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Sciatica

Sciatica is pain, tingling, numbness or weakness that travels from the lower back or buttock down one leg. It is a symptom, most often caused by a slipped disc pressing on a nerve, and it usually improves over a few weeks to a few months. A few warning signs — especially loss of bladder or bowel control — need emergency care.

Go to the emergency room or call 911 right away if you have sciatica or back pain together with any of these:

  • Trouble controlling your bladder or bowels — finding it hard to start peeing, not being able to pee, not being able to control when you pee, or not noticing when you need to poo or being unable to control it (NHS). Trouble emptying the bladder is the most common symptom of cauda equina syndrome (AANS).
  • Numbness in the “saddle” area — around or under your genitals or around your anus (NHS), which can include the buttock region (AANS). Changes in how your genitals feel during sex are also on the NHS emergency list (NHS).
  • Sciatica on both sides, or weakness or numbness in both legs that is severe or getting worse (NHS).
  • Back pain after a serious accident, such as a car crash, or back pain with chest pain (NHS).

These could be signs of a serious back problem that needs hospital treatment as soon as possible. The NHS advises not driving yourself: ask someone to drive you or call for an ambulance (NHS). The most common cause of cauda equina syndrome is a very large herniated disc; left untreated it can cause permanent paralysis and incontinence, and surgery within 48 hours of the start of symptoms gives a significant advantage in recovery (AANS).

Get medical help promptly (the same day if you can) for:

  • New weakness in a leg or foot, such as difficulty lifting the front of your foot and toes (foot drop). A slipped disc is one cause; foot drop can get better, but sometimes it is permanent (NHS). Weakness is also on the list of warning symptoms for cauda equina syndrome (AANS). MBHA suggests not waiting for a routine appointment.
  • Severe pain that starts suddenly or is getting worse quickly, or back pain with feeling hot, cold, shivery or generally unwell — the NHS advises urgent medical advice for both. Very rarely, back pain is a sign of a broken bone, cancer or an infection (NHS).

Do not wait for a chiropractic, acupuncture or massage appointment, and do not try an herb or supplement first, if you have any of these signs.

What is sciatica?

Sciatica is a symptom, not a disease. It means a problem with the sciatic nerve, the largest nerve in the body, which controls muscles in the back of the knee and lower leg and gives feeling to the back of the thigh, part of the lower leg and the sole of the foot. You can have pain, weakness, numbness or tingling that may start in the lower back and extend down the leg to the calf, foot or even the toes, usually on one side (MedlinePlus). The NHS adds that the pain is often sharp or burning, can come on suddenly or slowly, and may be worse when you move, sneeze or cough. You may have some back pain, but it is not usually as bad as the leg pain — and you probably do not have sciatica if you only have back pain (NHS). For mostly-back pain, see our back pain guide.

The outlook is usually good: sciatica gets better in a few weeks to a few months, but it can last longer and can come back (NHS). MedlinePlus likewise says it sometimes goes away on its own (MedlinePlus).

What causes sciatica?

Sciatica happens when something presses on or rubs against the sciatic nerve (NHS). In many cases no cause can be found (MedlinePlus). Common causes include:

What raises the risk: two large reviews linked being overweight or obese, and being a current smoker, to more sciatica. Obesity had an odds ratio of 1.40 for lumbar radicular pain (leg pain from an irritated spinal nerve root) (Shiri et al., 2014), and current smokers 1.46; former smokers were only slightly above never-smokers, suggesting quitting reduces but does not erase the extra risk (Shiri & Falah-Hassani, 2016). These are patterns in populations, not proof about any one person.

