Despite all the ligaments, discs, and muscles that protect our spines, the most common chronic pain for adults in the U.S is lower back pain. Up to 90% of people will experience an episode of back pain at some point in their lives. Because this pain is so common, there are many at-home treatments and remedies. But for the estimated 5-10% of patients with lower back pain who also have sciatica, recovery and treatment can be more difficult.
Sciatica may also be called lumbar radiculopathy, and this pinched nerve can be incredibly painful and sensitive, and lead to weakness and numbness of the leg. The type of pain and its severity varies, and symptoms can be extremely uncomfortable or debilitating. In this article, I’ll look into the causes of sciatica and how long a person can expect to deal with symptoms by exploring what sciatica is, how long the pain lasts, and what causes it to flare up. I’ll also discuss how to manage sciatica pain, when to see a doctor, and outline some additional prevention tips.
What is Sciatica?
The sciatic nerve is the body’s longest and widest nerve. It extends from the lower spine around the pelvis, hip, and thigh and down to the foot. Irritation of this nerve leads to pain, numbness, or weakness that can run down the entire side of one leg, or both—this irritation of the sciatic nerve is what’s called sciatica. Other common symptoms of sciatica include a burning sensation, sharp, shooting pains, tingling or numbness, and worsening pain with extended periods of inactivity or sitting.
About 90% of sciatica cases are caused by a bulging disc with nerve root compression in the spine. Discs are donut-like structures that sit between the bones of the spine, preventing vertebrae from painfully knocking into each other. If the outer rim of a disc tears or bulges, usually due to pressure on the lower back, the jelly-like material that usually lives in the disc pushes into the spine and pinches or inflames the nearby nerve. This is sometimes known as a herniated disc, and is the main cause of sciatica symptoms.
Sciatica is most common in people between 30-50 years old, though younger people involved in physical sports or other strenuous activities can also develop the condition. Other ways that the sciatic nerve can be irritated or compressed include:
- Spinal stenosis, or narrowing of the spinal canal, often associated with age
- Osteophyte formation (bone spur off the spine)
- Spondylolisthesis, or a slipped vertebrae
- Family history of degenerative bone conditions
- In very rare cases, tumor growth
Other risk factors for developing sciatica include poor posture, improper lifting techniques, or a past car accident, fall, or other injury.
How Long Does Sciatica Pain Last?
Up to 30% of sciatica sufferers may continue to have pain for more than a year. For those patients, more advanced treatment from a specialist may be needed.
But for most people, sciatica pain will improve or resolve in 1-2 weeks For these patients, behavioral modifications and at-home treatments can help speed recovery, or they can just wait for healing over time. Sciatica usually goes away on its own for 3 out of 4 sufferers, due to the spine being able to reabsorb the disc material causing symptoms.
Although most episodes of sciatica will resolve, symptoms often re-appear over the ensuing years after the initial injury, especially with age or repeated stress on the back. Once you have had more than one episode of sciatica, it is likely to become chronic, flaring up from time to time or causing ongoing symptoms. This is why we recommend seeking medical care from a spine specialist to address underlying issues and hopefully prevent long-standing or worsening symptoms.
What Causes Sciatica Flare-ups?
Many things can cause sciatica to flare up. Some are related to lifestyle, and some are beyond your control—like genetics or age. Common causes for sciatic flare-ups include:
- Sitting for long periods: This is especially true when sitting with bad posture.
- Lifting heavy objects by bending over: When lifting by bending over—”lifting with your back”—instead of squatting down, you can potentially slip a disc, which can put pressure on the sciatic nerve and cause a flare-up. Twisting while holding or lifting something heavy puts stress on the spine as well.
- Carrying more weight than usual: This puts extra pressure on the spine.
- Wearing the wrong shoes: High heels pitch your body forward, putting extra pressure on the hips, while uncushioned shoes transfer the impact of steps to the back and hips.
