Condition
Shooting pain, numbness or tingling down the leg.
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- Registered Chiropractor 註冊脊醫
- Doctor of Chiropractic D’Youville College, USA
- Whampoa & Hung Hom Near Whampoa MTR
Sciatica is pain, tingling or numbness that travels from the lower back or buttock down the back of one leg, often below the knee and into the foot. It happens when one of the nerve roots that form the sciatic nerve is irritated or squeezed, most often by a herniated disc. Many cases improve within weeks to a few months without surgery. Sciatica in both legs, numbness around the groin or a change in bladder or bowel control needs emergency medical care.
Key points
- The leg pain is usually worse than any back pain, and may come with tingling, numbness or weakness in the leg or foot.
- A herniated disc is the most common cause; narrowing around the nerve and a slipped vertebra are others.
- Staying active usually helps more than bed rest. Treatment ranges from exercise and hands-on care to injections; surgery is considered for severe or persistent cases.
- Sciatica on both sides, numbness around the groin, bladder or bowel changes or a weakening leg need prompt medical attention.
The sciatic nerve is the longest nerve in the body. It forms from nerve roots that leave the lower spine, passes through the buttock beneath the piriformis muscle and runs down the back of the thigh. Just above the knee it divides into branches that supply the lower leg and foot.
Sciatica is a description of symptoms rather than a diagnosis: pain that follows the path of this nerve because something is irritating it, usually at a nerve root in the lower back. Where exactly the pain and numbness go depends on which root is involved, which helps pinpoint the source. Back pain alone, without leg symptoms, is not sciatica.
Symptoms usually affect one leg. They may start suddenly, after lifting or bending, or build up over days.
Common symptoms
- Pain in the buttock and down the back or side of the leg, often below the knee, described as sharp, burning or electric
- Tingling, pins and needles or numbness in the leg, foot or toes
- Weakness in the leg or foot, such as difficulty standing on your toes or lifting the front of your foot
- Pain that is worse when you cough, sneeze, strain or sit for a long time
- Lower back pain, usually milder than the leg pain
How it usually progresses
Most sciatica follows a broadly similar course:
- First weeksPain is often at its worst, and sitting, bending and coughing are hardest. Gentle movement usually helps more than rest.
- 6 to 12 weeksMany people improve steadily over this time, with the leg pain easing before any numbness.
- After 3 monthsSymptoms that persist, keep returning or include weakness need a fresh assessment, and sometimes a scan or a specialist opinion.
Symptoms don’t always follow this order, and sciatica can come back, which is why recovery usually includes exercises and changes to sitting and lifting.
Anything that crowds or irritates a nerve root in the lower back can cause sciatica.
- A herniated disc, the most common cause, especially between the ages of 30 and 50 (see Herniated disc)
- Narrowing around the nerves (foraminal or spinal stenosis), often from wear-related changes and bone spurs in older adults
- Spondylolisthesis, where one vertebra slips forward on the one below
- Tightness or irritation around the piriformis muscle in the buttock, which can cause similar pain (see Piriformis syndrome)
- Heavy lifting, long hours sitting or driving, being overweight and smoking
Sciatica is most common between the ages of 30 and 50. Most people with it never need surgery.
These two simple checks can help you describe your symptoms, but they cannot confirm a diagnosis. Don’t try nerve stretch tests at home, such as lifting a straight leg to provoke the pain.
Where exactly does the pain run?
Sketch your symptoms on a body outline, or trace them with a finger. Pain down the outer calf to the top of the foot and big toe, or down the back of the calf to the sole and little toe, points to particular nerve roots. Pain that stops at the buttock or thigh is more often from the joints and muscles of the lower back.
Does coughing or sneezing make the leg pain worse?
Notice whether a cough, a sneeze or straining sends pain down your leg. A sudden rise in leg pain at those moments suggests a nerve root is being irritated, often by a disc.
These checks can’t rule other causes in or out. If symptoms last more than a few weeks, keep coming back or come with weakness, have them properly assessed by a healthcare professional.
Several problems can cause pain in the buttock and leg. Finding where it comes from is the key to choosing the right treatment.
Sciatica (an irritated nerve root in the lower back)
- Where it usually hurts
- From the buttock down the back or side of the leg, often below the knee into the foot
- Other clues
- Tingling or numbness; worse with coughing, sneezing or sitting
Piriformis syndrome
- Where it usually hurts
- Deep in the buttock, sometimes down the back of the thigh
- Other clues
- Worse sitting on a hard seat; tender in the middle of the buttock; back movements often pain-free
Hip or sacroiliac joint problems
- Where it usually hurts
- The groin, the side of the hip, or low down on one side of the back
- Other clues
- Usually stops above the knee; worse with walking, stairs or standing on one leg
Poor circulation in the leg (vascular claudication)
- Where it usually hurts
- The calf, sometimes the thigh or buttock
- Other clues
- Comes on when walking and eases within minutes of standing still; see a doctor
Narrowing of the spinal canal can also cause leg pain on walking, but it usually eases on sitting or bending forward rather than on standing still.
Further reading: Piriformis syndrome, Herniated disc, Hip pain.
Diagnosis relies mainly on your history and a physical examination. A scan is needed only in some cases.
