic sciatic

nerve entrapment Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a ''trapped nerve'', though this may also refer to n ...

in the deep gluteal space. Piriformis syndrome was once the traditional model of sciatic nerve entrapment in this anatomic region. The understanding of non-discogenic sciatic nerve entrapment has changed significantly with improved knowledge of posterior hip anatomy, nerve kinematics, and advances in

endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

techniques to explore the sciatic nerve. There are now many known causes of sciatic nerve entrapment, such as fibrous bands restricting nerve mobility, that are unrelated to the piriformis in the deep gluteal space. Deep gluteal syndrome was created as an improved classification for the many distinct causes of sciatic nerve entrapment in this anatomic region. Piriformis syndrome is now considered one of many causes of deep gluteal syndrome.

Endometriosis

Sciatic

endometriosis Endometriosis is a disease in which Tissue (biology), tissue similar to the endometrium, the lining of the uterus, grows in other places in the body, outside the uterus. It occurs in women and a limited number of other female mammals. Endomet ...

, also called catamenial or cyclical sciatica, is a sciatica whose cause is endometriosis. Its incidence is unknown. Diagnosis is usually made by an

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

or CT-

myelography Myelography is a type of radiographic examination that uses a contrast medium (e.g. iodised oil) to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. Historically the procedure involved the inj ...

Pregnancy

Sciatica may also occur during pregnancy, especially during later stages, as a result of the weight of the

fetus A fetus or foetus (; : fetuses, foetuses, rarely feti or foeti) is the unborn offspring of a viviparous animal that develops from an embryo. Following the embryonic development, embryonic stage, the fetal stage of development takes place. Pren ...

pressing on the sciatic nerve during sitting or during leg spasms. While most cases do not directly harm the woman or the fetus, indirect harm may come from the numbing effect on the legs, which can cause loss of balance and falls. There is no standard treatment for pregnancy-induced sciatica.

Other

Pain that does not improve when lying down suggests a nonmechanical cause, such as

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

, or

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

. Sciatica can be caused by

tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

impinging on the spinal cord or the nerve roots. Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness may result from

spinal tumor Spinal tumors are neoplasms located in either the vertebral column or the spinal cord. There are three main types of spinal tumors classified based on their location: extradural and intradural (intradural-intramedullary and intradural-extramedulla ...

s or

cauda equina syndrome Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, sciatica, pain that radiates down the leg, numbness ...

. Trauma to the spine, such as from a car accident or hard fall onto the heel or buttocks, may also lead to sciatica. A relationship has been proposed with a latent ''

Cutibacterium acnes ''Cutibacterium acnes'' (''Propionibacterium acnes'') is the relatively slow-growing, typically aerotolerant anaerobic, gram-positive bacterium (rod) linked to the skin condition of acne; it can also cause chronic blepharitis and endophthalmitis ...

'' infection in the intervertebral discs, but the role it plays is not yet clear.

Pathophysiology

The sciatic nerve comprises nerve roots L4, L5, S1, S2, and S3 in the spine. These nerve roots merge in the pelvic cavity to form the

sacral plexus In human anatomy, the sacral plexus is a nerve plexus which provides motor and sensory nerves for the posterior thigh, most of the lower leg and foot, and part of the pelvis. It is part of the lumbosacral plexus and emerges from the lumbar verteb ...

and the sciatic nerve branches from that. Sciatica symptoms can occur when there is pathology anywhere along the course of these nerves.Davis D, Maini K, Vasudevan A
Sciatica
pdated 2022 May 6 In: StatPearls nternet Treasure Island (Florida): StatPearls Publishing; 2023 January. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/.

Intraspinal sciatica

Intraspinal, or discogenic sciatica refers to sciatica whose pathology involves the spine. In 90% of sciatica cases, this can occur as a result of a spinal disc bulge or

herniation A hernia (: hernias or herniae, from Latin, meaning 'rupture') is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal development of the in ...

. Sciatica is generally caused by the compression of

lumbar nerves The lumbar nerves are the five pairs of spinal nerves emerging from the lumbar vertebrae. They are divided into posterior and anterior divisions. Structure The lumbar nerves are five spinal nerves which arise from either side of the spinal cord ...

L4 or L5 or

S1. Less commonly,

sacral nerves A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into t ...

S2 or S3 may cause sciatica. Intervertebral spinal discs consist of an outer anulus fibrosus and an inner

nucleus pulposus An intervertebral disc (British English), also spelled intervertebral disk (American English), lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vert ...

