Sciatica / Radiculopathy

Sciatica and radiculopathy refer to pain and neurologic symptoms caused by irritation or compression of a spinal nerve root, most commonly in the lower back. Symptoms often travel from the back into the buttock, thigh, and leg, and may include numbness, tingling, or weakness.

Our PM&R team focuses on reducing nerve irritation, restoring mobility, and helping you return to activity safely.

Symptom Onset & Initial Evaluation

Symptoms may begin after lifting, prolonged sitting, or seemingly “out of nowhere.” Common signs of sciatica include:

• Radiating pain down one leg
• Numbness/tingling (“pins and needles”)
• Pain worsened by sitting, coughing, or bending (in many cases)
• Weakness (such as trouble lifting the foot) in more significant nerve involvement

Your provider will perform a focused neurologic exam to assess strength, sensation, reflexes, and nerve tension signs.

Diagnosis

Diagnosis is often based on the signs and symptoms. Additional testing may include:

• MRI lumbar spine: If symptoms are severe, persistent, associated with weakness, and/or impact urination
• EMG/Nerve conduction study: Sometimes used when the diagnosis is unclear, or symptoms don’t match imaging findings

Treatment

Treatment for sciatica is individualized and typically progresses in a stepwise manner, starting with conservative approaches and advancing to interventional care when symptoms persist or worsen.

Conservative Care (First-Line for Many Patients)

Most people improve with non-surgical treatment focused on reducing nerve irritation and restoring safe movement patterns. Initial care often includes:

• Activity modification with a gradual, guided return to normal movement
• Physical therapy emphasizing nerve mobility, hip and core strengthening, and symptom centralization strategies
• Anti-inflammatory or short-term symptom-relief medications, when appropriate, to manage pain and inflammation

Interventional Options (When Indicated)

When conservative measures do not provide adequate relief or when symptoms significantly limit function, interventional treatments may be considered. These options can include:

• Targeted epidural steroid injections to reduce inflammation and relieve persistent radiating pain
• Coordination with spine surgery specialists in cases of progressive neurologic weakness or refractory symptoms despite appropriate non-surgical care¹

1. Peul, Wilco C., et al. “Surgery versus Prolonged Conservative Treatment for Sciatica.” New England Journal of Medicine, vol. 356, no. 22, 31 May 2007, pp. 2245–2256.

Ongoing Management & Long-Term Care

Long-term success depends on maintaining spinal health and preventing recurrence once symptoms improve. Ongoing care typically focuses on:

• A personalized home exercise program to support flexibility, strength, and nerve health
• Ergonomic and posture coaching for work, daily activities, and sleep positions
• Follow-up visits to monitor neurologic function, symptom resolution, and overall recovery