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Sciatica

Also called lumbosacral radicular syndrome, lumbosacral radicular pain, lumbar radicular pain, nerve root pain, ischias

How guidelines and reviews define sciatica, leg pain that starts at a nerve root in the lower back, how common it is, how it tends to go, and what trials of rest, exercise, medicines, injections and surgery found.

Region
Spine
Updated
October 9, 2026
Reviewed
October 9, 2026 · how entries are checked

What it is

How guidelines and reviews define it

A NICE guideline uses the word for leg pain secondary to a problem at a lumbosacral nerve root1. It notes that two other terms are more accurate1. They are radicular pain (pain that comes from a nerve root) and radiculopathy (a problem at a nerve root). A 2010 review states that sciatica is a symptom, not a specific condition4.

Reviews describe it in these ways2,5,6:

  • A radiating leg pain. A 2020 Cochrane review describes lumbosacral radicular pain, commonly called sciatica, as a syndrome in which people report radiating leg pain5. A Cochrane review is a systematic review done to the Cochrane Collaboration’s published standards.
  • A pattern in the leg. A 2014 systematic review (a checkable search of the research on a question) describes the pain as radiating in a dermatomal pattern6. The pattern lies in the territory of the sciatic nerve6. A dermatome is the area of skin that one spinal nerve supplies.
  • Leg pain worse than back pain. A 2007 BMJ review states that low back pain may come with sciatica, but the leg pain is usually the more severe2.

Where the pain starts

Two views of the bones of the lower spine, the pelvis on the right side and the top of the right thigh bone, with nerves coloured orange. From the front and slightly to the outer side, orange strands leave the side of the lowest part of the spine, run down across the front of the sacrum and merge into one band that passes back out of the pelvis and down behind the thigh bone. From behind, thin orange strands run down inside the lower spine, and a thick orange nerve comes out below the pelvis, behind the hip joint, and runs down the back of the thigh with thin branches beside it. The discs between the spinal bones are drawn pale blue.
The right sciatic nerve and the nerve roots that join to form it, from the front and from behindRendered by Your Basic Trainer from the Open 3D Model by AnatomyTOOL, which builds on Z-Anatomy and BodyParts3D (Database Center for Life Science). (source, CC BY-SA 4.0). Rendered from the 3D model with only the lower spine, its discs, the sacrum, tailbone, right hip bone and right thigh bone shown, the L4 to S3 nerve roots, lumbosacral trunk, sacral plexus and sciatic nerve coloured orange as one piece, and everything below the upper thigh cut away

The sciatic nerve, the body’s largest, starts in the lower back and runs down the back of the leg as far as the heel7. It arises from the spinal nerves labelled L4 to S37.

A 2007 BMJ article states that in about 90% of cases, a herniated disc compressing a nerve root causes sciatica2. It names spinal narrowing and, less often, tumours as other possible causes2. In a herniated disc, the disc bulges or ruptures backward, or backward and to one side, and presses on nerve roots in the spinal canal8. Herniation of the L4/L5 or L5/S1 disc, both in the lower back, can cause sciatica9.

A 2007 BMJ review states that scans show no lumbar (lower back) disc herniation in many people who have the symptoms of sciatica2.

Who it affects

How common it is

A 2007 BMJ review states that exact figures for how often sciatica occurs are lacking2. Reviews give these estimates2,10,11:

What was estimatedEstimateSource
Share of people with low back pain who have sciatica5% to 10%A 2007 BMJ review2
Annual prevalence of disc-related sciatica in the general population2.2%The same review2
Lifetime share with radicular pain from a herniated lumbar disc, in the sciatic nerve’s territory13% to 40%A second 2007 review10
How common sciatica is, across 23 studies1.2% to 43%A 2008 review11

Prevalence is the share of people in a group who have a condition at a given time. The 2008 review found that 2 of its 23 studies used a clinical assessment to identify sciatica11. Its authors suggest that differences in definitions, data collection and perhaps populations may explain the wide range11.

