What is it?

The sciatic nerve is the largest nerve in the human body. It originates from several nerve roots at the lower end of the lumbar spine—specifically L4, L5, S1, S2, and S3. This nerve controls the joints of the hips, knees, and ankles, as well as the muscles of the legs and feet.

Cause

Pressure on the sciatic nerve can lead to inflammation, resulting in what is commonly known as sciatica. The most frequent cause is a herniated disc—an issue involving the cartilage disc between the vertebrae.

A less common cause is compression of the sciatic nerve as it passes through the piriformis muscle (in the gluteal region). This type of compression is more common in athletes and runners, who tend to develop hypertrophy in this muscle.

Symptoms

pain in the back of the leg and buttock
mild lower back pain
shock-like or burning pain in the leg
usually affects only one leg
in severe cases, reduced strength in the affected leg
pain typically improves when lying down
pain worsens when sitting or standing
may intensify when sneezing or coughing

Diagnosis

physical exam: the Lasègue test (straight leg raise) is sensitive for detecting sciatic nerve compression. It involves lifting the extended leg hile the patient is lying down, which can trigger sharp pain radiating to the foot. Weakness or sensory loss in the leg may also be observed
imaging tests: CT scans or mris of the lumbar spine can help identify a herniated disc

Treatment

Conservative:

pain relievers and anti-inflammatory medications
physical therapy
local application of ice or heat
short periods of relative rest
pain management procedures such as corticosteroid injections guided by fluoroscopy or ct

Surgical:

If conservative treatment fails, surgery may be necessary to remove the herniated disc. These procedures are now minimally invasive and typically allow for a quick return to daily activities, using either a microscope or endoscope.

Prevention

regular physical activity
maintaining a healthy weight
stretching exercises
muscle strengthening with professional guidance
proper ergonomics at work and home (e.g., suitable chairs and mattresses)
avoiding improper lifting techniques

Incidence

Sciatic and lower back pain are highly prevalent. The incidence rate is around 13%, and over 60% of the population may experience this type of pain. Sedentary lifestyles, urban mobility patterns, and prolonged sitting contribute to this high rate.