Sciatica treatment without surgery

Sciatica is a description, not a diagnosis. It means pain travelling along the course of the sciatic nerve: from the lower back or buttock, down the back or side of the thigh, often into the calf and foot. The pain comes from irritation of one of the nerve roots that join to form the sciatic nerve.

The most common cause is a bulging or herniated disc pressing on a nerve root. Others include narrowing of the spaces the nerves pass through (foraminal or canal stenosis) from age-related changes, a slipped vertebra (spondylolisthesis), and swollen facet joints. Pain from the sacroiliac joint or a tight piriformis muscle in the buttock can imitate sciatica without a nerve root being involved. Treating the right cause makes the difference.

Most episodes improve within weeks to a few months. Early treatment is pain relief, nerve-pain medicines, avoiding prolonged bed rest and gentle physiotherapy. If the pain stays severe, a steroid epidural or nerve root injection is a common next step.

Surgery, such as microdiscectomy for a disc or decompression for stenosis, is considered when pain persists despite treatment, when weakness is significant or getting worse, or in an emergency. For the many patients in between, an accurate diagnosis and a targeted injection can avoid months of trial and error.