Most sciatica from a slipped disc gets better on its own. For most people it settles within a few weeks to a few months, though for some it lasts longer.
The pain can be FRIGHTENING. It shoots down the leg, burns, and makes sitting miserable. But severe pain doesn’t mean severe damage, and it doesn’t mean you need surgery.
The best thing you can do is keep moving, even when it hurts. Moving with sciatica isn’t harmful, and it can help you get better faster.
What sciatica actually is
- Sciatica is a symptom, not a diagnosis. It means a nerve root in your lower back is irritated, and you feel it as pain down the back of the leg, often past the knee
- A slipped disc is the most common cause. The soft center of a disc (the cushion between two bones in your spine) pushes out and presses on the nerve. Doctors call this a disc herniation or prolapse
- The leg often hurts more than the back. You may also feel pins and needles, numbness or some weakness in the leg or foot
- It’s very common. Many people with a disc bulge on a scan have no pain at all, so the scan picture and the pain don’t always match
How long does it last?
- The first few weeks: usually the worst. Pain can be sharp, sleep is hard, and sitting is often the most painful position
- Weeks 4 to 12: most people notice the pain easing and spreading less far down the leg. Pain that moves UP the leg toward the back is a good sign
- After three months: a smaller group still have symptoms. Numbness and pins and needles often hang on longer than the pain
- Good days and bad days are normal. Recovery rarely runs in a straight line. Judge it week to week, not day to day
The disc can shrink back on its own
This surprises most people. Your body can reabsorb the part of the disc that has pushed out, and scans taken months later often show it smaller or gone.
- Bigger herniations shrink MORE often. When the disc material has broken right through, it shrinks back in about 7 in 10 cases, and nearly always when a piece has broken off completely
- Small bulges shrink less often, but they also press on the nerve less
- So a scary-looking scan is not a reason to rush to surgery
The worst-looking discs are often the ones your body clears away best.
What helps
- Keep up your normal activities as much as you can. Short walks through the day are better than one long one
- Change position often. Sitting still for long periods usually makes it worse. Get up every 20 to 30 minutes if you can
- Gentle exercise: start as soon as you can. A physio can show you movements that ease the leg pain rather than stir it up
- Heat or cold: use whichever feels better. Neither fixes the disc, but both can take the edge off
- Pain relief: honest answer, the evidence is weak. Paracetamol is unlikely to help much, and it’s not clear how much ibuprofen helps. Ask your doctor or pharmacist before trying stronger medicines
What doesn’t help
- Bed rest. Lying down for days tends to slow recovery. Rest when you need to, then get up again
- Waiting for the pain to go before moving. Moving through some pain is safe with sciatica
- Chasing a scan early. Unless there are red flags, a scan in the first weeks rarely changes what you should do
When is surgery considered?
- When the pain is severe and not settling after several weeks of good nonsurgical care
- When weakness in the leg or foot is getting worse, not better
- Straight away if you have the emergency signs below
The usual operation is a microdiscectomy, which removes the piece of disc pressing on the nerve. Surgery tends to ease leg pain faster. Over the longer run, many people who wait end up in a similar place, so it’s often a choice about speed and how much pain you can live with. See microdiscectomy recovery week by week.
If your leg pain gets worse walking and eases when you sit or lean forward, and you’re over 60, the cause may be narrowing of the spine instead of a disc. See spinal stenosis.
If the pain stays low in one buttock and doesn’t travel below the knee, it may be coming from the joint between your spine and pelvis instead. See SI joint pain.
Go to the emergency department now if
These can be signs of cauda equina syndrome, where the nerves at the bottom of the spine are badly squashed. It is rare, but it needs hospital treatment the same day. Don’t wait to see if it settles.
- Sciatica in BOTH legs
- Numbness around your genitals or buttocks, the area that would touch a saddle
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Severe or worsening weakness or numbness in both legs
- New problems getting or keeping an erection, or loss of feeling during sex
Get it checked if
- Your foot is slapping down or catching when you walk, or the leg is getting weaker
- The pain is no better after four to six weeks
- You also have a fever, weight loss you can’t explain, or a history of cancer
- The pain is so bad you can’t sleep or move at all, despite painkillers
Sciatica feels like something is badly broken, but most of the time your body is already fixing it.