. The anulus fibrosus forms a rigid ring around the

early in human development, and the gelatinous contents of the nucleus pulposus are thus contained within the disc. Discs separate the spinal vertebrae, thereby increasing spinal stability and allowing nerve roots to properly exit through the spaces between the vertebrae from the spinal cord. As an individual ages, the anulus fibrosus weakens and becomes less rigid, making it at greater risk for tear. When there is a tear in the anulus fibrosus, the

may extrude through the tear and press against spinal nerves within the spinal cord,

, or exiting

nerve root A nerve root () is the initial segment of a nerve leaving the central nervous system. Nerve roots can be classified as: * Cranial nerve roots: the initial or proximal segment of one of the twelve pairs of cranial nerves leaving the central nervous s ...

s, causing inflammation, numbness, or excruciating pain. Inflammation of spinal tissue can then spread to adjacent facet joints and cause

facet syndrome Facet syndrome is a syndrome in which the facet joints (synovial joint, synovial diarthroses) cause painful symptoms. In conjunction with degenerative disc disease, a distinct but functionally related condition, facet arthropathy is believed to be ...

, which is characterized by lower back pain and referred pain in the posterior thigh. Other causes of sciatica secondary to spinal nerve entrapment include the roughening, enlarging, or misalignment (''

'') of

vertebra Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

e, or disc degeneration that reduces the diameter of the lateral foramen through which nerve roots exit the spine. When sciatica is caused by compression of a dorsal nerve root, it is considered a lumbar

radiculopathy Radiculopathy (; ), also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). Radiculopathy can result in pain (radicular pain), weakness, altered se ...

radiculitis Radicular pain, or radiculitis (from the ), is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column. A common form ...

when accompanied by an inflammatory response.

Extraspinal sciatica

Fibrovascular entrapment of the sciatic nerve undefined distribution

The sciatic nerve is highly mobile during hip and leg movements. Any pathology which restricts normal movement of the sciatic nerve can put abnormal pressure, strain, or tension on the nerve in certain positions or during normal movements. For example, the presence of

scar tissue "Scar Tissue" is the first single from American rock band Red Hot Chili Peppers' seventh studio album, ''Californication'' (1999). Released on May 25, 1999, the song spent a then-record 16 consecutive weeks atop the US ''Billboard'' Hot Modern R ...

around a nerve can cause traction neuropathy. A well known muscular cause of extraspinal sciatica is

. The

is directly adjacent to the course of the sciatic nerve as it traverses through the intrapelvic space. Pathologies of the piriformis muscle such as injury (e.g. swelling and scarring), inflammation (release of

cytokine Cytokines () are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are produced by a broad range of cells, including immune cells like macrophages, B cell, B lymphocytes, T cell, T lymphocytes ...

s affecting the local cellular environment), or space occupying lesions (e.g. tumor, cyst, hypertrophy) can affect the sciatic nerve. Anatomic variations in nerve branching can also predispose the sciatic nerve to further compression by the piriformis muscle, such as if the sciatic nerve pierces the piriformis muscle. The sciatic nerve can also be entrapped outside of the pelvic space and this is called

deep gluteal syndrome Deep gluteal syndrome describes the non- discogenic extrapelvic entrapment of the sciatic nerve in the deep gluteal space. In simpler terms this is sciatica due to nerve irritation in the buttocks rather than the spine or pelvis. It is an extensio ...

. Surgical research has identified new causes of entrapment such as fibrovascular scar bands, vascular abnormalities, heterotropic ossification,

gluteal muscles The gluteal muscles, often called glutes, are a group of three muscles which make up the gluteal region commonly known as the buttocks: the gluteus maximus muscle, gluteus maximus, gluteus medius muscle, gluteus medius and gluteus minimus muscl ...

hamstring muscles A hamstring () is any one of the three posterior thigh muscles in human anatomy between the hip and the knee: from medial to lateral, the semimembranosus, semitendinosus and biceps femoris. Etymology The word "ham" is derived from the Old Englis ...

, and the gemelli-

obturator internus The internal obturator muscle or obturator internus muscle originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis (bone), pubis. It exits the pelvis, pelvic cavity through the lesser sc ...

complex. In almost half of the endoscopic surgery cases, fibrovascular scar bands were found to be the cause of entrapment, impeding the movement of the sciatic nerve.

Diagnosis

Sciatica is typically diagnosed by physical examination, and the history of the symptoms.

Physical tests

Generally, if a person reports the typical radiating pain in one leg, as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed. The most frequently used diagnostic test is the

straight leg raise The straight leg raise is a test that can be performed during a physical examination, with the leg being lifted actively by the patient or passively by the clinician. If the straight leg raise is done actively by the patient, it is a test of fu ...

to produce

Lasègue's sign The straight leg raise is a test that can be performed during a physical examination, with the leg being lifted actively by the patient or passively by the clinician. If the straight leg raise is done actively by the patient, it is a test of fu ...

