Sciatica typically resolves within four to twelve weeks with conservative care: physical therapy, anti-inflammatory medication, activity modification, and time. About 10 to 15 percent of cases require interventional procedures like fluoroscopically-guided epidural steroid injections to break the inflammatory cycle. A smaller fraction — under 10 percent — ultimately benefit from minimally invasive surgery. The clinical work is figuring out which category a given patient falls into. Grewal Orthopedic & Spine Care evaluates and manages sciatica across four Long Island and Queens locations: East Meadow, Westbury, Lindenhurst, and Elmhurst. Same-day evaluation is available at East Meadow; call (516) 743-9450.
What sciatica actually is
Sciatica is a symptom, not a diagnosis. The sciatic nerve is the largest nerve in the human body — about as thick as a finger at its origin — and runs from the lower spine through the buttock and down the back of each leg. When something compresses or irritates a nerve root that contributes to the sciatic nerve (most commonly at L4-L5 or L5-S1), the result is a characteristic pattern of pain, often accompanied by tingling, numbness, or weakness, that radiates from the lower back through the buttock and down the leg, sometimes to the foot.
The most common underlying causes are lumbar disc herniations (responsible for roughly 90 percent of clinically significant sciatica in adults under 50), lumbar spinal stenosis (more common after age 60), spondylolisthesis, and less frequently piriformis syndrome. Identifying the specific cause matters because the treatment trajectory differs.
How sciatica typically presents
• Pain radiating from the lower back down one leg, often described as burning, electric, or shooting. Bilateral sciatica is much less common and warrants more careful evaluation.
• Pain that worsens with sitting and is partially relieved by walking or lying flat. The opposite pattern — pain worse with walking, better with sitting — is more typical of spinal stenosis. • Tingling or numbness in specific dermatomes. L5 distribution involves the top of the foot and big toe; S1 involves the back of the calf and lateral foot.
• Weakness in foot or leg muscles. Trouble lifting the foot (foot drop) or pushing off when walking signals more significant nerve involvement.
• In rare but serious cases, loss of bowel or bladder function alongside severe leg pain. This is a surgical emergency (cauda equina syndrome) requiring an emergency room evaluation.
How we diagnose sciatica
The first visit is a focused clinical evaluation. History takes about ten minutes: when the pain started, what triggered it, what makes it better or worse, what’s been tried, what medications are on board, and any red flag symptoms. Physical examination focuses on neurologic findings: strength testing of specific muscle groups, reflex testing at the knee and ankle, sensory testing, straight-leg raise testing, and assessment of gait and posture.
Most patients with classic sciatica do not need imaging on the first visit. The natural history is favorable, and an early MRI often shows findings that don’t change the management plan. Imaging is typically ordered if conservative care hasn’t produced meaningful improvement at four to six weeks, if there are red flag symptoms, or if interventional or surgical treatment is being considered. When imaging is needed, it’s coordinated through the Westbury location, where MRI, CT, X-ray, and ultrasound are on site.
Conservative treatment — where most sciatica should start
Roughly 80 to 90 percent of acute sciatica cases improve within twelve weeks with conservative management:
• Activity modification rather than bed rest. Bed rest beyond a day or two has been shown to slow recovery, not accelerate it.
• Anti-inflammatory medication for acute inflammation in the first two to three weeks, typically NSAIDs.
• Focused physical therapy emphasizing core stabilization, hip and gluteal strengthening, and neural mobilization. Generic stretching is not the same as therapy directed at the specific dermatomal pain pattern.
• Selective heat application, ergonomic adjustments at work and home, and a structured home exercise program.
Interventional treatment — when conservative care plateaus
If sciatica isn’t meaningfully improving by four to six weeks, the next step is usually an MRI to confirm the underlying anatomy and discuss interventional pain management. The most common procedure is the fluoroscopically-guided epidural steroid injection, which delivers anti-inflammatory medication directly to the inflamed nerve root under live X-ray guidance with contrast confirmation.
Realistic expectations: approximately 60 to 75 percent of appropriately selected patients experience clinically meaningful relief from a single epidural injection. The injection isn’t a structural repair; it interrupts the pain-inflammation cycle, often allowing the disc to heal naturally and the patient to engage productively in physical therapy. Procedures are performed at the Westbury procedural suite.
Surgical options — reserved for the right cases
Surgery for sciatica is considered when conservative and interventional treatments haven’t produced meaningful relief over a reasonable timeline (typically three to six months), when there’s significant or progressive neurological compromise, or when imaging shows a clearly surgical lesion. The most common surgical procedure for disc-related sciatica is the lumbar microdiscectomy: a minimally invasive procedure removing the portion of the herniated disc compressing the nerve root.
Outcomes from microdiscectomy in well-selected patients are favorable. Roughly 90 percent experience significant relief of leg pain post-operatively, with typical recovery within six to eight weeks. The procedure is usually performed as an outpatient or with a single overnight stay. Risks include infection, dural tear, recurrent herniation in 5 to 10 percent of cases, and the rare but serious risks of any spine procedure.
When to escalate care urgently
• Loss of bowel or bladder control, or new urinary retention. This is a possible cauda equina syndrome — go to an emergency room.
• Rapidly progressive weakness in the foot or leg, especially foot drop developing over days rather than weeks.
• Severe pain that wakes you from sleep and isn’t relieved by any position or medication. • Fever, unexplained weight loss, or a history of cancer accompanying new back and leg pain.
Frequently asked questions
How long does sciatica usually last?
Most cases improve within four to twelve weeks with conservative care. Roughly 80 to 90 percent of acute sciatica resolves within three months without surgery.
Will sciatica go away on its own?
Often, yes. The natural history of disc-related sciatica is favorable, and a majority of patients recover with time and basic conservative care. The role of a specialist is to identify the cases that need more — interventional or surgical care — and the rare cases that need urgent attention.
Should I get an MRI right away?
Usually not. Early MRI doesn’t change management for most patients, and abnormal findings on MRI are common in people without sciatica. Imaging becomes useful at four to six weeks if pain isn’t improving, or earlier with red flag symptoms.
Do epidural steroid injections actually work for sciatica?
For appropriately selected patients with disc-related radicular pain, yes — roughly 60 to 75 percent experience clinically meaningful relief from a single injection.
Is surgery the answer for sciatica?
For under 10 percent of cases, yes. For the great majority, no. Surgery is the right answer when conservative and interventional care haven’t produced relief over a reasonable timeline, when there’s progressive neurological compromise, or when there’s a specific surgical lesion.
Can sciatica be a workers’ compensation injury?
Yes — particularly when it follows a specific work-related event like a lifting injury, a fall on the job, or repetitive-strain exposure. Documentation of the mechanism of injury at the first visit is critical to supporting the claim. Our practice handles WCB cases in-house.
Where can I be seen for sciatica?
Any of our four locations: East Meadow (30 Merrick Avenue), Westbury (514 Old Country Road), Lindenhurst (150 Sunrise Highway), or Elmhurst (88-12 Queens Boulevard). Same-day evaluation at East Meadow. Call (516) 743-9450.
S C H E D U L E A N E V A L U A T I O N
Call (516) 743-9450. Same-day appointments at East Meadow. Multilingual care available. Workers’ comp and no-fault paperwork handled in-house.