When to see a provider (not an emergency): if sciatica has not improved after a few weeks of home care, is getting worse, or is stopping you doing normal activities (NHS). Also if back pain comes with unexplained weight loss, a lump or swelling in the back, pain that is worse at night or does not ease with rest, or pain that is worse when you sneeze, cough or have a bowel movement (NHS). Scans are sometimes used — MedlinePlus lists spine CT and MRI among the diagnostic tests for sciatica (MedlinePlus) — and your provider can say whether one is right for you.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Stay active, use heat, and see a provider if it isn't improving in a few weeks. Physical therapy; sometimes medicines, epidural steroid injections or, for a slipped disc that hasn't improved, surgery (discectomy). Emergency surgery for cauda equina syndrome. Medicare Part B covers medically necessary outpatient physical therapy (20% coinsurance after the deductible). Other costs: being researched. Most sciatica improves over weeks to months. Studies of common medicines have mostly shown little benefit over placebo; injections give small, short-term benefit; surgery gives faster relief of leg pain but the benefit fades over time.
Chiropractic Spinal manipulation, often with home exercise and advice, over several weeks. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation (20% coinsurance after the deductible). One trial found a short-term edge over exercise and advice alone that faded by one year; reviews call the evidence weak. Never a substitute for emergency care if you have bladder, bowel or saddle-area changes.
Acupuncture A course of needle treatments, usually over several weeks, alongside staying active. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain; sciatica isn't listed, so ask first. One blinded, sham-controlled trial in China found less leg pain than sham needling through one year; earlier reviews were encouraging but low quality. Few serious problems with sterile, single-use needles.
Herbal medicine No herb has been proven for sciatica. Some products tested for low back pain include cayenne cream, devil’s claw and white willow bark. Cost estimate being researched. We found little research on herbs for sciatica in people. Willow bark can act like aspirin, devil’s claw has been linked to ulcers and bleeding, and comfrey can harm the liver.
Massage therapy Gentle hands-on soft-tissue work for comfort and muscle tension in the back, buttock and leg. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. Medicare doesn’t cover massage therapy. We found little research on massage for sciatica. For low back pain, reviews find only short-term relief with low confidence. Low risk with gentle pressure.
MBHA Wellness Coach A gradual walking and movement plan, heat, breaking up long sitting, safe lifting and posture, weight, quitting smoking, and pain-coping skills. Cost estimate being researched. Supports — never replaces — medical care. Staying active is the foundation of self-care for sciatica.

Approach 1 of 6

Conventional medicine (AMA)

Sciatica care starts at home. The NHS advises carrying on with normal activities as much as possible, starting gentle exercise early, using heat packs on the painful areas, and not sitting or lying down for long periods — even if moving hurts, it is not harmful and can help you recover faster (NHS).

1. Stay active

A Cochrane review found little or no difference in sciatica between advice to rest in bed and advice to stay active (Cochrane review, 2010). A review of five trials found that supervised exercise had a small short-term edge over advice to stay active for leg pain, with no difference in disability or over the longer term (Fernandez et al., 2015).

2. Physical therapy

The NHS lists exercises, stretches and physiotherapy — including hands-on techniques such as massage — as the main treatments (NHS). In a trial of 220 adults with sciatica of less than 90 days, early referral to four weeks of physical therapy (exercise and manual therapy) led to less disability at six months than usual care, and 45.2% versus 27.6% reported treatment success at one year; patients and providers could not be blinded (Fritz et al., 2021). The overall evidence is mixed: a 2023 review of 18 trials judged all of them at high or unclear risk of bias and found too little evidence to make recommendations (Dove et al., 2023).

3. Medicines

Many people are surprised by how little research supports the medicines most often prescribed. We don’t list doses; ask your doctor or pharmacist what, if anything, is safe for you.

  • Over-the-counter pain relievers: the NHS says paracetamol (acetaminophen) is unlikely to help and it is not clear how much NSAIDs such as ibuprofen help (NHS). A Cochrane review of 10 trials (1,651 people) found NSAIDs did not reduce pain significantly more than placebo, though people were somewhat more likely to report overall improvement, and side effects were more common; the evidence was low to very low quality (Cochrane review, 2016).
  • Nerve-pain medicines (gabapentin, pregabalin): in a 209-person placebo-controlled trial, pregabalin did not significantly reduce leg pain over eight weeks and caused more side effects, including dizziness (Mathieson et al., 2017). A 2022 review of eight trials concluded routine use cannot be supported (Giménez-Campos et al., 2022).
  • Steroid medicines by mouth or injected into a muscle or vein: a 2020 review of nine trials found short-term effects uncertain (Abdel Shaheed et al., 2020).
  • Opioids: a broad 2015 comparison did not find support for opioid pain medicine in sciatica (Lewis et al., 2015).
  • Guidelines disagree: a 2024 review of 11 guidelines found very little agreement. Every medicine class recommended by one guideline was advised against by another, and three guidelines recommended no medicine at all (Price et al., 2024).