, which is considered positive if pain in the distribution of the sciatic nerve is reproduced with passive flexion of the straight leg between 30 and 70 degrees. While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica. Straight leg raising of the leg unaffected by sciatica may produce sciatica in the leg on the affected side; this is known as the Fajersztajn sign. The presence of the Fajersztajn sign is a more specific finding for a herniated disc than Lasègue's sign. Maneuvers that increase intraspinal pressure, such as coughing, flexion of the neck, and bilateral compression of the

jugular vein The jugular veins () are veins that take blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid muscle. Struc ...

s, may transiently worsen sciatica pain.

Medical imaging

Imaging modalities such as

computerised tomography A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

or magnetic resonance imaging can help with the diagnosis of lumbar disc herniation. Both are equally effective at diagnosing lumbar disk herniation, but computerized tomography has a higher radiation dose.

Radiography Radiography is an imaging technology, imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiog ...

is not recommended because disks cannot be visualized by

X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

s. The utility of MR neurography in the diagnosis of piriformis syndrome is controversial.

Discography Discography is the study and cataloging of published sound recordings, often by specified artists or within identified music genres. The exact information included varies depending on the type and scope of the discography, but a discography entry ...

could be considered to determine a specific disc's role in an individual's pain.

involves the insertion of a needle into a disc to determine the pressure of disc space.

Radiocontrast Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically iod ...

is then injected into the disc space to assess for visual changes that may indicate an anatomic abnormality of the disc. The reproduction of an individual's pain during

discography Discography is the study and cataloging of published sound recordings, often by specified artists or within identified music genres. The exact information included varies depending on the type and scope of the discography, but a discography entry ...

is also diagnostic.

Differential diagnosis

Cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

should be suspected if there is previous history of it, unexplained weight loss, or unremitting pain. Spinal

epidural abscess An epidural abscess refers to a collection of pus and infectious material located in the epidural space superficial to the dura mater which surrounds the central nervous system. Due to its location adjacent to brain or spinal cord, epidural absce ...

is more common among those who have

diabetes mellitus Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained hyperglycemia, high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or th ...

immunodeficiency Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that aff ...

, or who have had spinal

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

injection Injection or injected may refer to: Science and technology * Injective function, a mathematical function mapping distinct arguments to distinct values * Injection (medicine), insertion of liquid into the body with a syringe * Injection, in broadca ...

catheter In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...

; it typically causes

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

leukocytosis Leukocytosis is a condition in which the white cell (leukocyte) count is above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain parasit ...

and increased

erythrocyte sedimentation rate The erythrocyte sedimentation rate (ESR or sed rate) is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. It is a common hematology test, and is a non-specific measure of in ...

. If cancer or spinal epidural abscess is suspected, urgent

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

is recommended for confirmation.

Proximal diabetic neuropathy Proximal diabetic neuropathy, also known as diabetic amyotrophy, is a complication of diabetes mellitus that affects the nerves that supply the thighs, hips, buttocks and/or lower legs. Proximal diabetic neuropathy is a type of diabetic neuropathy ...

typically affects middle aged and older people with well-controlled type-2

; onset is sudden, causing pain, usually in multiple dermatomes, quickly followed by weakness. Diagnosis typically involves

electromyography Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyo ...

and lumbar puncture.

Shingles Shingles, also known as herpes zoster or zona, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. T ...

is more common among the elderly and immunocompromised; typically, pain is followed by the appearance of a

rash A rash is a change of the skin that affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracke ...

with small blisters along a single

. Acute Lyme radiculopathy may follow a history of outdoor activities during warmer months in likely tick habitats in the previous 1–12 weeks. In the U.S., Lyme is most common in

New England New England is a region consisting of six states in the Northeastern United States: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. It is bordered by the state of New York (state), New York to the west and by the ...

and

Mid-Atlantic Mid-Atlantic or Mid Atlantic can refer to: *The middle of the Atlantic Ocean *Mid-Atlantic English, any mix between British and American English *Mid-Atlantic Region (Little League World Series), one of the United States geographic divisions of the ...

states and parts of

Wisconsin Wisconsin ( ) is a U.S. state, state in the Great Lakes region, Great Lakes region of the Upper Midwest of the United States. It borders Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michig ...

and

Minnesota Minnesota ( ) is a U.S. state, state in the Upper Midwestern region of the United States. It is bordered by the Canadian provinces of Manitoba and Ontario to the north and east and by the U.S. states of Wisconsin to the east, Iowa to the so ...

