Sciatica: Why the Leg Hurts, How Long It Lasts, and What Actually Helps
Sciatica — pain shooting from the lower back or buttock down the leg, often with tingling or numbness — can be frightening and exhausting. The good news from the research is strong: most cases improve, herniated discs often shrink by themselves, and surgery mainly speeds recovery rather than changing the result. Here is what helps, what doesn't, and when to get urgent help.
By Taha Raza
Published
Sciatica is not a diagnosis of the back itself but a description of pain travelling along the sciatic nerve — from the lower back or buttock down the back or side of the leg, sometimes into the foot. In most adults it comes from a disc in the lower back bulging and irritating a nerve root. It is often worse with sitting, coughing or bending, and can come with pins and needles, numbness or weakness in the leg.
How long does sciatica last?
Many episodes improve over weeks, though some take a few months. The clearest picture comes from a Dutch trial published in the New England Journal of Medicine in 2007. It took 283 people who had severe sciatica for 6 to 12 weeks and randomly assigned them to early surgery or to continued non-surgical care, with surgery later if needed. Early surgery relieved leg pain faster. But after one year, 95 percent in both groups reported they had recovered, and disability scores over the year were not significantly different. Only 39 percent of the non-surgery group ended up having an operation.
Does a herniated disc heal on its own?
Often, yes — and counter-intuitively, the worst-looking discs on an MRI are the most likely to shrink. A 2015 systematic review of 31 studies of people treated without surgery found spontaneous regression in 96 percent of sequestrated discs (where a piece has broken off), 70 percent of extrusions, 41 percent of protrusions and 13 percent of bulges. Complete disappearance occurred in 43 percent of sequestrated discs. The body's immune system clears the displaced disc material over time.
| Treatment | Evidence | Verdict |
|---|---|---|
| Staying active, walking | Bed rest is no better than staying active for sciatica (Cochrane 2010) | First choice |
| Exercise and physiotherapy | Recommended in UK NICE guidance as part of care | Recommended |
| Pregabalin (nerve-pain medicine) | No better than placebo for leg pain; more side effects, especially dizziness (NEJM 2017) | Not recommended for sciatica |
| Epidural steroid injection | Leg pain about 5 points lower on a 100-point scale, short term only (Cochrane 2020) | Small, brief benefit |
| Surgery (microdiscectomy) | Faster leg-pain relief; similar results at one year (NEJM 2007) | An option for severe, persistent cases |
Should you rest or stay active with sciatica?
Stay active within what you can manage. A Cochrane review comparing advice to rest in bed with advice to stay active found the two were about the same for sciatica — bed rest added nothing, and long periods lying down make stiffness and deconditioning worse. Short walks several times a day, changing position often, and avoiding long spells of sitting usually help. Find the positions that ease the leg pain; for many people lying on the back with knees bent or walking is more comfortable than sitting.
What exercises help sciatica?
| Stage | What to do | Dose |
|---|---|---|
| 1. Painful phase | Short, comfortable walks; positions that ease leg pain; gentle knee-to-chest or lying back extension if it reduces leg symptoms | 5–10 min walks, several times a day |
| 2. Settling | Glute bridges, bird-dog, side-lying leg raises, gentle nerve glides (straighten and bend the knee while seated) | 2–3 × 10, daily; stop if leg symptoms spread further |
| 3. Building | Bodyweight squats to a chair, step-ups, dead bugs, longer walks | 3 × 10, every other day |
| 4. Back to training | Gradually return to lifting with lighter weights; hinge patterns (Romanian deadlift) last | Add load slowly over weeks |
A useful rule: exercises that move pain out of the leg towards the back are usually helpful; exercises that send pain further down the leg are a sign to back off. Leg pain matters more than back pain as a guide. A physiotherapist can find the movements that suit you, which is worth it if pain is not settling after a few weeks.
Do medicines and injections help sciatica?
Less than people hope. In a 2017 Australian trial in the NEJM, 209 people with sciatica took pregabalin or a placebo for 8 weeks. Leg pain was no better with pregabalin (3.7 vs 3.1 on a 10-point scale at 8 weeks) and still no better at one year, while side effects were almost twice as common (227 vs 124 events), especially dizziness. UK NICE guidance advises against gabapentinoids such as pregabalin and gabapentin for sciatica. A 2020 Cochrane review of 25 trials found epidural steroid injections reduced leg pain by about 5 points on a 100-point scale in the short term only — a small effect. Simple painkillers taken as your doctor advises can make it easier to stay active.
When is sciatica an emergency?
- Numbness or tingling around the genitals, buttocks or back passage ('saddle' area) — go to an emergency department immediately.
- New difficulty passing urine, loss of bladder or bowel control, or new sexual dysfunction — emergency.
- Sciatica in both legs at once, or weakness that is getting worse, such as foot drop (the foot slapping or catching when you walk).
- Back or leg pain with fever, unexplained weight loss, a history of cancer, or after significant trauma.
- Pain that is severe and not settling after about 6 weeks — see a doctor or physiotherapist for assessment.
This article is general information, not medical advice. Sciatica should be assessed by a doctor or physiotherapist, and the emergency signs above need same-day hospital care. Do not start, stop or change prescribed medicines without your doctor's advice.
Frequently Asked Questions
How long does sciatica take to heal?
Many cases improve within weeks, though some take a few months. In a 2007 trial of people with severe sciatica, 95 percent felt recovered after one year whether or not they had early surgery.
Can a herniated disc heal without surgery?
Often. A 2015 systematic review found herniations shrank on their own in 96 percent of sequestrated discs, 70 percent of extruded discs and 41 percent of protrusions.
Is walking good for sciatica?
Usually, yes. Short, comfortable walks several times a day keep you moving without the stiffness of bed rest, which was no better than staying active in a Cochrane review. Back off if walking sends pain further down the leg.
Does pregabalin help sciatica?
Not according to a 2017 NEJM trial: leg pain was no better than with placebo at 8 weeks or one year, and side effects such as dizziness were more common. UK NICE guidance advises against it for sciatica.
Do I need surgery for sciatica?
Most people don't. Surgery relieved leg pain faster in a 2007 trial, but results at one year were similar, and only 39 percent of people who waited ended up having an operation. It is considered for severe, persistent pain or worsening weakness.
When is sciatica an emergency?
Numbness around the genitals or back passage, new bladder or bowel problems, sciatica in both legs, or rapidly worsening leg weakness need emergency care the same day.
Sources
- Peul WC et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 2007
- Chiu CC et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation, 2015
- Mathieson S et al. Trial of pregabalin for acute and chronic sciatica. New England Journal of Medicine, 2017
- Oliveira CB et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database of Systematic Reviews, 2020
- Dahm KT et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews, 2010
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59)
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