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Record in brite how strong your sciatic pain is, get reminded to take your painkillers, and arrive at your appointment with a clear overview. Free of charge.
Numbness in the saddle area, disturbances of the bladder or bowel, or increasing paralysis in the leg are an emergency. Do not wait — call the emergency number 112 immediately.
Sciatica (medically called sciatic neuralgia) describes pain that runs along the sciatic nerve — it travels from the lower back or buttock down the back of the thigh into the leg, sometimes as far as the calf and foot. Strictly speaking, sciatica is not a disease in its own right but a symptom: it arises when one of the nerve roots that form the sciatic nerve becomes irritated or comes under pressure.
The sciatic nerve is the thickest and longest nerve in the body. It originates from several nerve roots of the lower lumbar spine and the sacrum, runs deep through the buttock and divides into further branches at the leg. It supplies large parts of the leg with movement signals and sensation. When it is compressed or irritated along its course — often right where it exits the spine — it reports this as radiating pain precisely along the area it supplies. This explains the typical pattern: the trigger sits in the back, but the pain is felt in the leg.
The decisive feature that distinguishes sciatica from ordinary low back pain is this radiation into the leg. Pure back pain stays in the back; with sciatica the pain travels downwards and often follows a clear line. The good news first: in the vast majority of cases sciatica is very unpleasant but harmless and self-limiting — for most people the symptoms improve on their own within a few weeks, without any surgery at all.
Many people say "sciatica" but mean quite different complaints. For the right treatment it helps to understand what sets sciatica apart from two common "look-alikes" — pure back pain and a problem in the hip joint. All three can hurt in the buttock, but they feel different in the detail.
| Feature | Sciatica | Pure back pain | Hip problem |
|---|---|---|---|
| Location of the pain | Radiates from the buttock into the leg, often below the knee | Stays in the lower back, possibly into the buttock | Groin, side of the hip, front of the thigh |
| Character | Pulling, burning, electric | Dull, pulling, like muscle ache | Deep, load-dependent, "mechanical" |
| Accompanying signs | Tingling, numbness, sometimes loss of strength in the leg | Usually no sensory disturbance | Stiffness, restricted rotation |
| What makes it worse? | Coughing, sneezing, straining, prolonged sitting | Certain postures, bending | Walking, climbing stairs, putting on and taking off shoes |
A simple rule of thumb: sciatica travels, back pain stays. As soon as the pain clearly moves below the buttock into the leg — and especially when it is accompanied by tingling or numbness — this points to nerve involvement in the sense of sciatica. If, on the other hand, the pain stays in the small of the back, it is usually a non-specific back pain. Pain that sits mainly in the groin and occurs when walking or turning the leg points more towards the hip and is listed as hip pain. This distinction is not merely academic: it helps decide which exercises help and which speciality to turn to if in doubt.
The hallmark of sciatica is radiating, one-sided pain along the course of the nerve. How strong it is and how far it travels into the leg varies from person to person — from an occasional pulling in the buttock to an electric pain that shoots right into the foot. The following complaints are typical:
An important point: a loss of strength or a marked, increasing numbness is a warning sign that should be assessed by a doctor — more on this in the chapter on warning signs. Pain alone without paralysis is, by contrast, agonising but as a rule not dangerous.
Sciatica always arises when the sciatic nerve or one of its roots becomes irritated, compressed or constricted. The site of this irritation usually lies in the lower spine, but can also sit deeper in the buttock. The three most common triggers:
Less often, other causes are behind it — for example a slipped vertebra, inflammatory processes, in very rare cases a tumour or an infection. These rare but serious causes are the reason why certain warning signs (see below) are taken seriously.
Sciatica is favoured by several risk factors, some of which can be influenced:
The doctor usually makes the diagnosis of sciatica from the description and a physical examination — without an image having to be taken straight away. The typical radiating pain, its course along the leg and accompanying tingling or numbness are often already meaningful enough.¹,²
A central test is the Lasègue sign (straight-leg-raise test). Its basics can even be checked yourself — but it does not replace a medical examination:
Imaging (MRI) is usually not needed in the first few weeks — the guidelines even expressly advise against x-raying or performing an MRI prematurely in an uncomplicated course. The reason: imaging findings such as disc bulges are also found in many people without symptoms and easily lead to unnecessary anxiety and treatment. An MRI is used specifically when warning signs are present, when the symptoms persist despite treatment or when surgery is being considered.
The most important and often most surprising principle with sciatica is: stay active. In the past, strict bed rest was prescribed for radiating back pain — today we know that lying down for a long time tends to delay healing. Those who stay active and carry on with everyday life as far as possible are, on average, pain-free again sooner.¹
This does not mean you should push through severe pain. It means: light, regular movement rather than protective postures. A short walk, gently getting up and moving around, normal everyday activities — all of this keeps the muscles active and the nerve irritation often subsides more quickly. A brief period of relief at most during the acute phase is fine, longer bed rest is not.
So that you can stay active at all, adequate pain relief during the acute phase makes sense. Medication does not heal sciatica — but it creates the room to move and cope with everyday life while the body repairs itself. This is complemented by physiotherapy, which plays the most important role in the longer term.¹,²
Current guidelines tend to advise against injections into the buttock (pain or cortisone injections) for uncomplicated sciatica — their benefit is limited and they carry their own risks. Targeted injections at the nerve root under imaging guidance may be considered in selected, stubborn cases, but are not a standard for everyday use.
brite reminds you to take your painkillers and documents how your sciatica develops — ready for your next appointment with the doctor.
The most important message about the course: sciatica has a good prognosis. In the great majority of those affected the symptoms recede markedly within weeks, often with no lasting consequences at all. Even a herniated disc pressing on the nerve often shrinks by itself over time — the body gradually breaks down the protruded tissue.¹
Surgery is therefore only rarely needed. It is considered when there are clear warning signs (see below), when progressive paralysis occurs or when severe, nerve-related pain does not ease over several weeks despite consistent conservative treatment. It is important to know: with pain alone and no paralysis, early surgery usually offers no long-term advantage over conservative treatment — it can relieve the pain more quickly in the short term, but the result after months is comparable. That is why, as a rule, it is worth giving the body time first.
| Situation | Recommended approach | Note |
|---|---|---|
| Pain without paralysis | Conservative: stay active, painkillers, physio | Usually improves within weeks |
| Persistent despite treatment | Medical re-evaluation, MRI if needed | After about 6 weeks |
| Increasing paralysis in the leg | Prompt specialist assessment | Surgery may become necessary |
| Saddle numbness, bladder disturbance | Call 112 immediately | Emergency (cauda equina syndrome) |
For everyday life, what counts most is how you get moving again and prevent a relapse. A few habits help with this:
Record in brite how strong your pain is and how it develops — ideal for talking to your practice about the next steps.
Sciatica is almost always harmless — but there are rare warning signs that permit no delay. The most important is the so-called cauda equina syndrome, in which the lower bundle of nerves in the spinal canal is severely compressed. If it is not treated quickly, permanent damage to bladder, bowel and sexual function is threatened. That is why the following applies: with the following signs, every hour counts.
Other signs that are not an emergency call, but do require a prompt medical assessment: a worsening loss of strength in the leg, pain after a fall or accident, sciatica together with fever or unintentional weight loss, as well as symptoms that do not improve despite treatment over several weeks. In these cases a search is made specifically for a rarer cause.
Sciatica above all needs patience, movement and good pain control over several weeks. The treatment works best when you keep at it and keep an eye on the course. That is exactly where brite supports you.
