Sciatica
Sciatica is the common term for radiating pain, numbness, or weakness that travels from the lower back through the buttock and down one leg — following the path of the sciatic nerve. Although the experience of sharp, electric, or burning leg pain can be alarming, the natural history of sciatica is genuinely favorable: the majority of patients improve significantly within 6–12 weeks with appropriate non-operative care. At Maryland Orthopedic Specialists, we diagnose the underlying cause with precision and deliver targeted treatment — including physical therapy, oral medications, and epidural steroid injections — to accelerate recovery and minimize time away from work and activity.
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What is sciatica?
Sciatica is pain that radiates along the sciatic nerve, from the lower back through the buttock and down the leg. It usually results from a herniated disc or spinal narrowing pressing on a nerve root. Symptoms include burning pain, numbness, or tingling, most often in one leg.
The sciatic nerve is the largest nerve in the human body, formed by the convergence of nerve roots from L4, L5, S1, S2, and S3. It exits the pelvis through the greater sciatic foramen, passes beneath (or, in some individuals, through) the piriformis muscle, travels down the posterior thigh, and branches at the popliteal fossa into the tibial and common peroneal nerves.
True radiculopathy vs. referred pain: The term "sciatica" is used loosely in clinical practice. True sciatic radiculopathy results from compression or chemical irritation of a specific lumbar or sacral nerve root at the spine — most commonly from a disc herniation or foraminal stenosis. This produces a dermatomal pattern of pain, numbness, and potentially motor weakness corresponding to the compressed root. Referred pain (from lumbar muscles, facet joints, or the sacroiliac joint) can radiate into the buttock and posterior thigh but does not follow a strict dermatomal pattern and is not true radiculopathy.
Common causes:
- Lumbar disc herniation (the most common cause, especially in patients under 50)
- Lumbar spinal stenosis with foraminal narrowing (more common in older adults)
- Spondylolisthesis with nerve root impingement
- Piriformis syndrome (see below)
- Less commonly: pelvic mass, sacroiliac joint dysfunction, or, rarely, spinal tumor/infection
Treatment options
Most sciatica resolves on its own — 75 to 90% of patients improve within 12 weeks without surgery.
Physical Therapy
Targeted exercises reduce nerve irritation and strengthen the muscles that support the lumbar spine. McKenzie-based directional exercises and nerve gliding techniques are particularly effective at reducing the radiating leg pain that defines sciatica. PT begins as soon as pain allows and is the cornerstone of recovery.
Medications
NSAIDs and short-term oral steroids reduce inflammation around the nerve and help patients stay active during the healing process. Muscle relaxants help when back spasm accompanies the leg pain. Neuropathic agents such as gabapentin address the burning or shooting quality of leg pain that anti-inflammatories alone may not fully control.
Epidural Steroid Injection
A precisely guided injection near the inflamed nerve root provides significant pain relief and allows patients to engage more fully in physical therapy. Epidural steroid injections are most effective when performed within the first 3–6 months of symptoms, before nerve irritation becomes chronic. Effects typically last weeks to months and can make a meaningful difference in recovery speed.
Surgical Referral
Bowel or bladder symptoms require emergency evaluation for cauda equina syndrome, and MOS will direct patients to the appropriate urgent care immediately. When symptoms fail to improve after 6–12 weeks of aggressive conservative care, MOS coordinates elective surgical consultation with a trusted spine specialist.
Frequently Asked Questions
How do I know if my sciatica is serious?
Can sciatica go away on its own?
Is an epidural injection the same as an epidural for childbirth?
How long does an epidural injection take to work?
Can I exercise with sciatica?
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John J. Christoforetti, MD
Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery
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References
- Ropper AH, Zafonte RD. "Sciatica." New England Journal of Medicine 2015;372(13):1240–1248. https://doi.org/10.1056/NEJMra1410151
- Chou R, Hashimoto R, Friedly J, et al. "Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis." Annals of Internal Medicine 2015;163(5):373–381. https://doi.org/10.7326/M15-0934
- Deyo RA, Weinstein JN. "Low back pain." New England Journal of Medicine 2001;344(5):363–370. https://doi.org/10.1056/NEJM200102013440508
- Stafford MA, Peng P, Hill DA. "Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management." British Journal of Anaesthesia 2007;99(4):461–473. https://doi.org/10.1093/bja/aem238
- Siddiq MAB. "Piriformis syndrome and wallet neuritis: are they the same?" Cureus 2018;10(5):e2551. https://doi.org/10.7759/cureus.2551
- OrthoInfo / AAOS. "Herniated Disk in the Lower Back." https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/