4. Injections

If pain is severe and other treatments have not helped, the NHS says you may be referred to a hospital specialist for a painkilling injection such as an epidural, or a procedure to seal off some nerves so they stop sending pain signals (radiofrequency denervation) (NHS). A 2020 Cochrane review of 25 trials (2,470 people) found epidural steroid injections probably reduce leg pain and disability slightly in the short term compared with placebo injections, but the effects were small and may not matter much to patients (Cochrane review, 2020).

5. Surgery

The NHS says decompression surgery can sometimes help relieve sciatica (NHS). A 2023 review of 24 trials found that discectomy (removing the part of a disc pressing on the nerve) reduced leg pain more than non-surgical care at first, but the benefit shrank over time and was negligible at 12 months; certainty was very low to low (Liu et al., BMJ, 2023). In a Dutch trial of 283 people with severe sciatica for 6 to 12 weeks, leg pain eased faster with early surgery, but about 95% of both groups felt recovered at one year, and 39% of the conservative-care group ended up having surgery (Peul et al., 2007). Emergency surgery is the usual treatment for cauda equina syndrome (AANS).

6. Traction

A Cochrane review found low- to moderate-quality evidence that for low back pain with sciatica, traction probably has no impact on pain, function or overall improvement (Cochrane review, 2013).

The big picture

The most comprehensive comparison (122 studies) found the evidence for every sciatica treatment to be of very low quality. It supported non-opioid medicine, epidural injections and disc surgery, and suggested spinal manipulation and acupuncture may be considered (Lewis et al., 2015). For long-lasting sciatica, a 2025 review of 50 trials found the evidence very uncertain, with no high-quality proof that any non-surgical treatment is best (Zhu et al., 2025).

What it costs

Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it. After the Part B deductible you pay 20% of the Medicare-approved amount, with no yearly limit on medically necessary therapy (Medicare.gov). Physical therapy without insurance, medicines, injections and surgery: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Spinal manipulation is a controlled thrust applied to a joint of the spine by hand or with a device. It differs from mobilization, which has no thrust. Most manipulation is done by chiropractors, and some osteopathic physicians and physical therapists use it too (NCCIH).

What the research says

  • NCCIH says manipulation is not widely used for sciatica but may help, according to a 2015 review in which the authors noted many study limitations (NCCIH, Lewis et al., 2015).
  • In a trial of 192 adults with back-related leg pain lasting at least four weeks, 12 weeks of manipulation plus home exercise and advice beat home exercise and advice alone for leg pain at 12 weeks but not at 52 weeks, though satisfaction and lower medication use lasted. No serious treatment-related problems were reported (Bronfort et al., 2014).
  • For chronic sciatica, a 2025 network review found manipulation among the largest short-term leg-pain reductions versus placebo, but with very low confidence in the evidence (Zhu et al., 2025).

In plain terms: manipulation may add some short-term relief to exercise and advice. We found nothing showing it works better over the long run.

Safety

Mild side effects — more pain, stiffness or headache, mostly gone within 24 hours — are common. Serious problems are very rare but possible, and may be more likely in people with underlying health problems; tell the practitioner your health history and medicines. If you are pregnant, discuss the risks with your health care provider first (NCCIH). Because a very large herniated disc is the most common cause of cauda equina syndrome (AANS), MBHA suggests having any warning sign from the top of this page checked by a medical provider before manipulation, mentioning numbness or weakness to your chiropractor, and getting emergency care if bladder, bowel or saddle-area changes appear.

Medicare coverage

Part B covers only spinal adjustments by a chiropractor to correct a subluxation, by hand or with a device called an activator. It does not cover X-rays, massage or acupuncture ordered by a chiropractor. After the deductible you pay 20% of the Medicare-approved amount (Medicare.gov).

What it costs

Paying cash, a follow-up visit typically costs about $55 to $100 and a first appointment about $90 to $200. An initial exam followed by several weeks of treatment can turn a $60 visit into a $500 to $1,000 course of care (The Pricer). Ask how many visits to expect.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is a technique in which practitioners insert fine needles into the skin; in the United States it is most often used for pain such as back, joint or neck pain (NCCIH).

