Symptom Guide
Sciatica and Leg Pain That Will Not Settle
Pain that travels from the back or buttock down the leg is one of the most common reasons people look for a spine specialist. Most of it improves. A small number of presentations need attention today rather than in a few weeks.
Go to an emergency department now if you have any of these
Together these can indicate cauda equina syndrome, compression of the nerve bundle at the base of the spine. It is time-critical:
- Numbness in the saddle area, meaning the inner thighs, the genitals, or between the buttocks
- Difficulty passing urine, or not knowing when your bladder is full
- Loss of bladder or bowel control
- Numbness or weakness in both legs
- Weakness that is getting rapidly worse
Do not wait for an appointment, and do not wait to see if it improves overnight. Call 911 or go to an emergency department.
Get assessed soon, though not by ambulance, if
- Your foot is dragging or catching, or you cannot lift the front of your foot properly
- There is clear weakness in the leg rather than only pain
- The pain followed significant trauma such as a fall or a collision
- You have a history of cancer, or unexplained weight loss or fever alongside the pain
What is usually behind it
Sciatica describes the symptom. These are the things that commonly produce it, and the patterns that help tell them apart.
| Cause | What it tends to feel like | Read more |
|---|---|---|
| Herniated disc | Often one leg, with leg pain frequently worse than the back pain itself. Can be worse sitting, coughing or straining. May follow a sudden movement or build over days | Herniated disc |
| Spinal stenosis | Often both legs, described as heaviness, aching or cramping on walking, relieved by sitting or leaning forward, such as over a shopping cart | Spinal stenosis |
| Degenerative change | Long-standing back pain with intermittent leg symptoms, often stiff in the morning and variable day to day | Degenerative spine conditions |
| Degenerative disc disease | Back pain that may refer into the buttock or thigh, often worse with prolonged sitting | Degenerative disc disease |
Most sciatica gets better
A great deal of sciatica caused by a disc settles over weeks without an operation, as the inflammation around the nerve reduces. Staying as active as the pain allows generally helps more than bed rest. That is why a reasonable period of non-surgical care usually comes first.
It is also why an early scan is not always useful. Imaging findings are common in people with no symptoms at all, so a scan taken too early can produce a frightening report that does not change what should happen next. The exception is when there is weakness, when the pain is severe and unrelenting, or when any of the warning features above are present.
When it is worth seeing a surgeon
- There is weakness. Particularly a foot that drags, or difficulty getting up onto your toes or heels.
- It has not settled with reasonable non-surgical care. Persisting pain that is limiting your life deserves a proper explanation.
- It is progressing. Getting worse over weeks rather than better is a different trajectory.
- A scan has found something and nobody has explained it to you. An MRI report is not a treatment plan.
- Surgery has been recommended and you want to be sure. That is what a second opinion is for, and asking for one is routine.
You do not need a referral to ask. Most patients can request an appointment directly.
Common questions
What exactly is sciatica?
It is a description, not a diagnosis. Sciatica means pain travelling along the path of the sciatic nerve, usually from the lower back or buttock down the back of the thigh and often below the knee. The useful question is what is pressing on the nerve and where.
How long should I give it before seeking help?
Most sciatica from a disc settles over weeks with time, movement and non-surgical care. Seek help sooner if there is weakness, if the pain is severe and not responding, if it is getting worse rather than better, or if any of the emergency features on this page appear.
What is cauda equina syndrome?
It is compression of the bundle of nerves at the bottom of the spinal canal. The warning signs are numbness in the saddle area, difficulty passing urine or loss of bladder or bowel control, and numbness or weakness in both legs. It is a surgical emergency and needs immediate hospital assessment, not an appointment.
Does sciatica always mean a slipped disc?
No. A disc herniation is the most common cause, but narrowing of the spinal canal, degenerative change and other conditions can produce similar symptoms, and the pattern of what makes it better or worse often points to which.
Do I need a referral to be seen about sciatica?
Not usually. Most patients can request an appointment directly. Whether a referral is required depends on your insurance plan, and we will tell you if one is needed in your case.
This page is general information written by a neurosurgical practice to help you decide whether to seek assessment. It is not a diagnosis and it is not a substitute for being examined. If you are worried about your symptoms, speak to a clinician.
Get the leg pain properly assessed
Bring any imaging on CD or USB with the report. Dr. Khan will examine you, look at the scan directly, and tell you whether this needs surgery, time, or something else entirely.