How To Manage the Pain
Many patients understandably assume that the worse the pain is, the more likely something seriously bad is going on with their bodies. That isn’t necessarily true for sciatica. The body can heal and reabsorb the disc material causing symptoms, even in severe cases. So instead of relying on surgery, most treatment for sciatica focuses on controlling pain while keeping patients active and in tune with their spines.
In most cases, sciatic pain can be relieved through the right kind of rest and activity, and by altering certain behaviors. Try to avoid sitting or lying down for long periods, and take short walks to stay active.
Other home remedies and treatment options include:
- Lying down with a heat or ice pack on the affected area for a few minutes
- Having the area massaged
- Over-the-counter anti-inflammatory pain relief medication like ibuprofen (Advil), acetaminophen (Tylenol), or naproxen (Aleve)
- Prescription pain relief medication if symptoms are severe
- Topical lidocaine patches or creams
- Physical therapy
Severe or prolonged sciatica symptoms often require medical treatment. One common prescription is for physical therapy, which can help prevent future flare-ups by strengthening muscles and tendons in the core and back. A spine specialist also might try injecting steroids, Botox, or other nerve root injections to alleviate pain and help the body heal. If acute sciatic pain continues for six months to a year, a provider might recommend performing surgery to remove the part of the spinal disc affecting the nerve, though this can have mixed results. As a last resort, surgery to cut the piriformis tendon where it attaches to the hip might be considered.
When To See A Healthcare Provider
If you have been dealing for sciatic pain for a week, and it’s not improving, talk to a healthcare provider. If the pain in your back is unbearable—even if you’re not sure that it’s sciatica—don’t hesitate to see a provider. Imaging like X-rays, CT scans, or MRI, are not usually needed for classic sciatica symptoms, and your provider may be able to diagnose you just by hearing your symptoms and performing a physical exam. In some cases, they may recommend imaging to exclude any other conditions. Your provider should work through all treatment options before considering surgery.
While some sciatica is hereditary and accidents and injuries can happen to anyone, there are some behavioral changes a patient can make to help prevent sciatica, or to reduce flare-ups. A few helpful habits include:
- Sitting and standing with good posture, especially if work requires sitting or standing in the same position for hours at a time
- Avoid sitting or lying down for long periods if possible
- Lifting by squatting instead of bending over, especially when picking up something heavy
- Daily stretching after waking up, before bed, and before and after exercising
- Exercising and stretching regularly
Concerned that your back pain might be sciatica? K Health’s virtual diagnosis tool can help you quickly determine whether the symptoms you are experiencing may be caused by lumbar radiculopathy. Our providers are also available to help you learn how you can prevent any future lumbar spine injury.
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
Radiculopathy, Weill Cornell Brain And Spine Center. (2020). https://weillcornellbrainandspine.org/condition/radiculopathy
Radiculopathy, Johns Hopkins Medicine. (2021). https://www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy
Lumbar Radiculopathy (Nerve Root Compression), Emory Healthcare. (2019). https://www.emoryhealthcare.org/orthopedics/lumbar-radiculopathy.html
Sciatica, American Academy of Orthopaedic Surgeons. (2013). https://orthoinfo.aaos.org/en/diseases--conditions/sciatica
Chronic Pain: In Depth. (2018). https://www.nccih.nih.gov/health/chronic-pain-in-depth
Diagnosis and treatment of sciatica. (2007). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/
Conservative Treatment of Sciatica: A Systematic Review. (2000). https://journals.lww.com/jspinaldisorders/Abstract/2000/12000/Conservative_Treatment_of_Sciatica__A_Systematic.1.aspx
How Long Does Sciatica Last? (2020). https://ioaregenerative.com/blog/how-long-does-sciatica-last
Piriformis Syndrome. (2021). https://www.ncbi.nlm.nih.gov/books/NBK448172/
Taming the pain of sciatica: For most people, time heals and less is more. (2019). https://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048