Sciatica: symptoms, assessment and treatment

Sciatica is a form of nerve root pain. A prolapse, that is a bulging of an intervertebral disc, presses on or irritates the sciatic nerve. The cause lies in the back, but the pain is typically felt down one of the legs [1]. The disc has a firm outer ring and a soft core. The ring can weaken with age or after acute strain, so that parts of the core are pushed out [1].

The condition can affect all age groups, but is most common between 30 and 50 years [1].

Typically there is pain from the lower back and out into one leg, often together with back pain and stiffness. The pain is often very intense in the first days and then eases [1].

With greater pressure on the nerve there may be reduced sensation in the skin, weakness or paralysis. The symptoms can also appear only in certain positions [1].

The diagnosis is made mainly from the history and a clinical examination. Typical findings are stiffness in the lower back and a positive straight leg raise test, where pain occurs when the straightened leg is lifted. Skin sensation, muscle strength and reflexes can also be tested [1].

In classic sciatica at the start, imaging is usually not necessary, because the condition usually resolves on its own. Imaging is used for persistent pain, when another disease is suspected or when surgery is considered. MR is preferred over CT, and the images may show prolapses that have no significance for the symptoms [1].

NHI describes that there is no active treatment at the start. It is recommended to stay active and go for short walks as soon as possible, although some need to rest for a short period if the pain is very severe on movement. Pain-relieving medication is often necessary in the first days [1].

Research has not shown that general physical therapy, exercise or chiropractic care gives improvement in sciatica. Exercise after the acute phase can still help you get going again, and strengthening of the abdominal and back muscles appears to be useful. Guidance should be arranged so that you learn to exercise on your own [1].

Most people gradually get better over days to weeks and are well within four months. Many have had back problems before, and some have continued problems after the sciatica period is over [1]. Long-term sick leave makes it harder to return to work, and NHI recommends early contact with the workplace [1].

Surgery is considered if the pain does not improve within a few weeks or months. About 10 per cent are thought to need surgery [1]. A systematic review that NHI has described found that surgery reduced radiating pain more than non-surgical treatment in the first six months, but that there was no difference between the groups after one year. The quality of the studies was assessed as low to very low, so the findings are uncertain [2].

Call the out-of-hours service or seek emergency help if you lose control over urination, meaning you cannot pass urine or have urine leakage, or over bowel movements. This can be caused by cauda equina syndrome, where surgery is recommended as soon as possible, preferably within 24 to 48 hours. The same applies to rapidly increasing paralysis in the legs or feet [1].

Contact a doctor if the pain does not improve within a few weeks or months, if you have persistent severe pain that requires strong pain relief, or if you get reduced sensation or weakness in the leg [1].

Dr.Dropin is a supplement to your GP and the rest of the health service. A chiropractor can examine the back and nerve function, go through what activity and exercise are relevant, and assess whether there are signs that call for further investigation. The chiropractor can refer to a medical specialist and to MR where there is clinical need. You can read more about chiropractors, about disc prolapse and about low back pain.

What is sciatica?

Sciatica is pain that radiates from the lower back down one leg, most often because a prolapse in an intervertebral disc presses on or irritates the sciatic nerve [1].

How long does sciatica last?

Most people gradually get better over days to weeks, and 80 to 90 per cent are well within four months [1]. Some have continued back problems afterwards [1].

Should I rest when I have sciatica?

NHI recommends staying active and going for short walks as soon as possible. Some need to rest for a short period if the pain is very severe on movement [1].

Do I need an MR scan for sciatica?

In classic sciatica at the start, imaging is usually not necessary. It is used for persistent pain, suspicion of another disease or when surgery is considered [1].

When should I call the out-of-hours service with sciatica?

If you lose control over urination or bowel movements, or have rapidly increasing paralysis in the legs or feet, you should call the out-of-hours service or seek emergency help [1].

The page about disc prolapse describes the condition behind many cases of sciatica. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Isjias, prolaps i korsryggen (Sciatica, lumbar disc prolapse). NHI.no. Last updated 15 January 2026. Link

2. Johannessen T. Kirurgi ved isjias (Surgery for sciatica; commentary on the systematic review by Clark, Weber and Kahwati, J Gen Intern Med 2019). NHI.no. 25 November 2019. Link