, but it is expanding to other areas. The first manifestation is usually an expanding rash possibly accompanied by flu-like symptoms. Lyme can also cause a milder, chronic radiculopathy an average of 8 months after the acute illness.

Management

Sciatica can be managed with a number of different treatments with the goal of restoring a person's normal functional status and

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

. When the cause of sciatica is

lumbar disc herniation A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, ...

(90% of cases), most cases resolve spontaneously over weeks to months. Initially treatment in the first 6–8 weeks should be conservative. More than 75% of sciatica cases are managed without surgery. Smokers with sciatica are strongly urged to

quit Quit or quitter may refer to: * Resignation or quit, the formal act of giving up one's duties Films * ''The Quitter'' (1916 film), an American silent western film * ''The Quitter'' (1929 film), an American silent film * ''The Quitter'' (1934 ...

in order to promote healing. Treatment of the underlying cause of nerve compression is needed in cases of

, epidural tumors, and

Physical activity

Physical activity is often recommended for the

conservative management Conservative treatment is a type of medical treatment defined by the avoidance of invasive measures such as surgery or other invasive procedures, usually with the intent to preserve function or body parts. For example, in appendicitis, conservati ...

of sciatica for persons who are physically able. Bed rest is not recommended. Although structured exercises provide small, short-term benefit for leg pain, in the long term no difference is seen between exercise or simply staying active. The evidence for

physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

in sciatica is unclear though such programs appear safe. Physical therapy is commonly used. Nerve mobilization techniques for sciatic nerve are supported by tentative evidence.

Medication

There is no one medication regimen used to treat sciatica. Evidence supporting the use of

opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

s and

s is poor. Low-quality evidence indicates that NSAIDs do not appear to improve immediate pain, and all NSAIDs appear to be nearly equivalent in their ability to relieve sciatica. Nevertheless, NSAIDs are commonly recommended as a first-line treatment for sciatica. In those with sciatica due to

botulinum toxin Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon en ...

injections may improve pain and function. While there is little evidence supporting the use of epidural or systemic

steroids A steroid is an organic compound with four fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter mem ...

, systemic steroids may be offered to individuals with confirmed disc herniation if there is a contraindication to NSAID use. Low-quality evidence supports the use of

for acute pain relief in those with chronic sciatica.

Anticonvulsant Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-seizure medications (ASM)) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also used in the treatme ...

s and

biologics A biopharmaceutical, also known as a biological medical product, or biologic, is any pharmaceutical drug product manufactured in, extracted from, or semisynthesized from biological sources. Different from totally synthesized pharmaceuticals, th ...

have not been shown to improve acute or chronic sciatica.

Antidepressants Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sexu ...

have demonstrated some efficacy in treating chronic sciatica, and may be offered to individuals who are not amenable to NSAIDs or who have failed NSAID therapy.

Surgery

If sciatica is caused by a herniated disc, the disc's partial or complete removal, known as a

discectomy A discectomy (also called open discectomy, if done through a 1/2 inch or larger skin opening) is the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord. The procedure involves removing a portion of an int ...

, has tentative evidence of benefit in the short term. A modest reduction in pain is seen after 26 weeks, but not after one year (about 52 weeks). If the cause is spondylolisthesis or spinal stenosis, surgery appears to provide pain relief for up to two years. For non-discogenic sciatica, the surgical treatment is typically a

nerve decompression A nerve decompression is a neurosurgical procedure to relieve chronic, direct pressure on a nerve to treat nerve entrapment, a pain syndrome characterized by severe chronic pain and muscle weakness. In this way a nerve decompression targets the ...

. A decompression seeks to remove tissue around the nerve that may be compressing it or restricting movement of the nerve.

Alternative medicine

Low to moderate-quality evidence suggests that

is an effective treatment for acute sciatica. For chronic sciatica, the evidence supporting spinal manipulation as treatment is poor. Spinal manipulation has been found generally safe for the treatment of disc-related pain; however, case reports have found an association with

, and it is

contraindicated In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a rea ...

when there are progressive neurological deficits.WHO guidelines on basic training and safety in chiropractic. "2.1 Absolute contraindications to spinal manipulative therapy", p. 21.

WHO The World Health Organization (WHO) is a specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Geneva, Switzerland, and has 6 regional offices and 15 ...

Prognosis

About 39% to 50% of people with sciatica still have symptoms after one to four years. In one study, around 20% were unable to work at their one-year followup, and 10% had surgery for the condition.

Epidemiology

Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.

References

External links

* {{Authority control Orthopedic problems Pain Peripheral nervous system disorders Symptoms and signs: musculoskeletal system Wikipedia emergency medicine articles ready to translate Wikipedia medicine articles ready to translate