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What is Sciatica?
Sciatica (lumbosciatica, radiculopathy) is a pain syndrome caused by irritation or compression of the sciatic nerve or its roots (L4, L5, S1). The sciatic nerve is the longest and thickest nerve in the human body, running from the lumbar spine through the buttock and along the posterior surface of the leg to the foot.
Sciatica is not an independent disease, but a symptom of other spinal pathologies. According to statistics, up to 40% of the population experience at least one episode of sciatica in their lifetime.
Causes of Sciatica:
- Herniated Disc — the most common cause (60-90% of cases)
- Spinal Stenosis — narrowing of the canal with root compression
- Spondylolisthesis — vertebral slippage
- Piriformis Syndrome — muscle spasm compressing the nerve
- Osteophytes — bony outgrowths
- Spondyloarthrosis — facet joint osteoarthritis
Facts about Sciatica
- ICD-10: M54.3
- Prevalence: up to 40% of the population at least once in lifetime
- Peak: 30-50 years
- Main cause: herniated disc (60-90%)
- Recurrences: up to 50% of cases
Symptoms of Sciatica
Typical Presentation
- Sharp shooting pain from the lumbar spine into the leg
- Pain along the posterior/lateral thigh
- Pain in the calf and foot
- Worsening with coughing, sneezing, straining
- Antalgic posture
- Inability to sit or stand for long periods
Neurological Signs
- Numbness and tingling in the leg
- Sensation of «crawling ants»
- Foot drop weakness
- Reduced or absent reflexes
- Muscle atrophy (in prolonged cases)
⚠️ Seek Urgent Medical Attention
- Disruption of urination or defecation
- Numbness of the perineum (saddle anesthesia)
- Rapidly progressing weakness in the leg
- Bilateral Sciatica
- Pain not relieved by any medications
Sciatica: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Moderate evidence |
| Epidural or perineural injection | Reduces radicular pain for weeks or months, helps get through a flare-up | Moderate evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Little data |
| Microdiscectomy | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In most patients with a herniation or protrusion, leg or arm pain eases markedly within 6–12 weeks without surgery. Staying active, exercise therapy and painkillers help; for severe radicular pain, an epidural or perineural injection may be used. Intradiscal injections of PRP and cells are still experimental: the studies are small and disc regeneration has not been shown.
When surgery is discussed. Urgently — for leg weakness, numbness in the saddle area or bladder problems. Electively — if severe radicular pain does not ease within 6–12 weeks of treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell sciatica from other causes of leg pain
In sciatica pain runs from the buttock down the back or side of the leg below the knee, often with numbness or tingling in the foot; coughing and sneezing worsen it. The most common cause is an L4–L5 or L5–S1 disc herniation. Buttock pain without radiation below the knee occurs in piriformis syndrome and sacroiliac joint problems, and calf pain when walking that eases at rest in spinal stenosis or vascular disease. MRI is needed with red flags or pain lasting more than 6 weeks.
What you can do yourself
Stay active and walk as much as pain allows; bed rest does not speed recovery. Change position and avoid heavy lifting and prolonged sitting. Painkillers as prescribed; increasing foot weakness, numbness in the groin area or bladder problems need urgent care.
Outlook and timelines
In most people pain eases noticeably within 6–12 weeks, and the herniation often shrinks over time. An epidural or periradicular injection can relieve pain during this period. Surgery is discussed with neurological deficit or persistent severe pain; in the long term, results of surgery and conservative treatment are often comparable.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
- Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Tuakli-Wosornu YA et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R, 2016.
- Lurie JD et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial. Spine, 2014.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently Asked Questions about Sciatica Treatment
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request