What goes with it

A systematic review of studies of first-time sciatica identified smoking, obesity, occupational factors and health status as modifiable risk factors6. It identified age, gender and social class as non-modifiable ones6.

Three meta-analyses (studies that pool the results of several earlier studies) put numbers on some of these links, as odds ratios12,13,14. An odds ratio is how many times higher the odds of an outcome are in one group than in another.

  • Smoking. Across 28 studies, current smokers were more likely to have lumbar radicular pain, or sciatica verified clinically, with a pooled odds ratio of 1.4612.
  • Body weight. Across 26 studies, overweight (1.23) and obesity (1.40) were both associated with lumbar radicular pain13.
  • Work. Across 24 studies of workers, heavy physically demanding work was associated with clinician-identified lumbosacral radiculopathy syndrome (2.03)14. Of those studies, 19 were rated at high risk of bias, a rating of how likely flaws are to have skewed a result14.
  • Driving and sitting. The same analysis of studies of workers found no significant association with professional driving or with sitting at work14.

What studies found

How it tends to go

A 2007 BMJ review states that the course of acute sciatica is in general favourable, with most pain and related disability resolving within two weeks2. It reports on people with acute sciatica in the placebo (dummy) groups of randomised trials of non-surgical approaches2. About 50% said they had improved within 10 days, and after four weeks the figure was about 75%2. The same review states that up to 30% go on having pain for a year or more2.

Studies that followed people for longer report15,16,17:

Who was followedWhat was found
183 people with a lumbosacral radicular syndrome, in a randomised trial of two weeks of bed rest or watchful waiting87% of both groups reported improvement after 12 weeks15
609 UK adults seen by a family doctor for back-related leg pain, in a cohort (a group followed over time)55% had improved at 12 months, in the whole sample and in the sciatica group alike16
466 people with sciatica and lumbar disc herniation referred to secondary care (hospital and specialist services), about a third of whom had surgery44% at 1 year and 39% at 2 years had not reached the study’s threshold for success on its main back questionnaire17

Another cohort followed 79 people whose radicular pain from a lumbar disc herniation had resolved without surgery18. In 25%, the pain came back within a year of resolving18.

Rest, exercise and therapist-led programmes

  • Bed rest. In a 2010 Cochrane review, bed-rest advice and stay-active advice differed little or not at all in pain or function, on moderate-quality evidence19.
  • Exercise against advice. A meta-analysis of five randomised trials compared supervised structured exercise with advice to stay active20. Low-quality evidence showed a small short-term effect on leg pain favouring exercise, with no difference in disability20. In the long term, the same review found moderate-quality evidence of no difference in leg pain or disability20.
  • Therapist-delivered programmes. A 2023 meta-analysis of 18 randomised trials (2,699 participants) found no difference in pain or disability between such programmes and control approaches21. The review concluded that the evidence was inadequate to say how well such programmes work21.

Medicines and injections

In a 2012 meta-analysis of randomised trials of pain medicines for sciatica, most pooled estimates did not favour the active medicine over placebo22. The review called the evidence low quality22.

A randomised trial gave 209 people with sciatica the medicine pregabalin or a placebo for up to 8 weeks23. Pregabalin did not significantly reduce leg pain compared with placebo at week 8 or week 5223. More adverse events (unwanted effects seen during a trial) were reported in the pregabalin group, 227 against 12423.

A 2020 Cochrane review covered 25 trials of epidural corticosteroid injections against placebo in people with lumbosacral radicular pain5. An epidural injection goes into the space around the nerves inside the spine. A corticosteroid is a drug that copies a type of hormone the body makes. At short-term follow-up, the injections were probably slightly more effective than placebo for leg pain, by about 5 points on a 0 to 100 scale5. The review concluded that the effects were small, and that patients and clinicians may not see them as clinically important5.

A UK randomised trial enrolled 163 people with sciatica from a herniated lumbar disc lasting 6 weeks to 12 months24. One group was assigned an epidural steroid injection, and the other microdiscectomy, surgery that removes disc material through a small cut24. Disability scores at 18 weeks did not differ significantly between the groups24. Four serious adverse events were associated with surgery and none with the injection24.

