Sciatica
Pain that shoots from the buttock down the back of the leg, often below the knee, usually from a disc bulge irritating a nerve in the lower back. It can be fierce, but most people get better within 6 weeks to 3 months, and staying active helps.
Symptoms. Leg pain that’s often worse than the back pain, usually on one side, sometimes reaching the foot. Pins and needles, numbness or weakness in the leg or foot. Often worse with coughing, sneezing, bending or sitting.
Causes. Most often a bulging (“slipped”) disc pressing on a nerve root. In older people, narrowing of the spaces in the spine from arthritis. Rarely, a slipped vertebra, infection or tumour. Pregnancy can bring it on too.
How it’s diagnosed. From your story and an examination of strength, feeling and reflexes in your legs. Scans aren’t usually needed at first; an MRI is for warning signs, worsening weakness, or when an injection or surgery is being considered.
The sciatica ladder
Most sciatica settles on its own. The lower steps make the wait more bearable; the upper ones are for pain that isn’t settling or a nerve that’s getting weaker.
- Step 1 · Self-careStay active, plus heat or coldKeep walking and doing normal things as you can, with short rests. Heat or cold packs for comfort.
- Works
- Recommended by national guidelines. Most people improve within 6 weeks to 3 months
- Cost
- Free; heat packs about $10–30
- How long
- Start now
- Watch for
- Long bed rest. Hurt doesn’t mean harm.
Lying still for a week mostly gets you a stiffer back.
- Step 2 · PharmacyAnti-inflammatories, short termIbuprofen or naproxen for a few days to take the edge off.
- Works
- Small benefit at best for sciatica leg pain in trials
- Cost
- About $5–15
- How long
- A few days
- Watch for
- Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
Helps a bit. The clock helps more.
- Step 3 · Allied healthPhysio and exerciseA tailored exercise program and advice on staying active and returning to work.
- Works
- Recommended by guidelines to keep you moving; no single exercise is best
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- A few sessions, then keep going at home
- Watch for
- Avoid heavy lifting and high-impact activity while it’s flared.
Movement is the treatment. The physio is the coach.
- Step 4 · ProcedureEpidural steroid injectionSteroid injected near the irritated nerve, with imaging guidance, for severe pain that isn’t settling.
- Works
- Leg pain about 6 points out of 100 lower than a dummy injection in the short term; no difference long term
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Weeks
- Watch for
- Rare: infection, headache, nerve injury.
A small, short boost. Not a cure.
- Step 5 · SpecialistSurgery (discectomy)Removing the part of the disc pressing on the nerve, for severe leg pain that won’t settle or worsening weakness.
- Works
- Faster relief than waiting, but after 1 year about 95 in 100 had recovered either way. Of those who waited, about 4 in 10 ended up having surgery. About 9 in 10 get relief; about 1 in 20 have pain come back
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs vary
- How long
- Weeks to recover
- Watch for
- Infection, nerve injury, another disc bulge later.
Speed, not a better destination. A reasonable choice if the pain is unbearable.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Pregabalin and gabapentinIn a trial of 209 people, pregabalin was no better than a dummy tablet for leg pain at 8 weeks or a year, with more side effects such as dizziness. NICE advises against these medicines for sciatica.
- Steroid tabletsNICE advises against oral steroids for sciatica.
- Opioids for long-lasting sciaticaNICE advises against them for chronic sciatica. Side effects and dependence, without good evidence of benefit.
- Diazepam and similar medicinesNICE advises against benzodiazepines for sciatica.
- Bed restLong rest slows recovery. Short breaks are fine; keep moving as you can.
What you can do
- Change position often: walk a little every hour rather than sitting for long spells.
- Lie on your side with a pillow between your knees, or on your back with pillows under your knees.
- Avoid heavy lifting and high-impact activity while it’s flared.
- When the leg pain eases, try our back exercise handout.
See your GP if
- Pain isn’t improving after 4 weeks, or is getting worse
- Your leg or foot feels weak, or your foot slaps when you walk
- Pain is severe at night or when lying down
- You also have fever, weight loss, a history of cancer, a weakened immune system or have injected drugs
Go to the emergency department or call 000 (Australia, or your local emergency number) if you have numbness around your genitals or bottom, new trouble passing urine or controlling your bladder or bowel, new sexual problems, or weakness in both legs. These can be signs of cauda equina syndrome, which needs surgery within hours.
Common questions
How long does sciatica last?
Most people improve within 6 weeks to 3 months. Some still have symptoms after a year, but it usually keeps getting better.
Do I need an MRI?
Not usually at first. An MRI is for warning signs, worsening weakness, or when an injection or surgery is being considered.
Does pregabalin (Lyrica) work for sciatica?
Not in good trials. A large Australian trial found it no better than a dummy tablet, with more side effects. NICE advises against it for sciatica.
Should I have surgery?
It’s a reasonable choice if leg pain is severe and not settling, or weakness is getting worse. Surgery speeds recovery, but by a year most people end up in a similar place whether they had it or not.
Helpful resources
- Lower back exercise handoutPrintable, one page, with sets and progressions. Free, from us.
- GLA:D BackAn 8-week education and group exercise program for persistent low back pain, run by trained physios. Ask whether it suits your symptoms. Paid, Australia.
- Healthdirect: SciaticaSymptoms, warning signs and treatment in plain English. Free, Australia.
Evidence and more information
- NICE: Low back pain and sciatica (NG59), rationale
- NEJM (2017): Pregabalin for acute and chronic sciatica (PRECISE trial)
- The Bottom Line: Summary of the PRECISE trial
- BJSM summary: Early surgery vs prolonged conservative care for sciatica (NEJM 2007)
- Annals of Internal Medicine (2012): Epidural steroid injections for sciatica, review summary
- Healthdirect: Sciatica
- Better Health Channel: Sciatica
- Australian Physiotherapy Association: GLA:D Back launches in Australia (2024)
maladywise.com/sciatica/