Sciatica & Slipped Disc: Causes, Treatment and When Surgery Helps

Quick answer

Sciatica is pain that travels from the lower back down the leg, usually below the knee, because a nerve root in the lower spine is irritated, most often by a slipped (herniated) disc. It can be severe, but most people improve within about six to twelve weeks with staying active, exercise and pain relief. Surgery is considered when pain stays severe despite good treatment. Numbness around the genitals or buttocks, or new problems with the bladder or bowel, need emergency care.

Written and medically reviewed by

Dr Udit Vinayak M.S. Orth (Gold Medalist)

Dip. FIFA, A.O Fellow, FIJR

Trauma, Sports Medicine & Joint Replacement Surgeon, VinayakM Health

Last reviewed:

September 27, 2026

Overview

The sciatic nerve is formed from several nerve roots that leave the lower spine. Between the vertebrae sit discs, each with a tough outer ring and a softer centre. If the outer ring weakens, part of the centre can bulge or push out (a disc herniation, or "slipped disc"). That material presses on and inflames a nearby nerve root, and the pain is felt along the path of the nerve.

The good news is that the body often reabsorbs the herniated material over time, which is why so many people recover without surgery.

First weeksMost intensePain is often at its worst. Staying gently active helps more than bed rest.

6 to 12 weeksMost improveFor most people the leg pain eases substantially over this period.

Beyond 12 weeksReviewIf pain remains severe, further treatment, including injections or surgery, is considered.

The usual course of sciatica from a disc herniation. Individual recovery varies.

Symptoms & signs

Leg pain that is often worse than back pain, travelling below the knee, sometimes to the foot.
Burning, shooting or electric pain, often worse when sitting, coughing or sneezing.
Pins and needles or numbness in the leg or foot.
Weakness, such as difficulty lifting the foot or standing on tiptoe.
Pain on bending forward or lifting.

Causes & risk factors

Disc herniation, most common between the ages of about 30 and 50.
Spinal stenosis: narrowing of the spinal canal in older adults, causing leg pain on walking that eases on sitting or bending forward.
Spondylolisthesis: one vertebra slipping forward on another.
Risk factors include heavy lifting with twisting, long hours of sitting or driving, smoking, and being overweight.

When to see a doctor

Numbness around the genitals, buttocks or inner thighs, new difficulty passing urine or controlling the bladder or bowel, or sciatica in both legs: go to an emergency department the same day. These can be signs of cauda equina syndrome, which needs urgent surgery.
Worsening weakness, such as a foot that drops or slaps when walking.
Fever, unexplained weight loss, or a history of cancer.
Back or leg pain after a significant fall or injury.

How it’s diagnosed

Sciatica is diagnosed by history and examination, including tests of nerve tension, strength, reflexes and sensation in the legs.

MRI is not needed for most people in the first weeks. It is used when a warning sign is present, when weakness is significant or worsening, or when pain has not improved enough and an injection or operation is being considered.

Treatment options

Stay as active as you can: bed rest slows recovery. Short walks and changing position often help.
Exercise and physiotherapy: a graded programme, and support to keep working and return to normal activities.
Pain relief: anti-inflammatories if suitable, for short periods. UK guidance advises against gabapentin-type medicines, other anti-epileptics, oral steroids and benzodiazepines for sciatica, because the evidence shows no overall benefit and some harm, and against opioids for long-standing sciatica.
Epidural injection of local anaesthetic and steroid: can be considered for severe, recent sciatica.
Surgery (usually microdiscectomy): considered when pain and loss of function persist despite good non-surgical treatment and the scan matches the symptoms, and urgently for cauda equina syndrome or progressive weakness.

A Dutch trial (Peul and colleagues) compared early surgery with prolonged non-surgical care for severe sciatica. Surgery brought faster relief, but by one year the two groups were doing similarly. This is why, for most people without warning signs, surgery is a choice about the speed of recovery rather than the only way to get better.

How VinayakM helps

At VinayakM, sciatica is examined carefully so that the few people who need urgent care are identified, and everyone else gets a clear plan.

An orthopaedic assessment of the nerves, with MRI arranged when it will change the decision.
A graded exercise and activity plan with our physiotherapist, including how to sit, work and sleep while it settles.
An honest discussion of injections and surgery if pain does not improve as expected.

Book your first review Call +91 92171 75397

Prevention & self-care

Lift close to your body, bend the knees and avoid twisting while lifting.
Break up long periods of sitting and driving.
Keep active: regular walking and core and hip strengthening support the lower back.
Stopping smoking and maintaining a healthy weight both help the discs.

Frequently asked questions

How long does sciatica last?

Most people improve substantially within six to twelve weeks. Some take longer, and a small number need further treatment.

Should I rest in bed?

No. Bed rest slows recovery. Keep moving within comfort, change position often, and build up activity gradually.

Do I need an MRI straight away?

Not usually. MRI is needed if there are warning signs, significant weakness, or if pain persists and an injection or surgery is being considered.

Will I need surgery?

Most people do not. Surgery is considered when pain stays severe despite good treatment, and urgently for cauda equina syndrome or worsening weakness.

Is sciatica the same as back pain?

No. In sciatica the leg pain, often below the knee, is usually worse than the back pain, because a nerve is involved.

References

National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. — https://www.nice.org.uk/guidance/ng59
National Health Service (NHS). Sciatica. — https://www.nhs.uk/conditions/sciatica/
American Academy of Orthopaedic Surgeons, OrthoInfo. Sciatica. — https://www.orthoinfo.org/diseases--conditions/sciatica/
Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245–2256. — https://doi.org/10.1056/NEJMoa064039
Wong DA, Transfeldt E. Macnab’s Backache. 4th ed. Lippincott Williams & Wilkins; 2007. (textbook, consulted for background)
Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA (eds). Rothman-Simeone The Spine. 6th ed. Saunders/Elsevier; 2011. (textbook, consulted for background)
Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23.

Written in our own words. Textbooks were used as background reading and are cited; no text, figures or tables have been reproduced from them.

This page is for general information and education only. It is not a substitute for a consultation, diagnosis or treatment from a qualified clinician. If you have any of the red-flag symptoms above, seek medical care promptly.