What the research says

  • A recent sham-controlled trial: in a 2024 trial in six hospitals in China, 220 people with chronic sciatica from a herniated disc were randomly assigned to 10 sessions over four weeks of real or sham acupuncture, with participants and assessors blinded. At four weeks leg pain fell by about 31 millimeters on a pain scale with real acupuncture versus about 15 with sham, disability improved more, the difference persisted through 52 weeks, and no serious adverse events occurred (Tu et al., JAMA Internal Medicine, 2024). This is one trial from one country, so it needs repeating elsewhere.
  • Earlier reviews: NCCIH describes two 2015 evaluations (12 studies with 1,842 people, and 11 studies with 962 people) concluding acupuncture may help sciatica pain, but that the research quality was too low for definite conclusions (NCCIH). A 2022 review of 28 trials found acupuncture rated effective more often than pain medicines, though those trials did not use sham needling and the authors called for more rigorous studies (Han et al., 2022).

In short: acupuncture is a reasonable option to discuss, especially for long-lasting sciatica from a herniated disc, alongside — not instead of — medical evaluation and staying active.

Safety

Relatively few complications have been reported, but non-sterile needles or improper treatment can cause infections, punctured organs and nervous-system injury. The FDA requires needles to be sterile and single-use, and most states license acupuncturists (NCCIH). MBHA suggests telling your acupuncturist if you take a blood thinner or are pregnant.

Medicare coverage

Part B covers acupuncture (including dry needling) only for chronic low back pain: pain lasting 12 weeks or longer, with no known cause such as spread cancer or an inflammatory or infectious disease, and not linked to surgery or pregnancy. Sciatica is not listed, so check before assuming coverage. Where it applies, Medicare covers up to 12 treatments in 90 days, with 8 more if you improve (20 in 12 months), from a doctor or other practitioner with the required degree and license — Medicare cannot pay licensed acupuncturists directly — and you pay 20% after the deductible (Medicare.gov).

What it costs

Published cash prices run about $125 to $230 for a first private visit and $90 to $185 for follow-ups; community clinics can be near $50 to $90 a visit (The Pricer). Ask about package prices and insurance.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little research on herbs for sciatica in people. Our PubMed searches turned up mostly laboratory and animal studies, so no herbal remedy has been shown to treat sciatica.

What is known from low back pain research

NCCIH reviewed herbal products tested for low back pain, which is not the same as sciatica. It found evidence that cayenne used on the skin reduces pain and said devil’s claw or white willow bark by mouth, and comfrey, Brazilian arnica and lavender oil on the skin, might help, while cautioning that herbal products can cause side effects or interact with medicines (NCCIH). Whether this applies to nerve pain from a slipped disc is unknown.

Safety of the most-mentioned herbs

  • White willow bark may have aspirin-like side effects. Memorial Sloan Kettering advises avoiding it with warfarin or other blood thinners or NSAIDs, with aspirin sensitivity, or with stomach problems or an ulcer; not giving it to children (Reye syndrome risk); and stopping it before surgery (Memorial Sloan Kettering).
  • Devil’s claw has been linked to indigestion, and ulcers and gastrointestinal bleeding have occurred with the root (Memorial Sloan Kettering).
  • Comfrey contains compounds toxic to the liver, and in 2001 the FDA advised supplement makers to remove comfrey products from the market (Memorial Sloan Kettering).

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, an NSAID or other medicines, or are pregnant, breastfeeding or planning surgery. Supplements may interact with medicines or pose risks around surgery, and some products sold as supplements have been found to contain prescription drugs or unlisted ingredients (NCCIH). We don’t list doses, and no herb should delay care for the warning signs at the top of this page.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage can feel good when your back, buttock and leg are tight and sore. We found little research on massage for sciatica itself.

What the research says

  • The NHS lists massage (manual therapy) among the techniques a physiotherapist may use (NHS), but the Utah physical-therapy trial combined manual therapy with exercise, so it cannot tell us whether massage alone helps (Fritz et al., 2021).
  • For low back pain, NCCIH says only weak evidence suggests massage may help. A 2015 review of 25 studies (3,096 people) found short-term pain improvement, but the studies were low quality and the investigators had very little confidence that massage is effective (NCCIH).

