Few kinds of pain are as recognisable as sciatica: a sharp, electric line running from the lower back into the buttock, down the thigh and sometimes past the knee into the foot. It can make sitting unbearable, standing exhausting, and sleep almost impossible.
What surprises most patients is that “sciatica” is not really a diagnosis. It is a description of where the pain travels.
Sciatica versus lumbar radiculopathy
Lumbar Radiculopathy (Sciatica) is the clinical term for irritation or compression of a nerve root as it exits the lumbar spine. Sciatica is the pattern of symptoms this often produces.
The distinction matters because treatment targets the cause, not the sensation. Two people with identical leg pain can need entirely different care depending on what is pressing on the nerve.
What actually causes it
The nerve root can be irritated or compressed by several different structures:
- A Lumbar Disc Herniation pressing on the nerve root
- Lumbar Spinal Stenosis, a narrowing of the space around the nerves
- Lumbar Spondylosis (Back Arthritis) and age-related degeneration
- Lumbar Degenerative Disc Disease
- Sacroiliac Joint Dysfunction & Sacroiliitis referring pain into the buttock
- Previous spine surgery, in some cases
How to tell nerve pain from muscle pain
This is the single most useful distinction a patient can make before an appointment.
Mechanical or muscular back pain tends to stay in the back and buttock, feels achy or tight, and worsens with certain movements.
Nerve-related pain tends to follow a defined path down the leg, and may bring:
- Shooting or burning pain rather than a dull ache
- Numbness or tingling
- Pins and needles in the foot or toes
- Weakness in the leg or foot
- Symptoms that extend below the knee
Pain extending below the knee, numbness, tingling or weakness generally points toward nerve-root involvement and deserves proper evaluation.
When to seek urgent care
Most sciatica is not an emergency. A small number of presentations are. Seek urgent evaluation for pain accompanied by:
- New loss of bladder or bowel control
- Rapidly worsening weakness
- Numbness in the saddle area
- Fever with severe spinal pain
- Sudden inability to walk
These can indicate a condition that needs immediate attention rather than routine treatment.
How sciatica is diagnosed
Because several structures can produce the same leg pain, diagnosis is about narrowing down which one is responsible.
- A detailed history — where the pain travels, what worsens it, how it began
- Physical and neurological examination, including strength, reflexes and sensation
- Imaging such as MRI when the picture warrants it
- Diagnostic injections, which can confirm whether a specific nerve level is involved
Treatment: most people do not need surgery
Many patients initially receive conservative care when appropriate — activity modification, physical therapy, home exercise, anti-inflammatory medication where suitable, and posture or movement changes.
When symptoms persist despite conservative treatment, or significantly interfere with function and quality of life, interventional options may be considered.
Epidural Steroid Injections deliver anti-inflammatory medication into the epidural space around the irritated nerve root, under image guidance. For pain following a specific nerve path, a Lumbar Transforaminal Epidural Steroid Injection targets that individual nerve root more selectively.
Where facet joints are contributing rather than the disc, Medial Branch Blocks can confirm the source and Radiofrequency Ablation may provide longer-lasting relief.
Treatment at TOPS Institute is individualised rather than based solely on the presence of back or leg pain.