Your history: Where the pain and numbness go, what makes them worse, and how they started, with questions to check for warning signs.
Physical examination: Checking how your lower back and hips move, and testing the strength, reflexes and sensation in your legs, including gentle tests of how the nerve responds to stretch.
Further tests: An MRI scan may be needed if symptoms are severe or getting worse, there is weakness, or surgery or an injection is being considered. If needed, Dr. Ho will refer you for a scan or to an orthopaedic doctor.
Most people improve with non-surgical treatment. Treatment usually aims to ease the leg pain, keep you moving and take pressure off the irritated nerve.
Non-surgical treatment
- Staying active: Keeping up normal activities as far as you can and avoiding long periods of sitting or lying down. Moving may hurt, but it is not harmful.
- Exercise and rehabilitation: Gentle exercises started early, then strengthening for the trunk and hips, built up gradually under guidance.
- Cox flexion-distraction (spinal decompression): A gentle, rhythmic technique on a special table, often considered when a disc is involved.
- Soft tissue treatment: Releasing tight muscles in the lower back, buttock and leg, which may ease pain in the short term.
- Spinal manipulation and mobilisation: Hands-on treatment to the lower back, which may help some people, as part of a plan that includes exercise.
- Heat: A heat pack on the lower back or buttock may ease muscle spasm and pain.
Treatment prescribed by a doctor
- Medication or injections: Ask a doctor or pharmacist which painkillers suit you; trials suggest common painkillers and some nerve-pain medicines help sciatica less than hoped. For severe pain, a specialist may offer a steroid injection around the nerve (epidural), which may ease pain for a time.
Surgery
- Discectomy or decompression: Removing the part of the disc or bone pressing on the nerve. It may be considered for severe pain that persists despite non-surgical treatment, or for weakness that is getting worse. Bladder or bowel problems need emergency surgery.
Dr. Ho first finds where the nerve is being irritated, then plans treatment based on the findings. General information only — your plan is set after an in-person assessment.
- 01
Assess
Examining your lower back, pelvis and hips and testing the nerves to your legs, to find the source of the pain and check for anything that needs a doctor’s attention.
- 02
Treat
Targeted adjustment and soft tissue release, with Cox flexion-distraction (spinal decompression) where a disc is involved.
- 03
Exercise and habits
Gentle exercises that ease the leg symptoms, building to strengthening, with advice on sitting, lifting, sleeping and keeping active.
- 04
Refer
If there is weakness, symptoms don’t improve, or a scan, injection or surgical opinion may be needed, you will be referred to a doctor or for imaging.
The habits that protect the lower back also help keep sciatica from coming back.
- Keep moving: break up sitting every 30 to 60 minutes, and choose short, regular walks.
- Exercise regularly to keep the trunk and hip muscles strong; swimming, walking, yoga and pilates may all help.
- Lift with the load close to your body, bending at your hips and knees, and don’t twist as you lift.
- Sit with your feet flat and your lower back supported, and get out of the car for a short walk on long drives.
- Sleep on your side with a pillow between your knees, or on your back with a pillow under your knees.
- Keep to a healthy weight, and don’t smoke: smoking makes discs more prone to problems.
When to seek medical attention promptly
Seek medical attention promptly if any of the following apply:
- Sciatica in both legs, or weakness or numbness in both legs that is severe or getting worse (go to A&E)
- Numbness around the buttocks, genitals or inner thighs (go to A&E immediately)
- New difficulty passing urine, or loss of bladder or bowel control (go to A&E immediately)
- Weakness in one leg that is getting worse, or a foot that drops or catches when you walk
- Leg pain after a significant fall or accident
- Back or leg pain with a fever, unexplained weight loss, or a past history of cancer
Lower back pain stays mainly in the back, though it may spread into the buttock or thigh. Sciatica is leg pain from an irritated nerve: it usually runs below the knee, is often worse than the back pain, and may come with tingling, numbness or weakness.
Many cases improve within weeks to a few months, but it can last longer or come back. Staying active and the right exercises may help you recover sooner. Weakness, or symptoms that keep getting worse, need prompt assessment.
Usually not. Most people improve with non-surgical treatment. Surgery may be considered if severe pain persists despite treatment or weakness is getting worse, and is needed urgently if bladder or bowel control is affected.
Yes, within comfort. Walking, swimming and gentle exercises usually help. Ease off activities that clearly send pain down the leg, such as heavy lifting or long runs, and build back up gradually.
Many people find it easiest to lie on their side with the painful leg on top and a pillow between the knees, or on their back with a pillow under the knees. Choose the position that eases your leg pain.
Disclaimer
This page is general information only, not a diagnosis or treatment advice. If you have any symptoms, please consult a qualified healthcare professional.
Treatment
Spinal Decompression
Gentle, controlled traction using a Cox flexion/distraction table to relieve pressure on the spine and discs.Read more
Soft Tissue Care
Hands-on and instrument-assisted soft tissue work, including the Graston Technique, to address muscle and fascial tightness.Read more
Rehabilitation
Guided exercises to rebuild strength, stability, and mobility, and help reduce the chance of recurrence.Read more
Book a consultation with Dr. Ho, or message us on WhatsApp with any questions first.