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Pain radiating into the leg (sciatica)

Before anything else — 4 symptoms that need urgent care
  • •Progressive weakness in the leg or foot (cannot lift foot, toes, or knee)
  • •Loss of bladder or bowel control
  • •Saddle anesthesia
  • •Bilateral leg symptoms
Full red-flag guide

Likely conditions

Common causes based on epidemiology alone — a physical exam and sometimes imaging are needed to identify which one applies to you.

Sciatica (lumbar radiculopathy)

10–40% lifetime prevalence

Condition detail

Lumbar disc herniation

Most common cause of sciatica under age 50

Condition detail

Lumbar spinal stenosis

Most common cause of sciatica over age 60

Condition detail

Piriformis syndrome

5–6% of low back pain with leg symptoms

Condition detail

Who to see first

Physical Medicine & Rehabilitation (PM&R)

Physicians who specialize in non-surgical treatment of musculoskeletal and nerve-related conditions. Often called "physiatrists."

When to see them: First stop for most persistent back or neck pain without red flags. Non-surgical. Often faster to book than a spine surgeon.

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Treatment sequence

Published guidelines (NASS, AAOS, ACP, NICE) recommend a conservative-first sequence unless red flags are present. Each step below lists the evidence strength and the primary source.

  1. 1
    Week 1–2Strong evidence

    Initial conservative care

    NSAIDs, short activity modification, and early physical therapy referral. Most acute radicular pain episodes improve significantly within 6 weeks regardless of specific intervention.

  2. 2
    Week 2–6Strong evidence

    Physical therapy + medication optimization

    PT with neural mobilization, directional preference exercises, and core stabilization. Neuropathic pain medications (gabapentin, pregabalin) may be added for nerve-related pain but have modest effect sizes.

  3. 3
    Week 6–12Moderate evidence

    Epidural steroid injection

    Transforaminal or interlaminar epidural steroid injection for persistent radicular pain. Typical response is 2–12 weeks of meaningful relief; some patients experience longer-term benefit. Not curative for the underlying structural cause.

    Source

  4. 4
    Week 8–12+Strong evidence

    Surgical consultation (microdiscectomy or decompression)

    For patients with persistent radicular pain and functional impairment despite 6–12 weeks of quality conservative care, surgical decompression produces faster and greater symptom relief than continued conservative care. The benefit is most pronounced for leg pain; back pain response is less predictable.

    Sources

Common causes

  • •Lumbar disc herniation compressing a nerve root
  • •Lumbar spinal stenosis
  • •Foraminal narrowing
  • •Piriformis syndrome (non-disc origin)

Your next steps

  • 1Screen yourself for red flags. If any apply, go to an emergency department before continuing with this Guide.
  • 2Start the first stage of the treatment ladder. Most new pain episodes improve significantly in the first 2–6 weeks with self-care and PT.
  • 3If symptoms persist, book with the specialist above. Bring: when it started, what makes it better or worse, medications tried, any imaging you have, and the questions from our surgery decision framework.
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