Do I Have Sciatica?

Part 1 — Pain Location and Character

• Sharp, shooting, or burning pain that starts in the lower back or buttock — not just a general ache
• Pain that travels down the back of the thigh, into the calf, or all the way to the foot
• Pain predominantly on ONE side of the body
• Leg pain is worse than back pain — or leg pain exists without much back pain
• Pain sharply worsens when you cough, sneeze, or strain

Part 2 — Numbness, Tingling, and Weakness

• Numbness or tingling (‘pins and needles’) that travels down the leg or into the foot
• Numbness on the top of the foot or between the big toe and second toe (L4–L5 nerve root pattern)
• Numbness on the outer edge or sole of the foot (L5–S1 nerve root pattern)
• Weakness in the affected leg — difficulty climbing stairs, rising from a chair, or walking on your heels
• Foot drop — catching your toes on the ground when walking

Part 3 — What Makes It Better or Worse

• Pain worsens significantly after sitting more than 20–30 minutes
• Pain improves when you lie down or walk slowly
• Straightening the affected leg while lying down reproduces the pain (positive straight leg raise test)

What Your Answers Suggest

Three or more items in Part 1, plus findings in Parts 2 or 3, suggests nerve root compression — most likely from a herniated lumbar disc or spinal stenosis. That does not mean surgery. The AAOS reports that 80–90% of sciatica patients recover without surgery. Even in the SPORT trial (JAMA 2006, n=501) — the largest RCT ever comparing surgery versus non-operative care for lumbar disc herniation — 45% of patients randomized to non-operative treatment were doing well enough at 2 years that they never needed surgery. Both groups improved significantly from baseline; surgical patients simply improved faster and to a greater degree early on.

If symptoms are primarily back pain without the radiating leg pattern, a muscular or mechanical cause is more likely — which responds well to physical therapy and activity modification.

What Causes Sciatica?

Herniated Lumbar Disc — Most Common Under 50

The inner gel of the disc pushes through a tear in the outer ring and contacts the nerve root. L4–L5 and L5–S1 are the most commonly affected levels. Larger herniations — including complete extrusions — actually have the highest rates of spontaneous resorption. The body treats the extruded material as foreign and resorbs it over 6–18 months in many cases.

Lumbar Spinal Stenosis — More Common After 50

Bone spurs, thickened ligaments, and disc collapse gradually narrow the spinal canal. This produces neurogenic claudication — leg cramping and weakness that comes on with walking and resolves quickly when you sit down or lean forward. Unlike disc herniation, stenosis pain is less sharp and often affects both legs rather than just one.

Your Path to Getting Better

Weeks 1–4:  Start with what works

Activity modification, NSAIDs if tolerated, gentle walking. Complete bed rest is not helpful. Most patients begin improving within 4–6 weeks.

Weeks 2–8:  Physical therapy

Structured PT through Go Rehab Physical Therapy — McKenzie extension exercises for disc-related sciatica, neural mobilization, core stabilization. The direction of exercises matters.

4–6 weeks with no improvement:  Specialist evaluation and imaging

MRI of the lumbar spine identifies the level and cause of nerve compression. Dr. Grewal correlates imaging with your symptoms and physical exam before making any recommendations.

If MRI confirms significant compression:  Epidural steroid injection

Fluoroscopically-guided injection by Dr. Patwary delivers corticosteroids directly to the inflamed nerve root — providing meaningful 4–12 week pain relief.

If conservative care has failed at 6–12 weeks:  Surgical evaluation

Lumbar microdiscectomy removes the fragment pressing on the nerve. Outpatient procedure; >90% of properly selected patients experience significant improvement in leg pain. The majority of patients never reach this step.