In short: massage is a comfort measure that may ease muscle tension, not a proven treatment for the nerve problem behind sciatica.

Safety

The risk of harm appears low. Rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in people at higher risk such as older adults (NCCIH). MBHA suggests telling the therapist about your sciatica and any numbness or weakness, and asking for gentle pressure.

What it costs

One national chain charges about $70 to $90 a month on a 12-month membership (The Pricer); prices elsewhere vary. Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most of what helps sciatica happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, medical care. A coach does not diagnose or treat.

Keep moving

The NHS advice is to carry on with normal activities as much as possible, start gentle exercise as soon as you can, hold heat packs to painful areas, and avoid long periods of sitting or lying down (NHS). Advice to stay in bed has no clear advantage over advice to stay active (Cochrane review, 2010). A coach can help you build a gradual plan — short walks that get a little longer, with breaks from sitting — and pace yourself so you neither overdo it on a good day nor stop moving after a bad one.

Preventing a repeat

Because sciatica can come back, the NHS recommends regular exercise, safe lifting, good posture when sitting and standing, sitting correctly at a computer, losing weight if you are overweight, and not smoking (NHS). The research agrees on weight and smoking: both were linked to more sciatica (Shiri et al., 2014, Shiri & Falah-Hassani, 2016). A coach can help with the hard part — setting realistic goals, making a weight or quit-smoking plan you can follow, setting up a workspace, and keeping an exercise habit going once the pain has eased.

Coping

Living with leg pain is tiring and worrying. A coach can offer support, accountability and ideas for relaxation and pacing, and can help you prepare questions for your doctor or physical therapist.

Another approach

Piriformis syndrome

The piriformis is a muscle deep in the buttock, close to the sciatic nerve. NIH’s Genetic and Rare Diseases Information Center describes piriformis syndrome as a rare condition in which the muscle presses on the nerve. Besides sciatica, it may cause tenderness, aching, tingling or numbness in the buttock and pain when sitting for a long time, climbing stairs, walking or running (GARD). A 2019 review calls it a relatively uncommon cause of sciatica that is hard to diagnose because many conditions of the low back and buttock overlap, and outlines conservative treatment, injections and surgery as options (Probst et al., 2019). If your sciatica doesn’t fit a typical disc pattern, ask your provider about it. Bladder or bowel changes and saddle-area numbness are never explained away as a tight muscle.

Another approach

Sciatica & pregnancy

Back pain is very common in pregnancy: ligaments naturally soften and stretch to prepare for labour, which can strain the joints of the lower back and pelvis (NHS). Leg pain in pregnancy is not always sciatica — pelvic girdle pain can be felt across the lower back and spread to the thighs (NHS). A herniated disc is uncommon in pregnancy (reported in about 1 in 10,000 pregnant women), and evidence on managing it is limited; one systematic review found only 30 studies covering 52 patients and said poor research quality prevents reliable conclusions (Whiles et al., 2020). Pelvic conditions such as a mass arising from the uterus or ovaries can also press on the nerve trunk (Al-Khodairy et al., 2007).

What can help

  • The NHS suggests lifting with bent knees, avoiding heavy lifting, flat shoes, rest, a massage or a warm bath, and a back-care class; for bad pain, ask your GP or midwife about an obstetric physiotherapist (NHS).
  • In a study of 93 pregnant women, those in a structured exercise program had a smaller rise in sciatic pain by late pregnancy than women who did not exercise (12.9 mm less on a pain-rating scale) (Aparicio et al., 2023). Ask your midwife or doctor what exercise is right for you.
  • For manipulation in pregnancy, see the chiropractic section above.

Pregnancy warning signs

Call 911 or go to the emergency room if you have back pain and lose feeling in one or both legs, your bottom or your genitals. Contact your provider urgently for back pain in the second or third trimester (it could be early labour), or back pain with a fever, vaginal bleeding, pain when you pee, or pain under your ribs (NHS). MBHA is planning a separate pregnancy guide.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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