Sciatica: Why the Pain Runs Down Your Leg
What sciatica actually is, how to tell it from ordinary back pain, which treatments work, and when leg pain means you should see a neurosurgeon in Uppal.
Published 13 Aug 2026 4 min read
Medically reviewed by Dr. Srinivas Thankari
MBBS, MS (Gen. Surgery), MCh Neurosurgery
Neurosurgeon — Brain & Spine · 18+ years
Last reviewed 17 Aug 2026
Short answer
Sciatica is pain travelling from the lower back down the back of the leg, caused by a disc or bone pressing on a nerve root — it is a symptom, not a diagnosis. Around 80 to 90 percent of cases settle within six to twelve weeks with medication, physiotherapy and staying active. Surgery is only considered for pain that will not settle or for progressive weakness.
Patients rarely arrive saying “I have sciatica”. They say the pain starts in the lower back and runs down the back of the leg, sometimes to the foot, and that it is worse than the back pain itself. Occasionally they mention the leg feeling weak, or a patch of numbness they only noticed in the shower.
That pattern — pain travelling below the knee — is what makes sciatica worth distinguishing from the ordinary back pain almost everyone gets.
What is sciatica, exactly?
Sciatica is not a diagnosis. It is a description of a symptom: pain along the path of the sciatic nerve, which runs from the lower back through the buttock and down the back of the leg.
The nerve itself is rarely the problem. Something is pressing on one of the nerve roots where it leaves the spine — most often a disc that has bulged or herniated, sometimes a narrowed canal, occasionally a slipped vertebra. The pain you feel in your calf originates in your back.
How do I know it is sciatica and not just back pain?
| Mechanical back pain | Sciatica | |
|---|---|---|
| Where | Back, maybe the buttock | Travels below the knee |
| Sensation | Ache, stiffness | Sharp, burning, electric |
| Extras | None | Pins and needles, numbness, weakness |
| On coughing | Unchanged | Often sharply worse |
| Position | Some position helps | Sitting usually worst |
The clearest single indicator is the pain going below the knee. Pain that stops at the buttock or thigh is more often mechanical.
What causes it?
Disc herniation — the commonest cause by a wide margin, especially between 30 and 50. The soft centre of a disc pushes through its outer ring and contacts a nerve root.
Spinal stenosis — the canal narrows with age. The tell here is different: legs feel heavy and painful on walking, and ease when you sit or lean forward.
Spondylolisthesis — one vertebra slips forward over another, narrowing the space the nerve passes through.
Piriformis syndrome — a buttock muscle irritating the nerve directly. Less common than the internet suggests, but real.
Do I need an MRI?
Not in the first few weeks. This surprises people, so it is worth explaining.
MRI scans of people with no pain at all routinely show disc bulges. If we scan every new case of sciatica, we will find something in most of them — and then face pressure to treat a finding that may have nothing to do with the symptoms.
An MRI earns its place when the pain persists beyond about six weeks, when there is weakness or numbness, when red flags are present, or when surgery is genuinely being planned. At that point it answers a specific question.
What actually treats it?
In roughly this order:
- Stay active. Not bed rest. Walking, normal movement within the pain.
- Medication — anti-inflammatories, and nerve-pain medication where the burning quality dominates.
- Physiotherapy — core and postural strengthening. This is the durable part, and it needs six to eight weeks of consistency before you judge it.
- Sitting habits. Stand every 30 to 40 minutes. Raise the screen. Avoid long unbroken drives.
- Nerve root injection if pain remains severe — often enough on its own to break the cycle.
- Microdiscectomy for the minority: severe pain not settling after six to twelve weeks, or progressive weakness. A small incision, the fragment removed, often a day-care or one-night stay.
When is it urgent?
Go to a hospital emergency department the same day, not a clinic, if you have:
- Loss of bladder or bowel control, or numbness around the groin or inner thighs
- Weakness in the leg or foot that is getting worse — a foot that drags or slaps
- Sciatica in both legs at once
- Fever alongside the back pain
The first of those is cauda equina syndrome. It is uncommon, treatable within hours, and can cause permanent damage if it waits.
When to see a neurosurgeon in Uppal
Book if the leg pain has not improved after four to six weeks, if there is any numbness or weakness, if walking distance is shrinking, or if surgery has been recommended elsewhere and you want an independent opinion.
Dr. Srinivas Thankari consults in neurosurgery at UNO Super Speciality Clinics, Uppal, Monday to Saturday, 6–9 PM. Bring your MRI films, not only the report.
Most people who come in with sciatica leave with a plan that does not involve an operation. That is the normal outcome.
A note on this article. It is written for general awareness and cannot replace an examination. Symptoms that look alike often have very different causes, and the right treatment depends on your own history and scans. If anything here sounds like your situation, please book a consultation rather than self-treating.
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Common questions
How long does sciatica take to go away?
Most people improve substantially within six to twelve weeks. Roughly half are noticeably better inside a month. If there has been no improvement at all by six weeks, or if the pain is worsening, that is the point to have it properly assessed rather than waiting longer.
Should I rest or keep moving with sciatica?
Keep moving, within the limits of the pain. More than a day or two of bed rest weakens the muscles supporting the spine and reliably lengthens recovery. Gentle walking and normal daily activity recover faster than rest.
Does sciatica always mean a slipped disc?
No. A herniated disc is the commonest cause, but sciatic-type pain can also come from spinal stenosis, a slipped vertebra, piriformis muscle tightness, or less often from something outside the spine entirely. This is why the examination matters as much as the scan.
Will I need surgery for sciatica?
Very probably not. The large majority settle without an operation. Surgery is considered when severe leg pain has not responded to six to twelve weeks of proper conservative treatment, or when there is progressive weakness or an emergency such as cauda equina syndrome.
Is sciatica worse when sitting?
Usually yes. Sitting raises pressure inside the lumbar discs more than standing or lying does, so long drives and desk work often make it worse. Standing up every 30 to 40 minutes genuinely helps.