What is sciatica?
Sciatica is pain along the sciatic nerve — from lower back, through buttock, down the leg. Caused by nerve compression, most commonly from a herniated disc, spinal stenosis, or muscle compression (piriformis syndrome).
Affects about 40% of people at some point. Most cases resolve with conservative treatment over weeks to months. Persistent symptoms or red flags warrant further workup.
Do I have sciatica? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Herniated disc (most common) compressing nerve root. Spinal stenosis. Piriformis syndrome (muscle compression). Spondylolisthesis. Rarely: tumor or infection.
Is it contagious?
No.
The standard timeline is 4–12 weeks of conservative treatment before considering injections or surgery — most people recover within that window.
Can it be treated online?
Routine sciatica without red flags is well-suited to telehealth. New severe weakness, loss of bowel/bladder control, severe numbness in genital area (saddle anesthesia), fever, history of cancer or IV drug use, or trauma — need urgent in-person evaluation.
How sciatica is treated
Conservative first. NSAIDs — ibuprofen, naproxen. Gabapentin or pregabalin for nerve pain. Muscle relaxants short-term. Physical therapy with directional exercises. Heat/ice. Steroids short course for severe pain. Epidural steroid injections for persistent pain. Surgery (microdiscectomy) for refractory cases or progressive neurologic deficit.
Self-care while you wait
- Stay active — avoid bed rest beyond 1–2 days
- Gentle stretches: knee to chest, piriformis stretch
- Walking is usually safe and helpful
- Ice 20 min, several times daily initially; switch to heat after 48 hours
- Sit with lumbar support
- Avoid heavy lifting and twisting
- Sleep position: side with pillow between knees, or back with pillow under knees
- Lose excess weight if applicable
How long does it last?
Most cases improve within 4–12 weeks. About 75% fully recover without surgery. Some persistent symptoms.
Frequently asked questions
Do I need an MRI?
Most acute sciatica without red flags doesn't need imaging. Persistent pain (>6 weeks) or red flags warrant MRI.
Should I rest in bed?
No — beyond 1–2 days, stay active. Movement helps recovery.
Will I need surgery?
Most don't. About 10% of sciatica from disc herniation eventually needs surgery for unresolved pain or weakness.
Are inversion tables effective?
Mixed evidence. May help some; not proven cure.
Should I avoid lifting weights?
Avoid heavy lifting during acute episode. Gradual return to strength training (good form, core engagement) helps long-term.