Surgery compared with non-surgical care

Three randomised trials compared surgery with non-surgical care3,25,26:

Who was studiedWhat was found
501 surgical candidates in the US with a lumbar disc herniation on imaging and at least 6 weeks of radiculopathyBoth groups improved substantially over 2 years; differences favoured surgery, and for the primary outcomes they were small and not statistically significant25
283 people with 6 to 12 weeks of severe sciaticaLeg pain eased faster with early surgery, and after 1 year the probability of perceived recovery was 95% in both groups3
128 people at a single centre whose sciatica from a lumbar disc herniation had lasted 4 to 12 monthsLeg pain at 6 months averaged 2.8 out of 10 with microdiscectomy and 5.2 with non-operative care, from 7.7 and 8.026

At two years in the 283-person trial, disability scores did not differ significantly between the groups, and 20% of patients reported an unsatisfactory outcome27. At five years, the groups did not differ significantly on the main outcome scores, and 46% of those assigned to non-surgical care had had surgery28.

A 2023 systematic review and meta-analysis pooled randomised trials in people with sciatica from a lumbar disc herniation29. It found very low to low certainty evidence that discectomy (surgery that removes disc material) reduced leg pain more than non-surgical care29. On a 0 to 100 scale, the gap was about 12 points up to three months and a negligible 2.3 points at 12 months29. For disability, it found small, negligible or no effects29. The risk of any adverse event was similar in the two groups29.

Connections

The sciatic nerve page covers the nerve, including the two ways a 2010 review found the word sciatica used4. The disc herniation and intervertebral disc pages cover the disc, including how a herniated disc presses on nerve roots8.

A systematic review of nine studies concluded that low back pain with leg pain appears linked to more pain and disability than back pain alone30.

A 2010 systematic review described piriformis syndrome as sciatica caused by the piriformis muscle compressing the sciatic nerve, and noted that it remained controversial31.

In one randomised trial of flexion-based or extension-based exercise for chronic axial low back pain, the flexion programme included the knee-to-chest stretch32. The one group with transient sciatica was the flexion group, in 3 of 27 patients32. The trial’s authors wrote that the mechanism is unknown32.

Sciatica is described as leg pain in the territory of the

Sciatica is attributed in about 90% of cases, by a 2007 BMJ article, to

Sciatica can follow herniation of a lower lumbar

Sciatica is estimated to affect 5% to 10% of people with

Sciatica is the leg pain named in one definition of

Sciatica was reported in 3 of 27 people in one trial of a flexion programme that included the

Sources

  1. National Institute for Health and Care Excellence (2016). Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence (NICE guideline NG59). Link
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  4. Valat JP, Genevay S, Marty M, Rozenberg S, Koes B (2010). Sciatica.. Best practice & research. Clinical rheumatology. doi:10.1016/j.berh.2009.11.005 PMID 20227645
  5. Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, Koes BW, Ferreira PH, Cohen SP, Pinto RZ (2020). Epidural corticosteroid injections for lumbosacral radicular pain.. The Cochrane database of systematic reviews. doi:10.1002/14651858.CD013577 PMID 32271952
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  7. Giuffre BA, Black AC, Jeanmonod R (2023). Anatomy, Sciatic Nerve. StatPearls. PMID 29494038
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  9. Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, Korol O, Johnson JE, Womble M, DeSaix P (2022). Anatomy and Physiology 2e. OpenStax. Link
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  17. Haugen AJ, Brox JI, Grøvle L, Keller A, Natvig B, Soldal D, Grotle M (2012). Prognostic factors for non-success in patients with sciatica and disc herniation.. BMC musculoskeletal disorders. doi:10.1186/1471-2474-13-183 PMID 22999108
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  19. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB (2010). Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD007612.pub2 PMID 20556780
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  30. Konstantinou K, Hider SL, Jordan JL, Lewis M, Dunn KM, Hay EM (2013). The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature.. The Clinical journal of pain. doi:10.1097/AJP.0b013e31826f9a52 PMID 23328336
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Every source the library cites

Changes

  • First published.