Intended for healthcare professionals

Practice Clinical Updates

Diagnosis and treatment of sciatica

BMJ 2019; 367 doi: (Published 19 November 2019) Cite this as: BMJ 2019;367:l6273
  1. Rikke K Jensen, associate professor1 2,
  2. Alice Kongsted, professor1 2,
  3. Per Kjaer, professor1 3,
  4. Bart Koes, professor1 4
  1. 1Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
  3. 3Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
  4. 4Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
  1. Correspondence to R K Jensen rikkekruger{at}

What you need to know

  • Sciatica is a clinical diagnosis based on symptoms of radiating pain in one leg with or without associated neurological deficits on examination

  • Most patients improve over time with conservative treatment including exercise, manual therapy, and pain management

  • Imaging is not required to confirm the diagnosis and is only requested if pain persists for more than 12 weeks or the patient develops progressive neurological deficits

  • Urgently refer patients with signs of urinary retention or decreased anal sphincter tone, which suggest cauda equina syndrome

  • Surgery is an option if symptoms do not improve after 6-8 weeks of conservative treatment. It may speed up recovery but the effect is similar to conservative care at one year

Sciatica is commonly used to describe radiating leg pain. It is caused by inflammation or compression of the lumbosacral nerve roots (L4-S1) forming the sciatic nerve.1 Sciatica can cause severe discomfort and functional limitation.

Recently updated clinical guidelines in Denmark, the US, and the UK highlight the role of conservative treatment for sciatica.234 In this Clinical Update, we provide an overview for non-specialists on diagnosing sciatica and key principles in its management.

The term “sciatica” is not clearly defined and it is often used inconsistently by clinicians and patients.5 Radicular pain and lumbosacral radicular syndrome have been suggested as alternatives.6 In this article, we use sciatica and radicular pain synonymously. Radiculopathy describes involvement of the nerve root, which causes neurological deficit including weakness or numbness.

How do patients present? (Box 1)

Box 1

Symptoms and signs suggesting sciatica

  • Unilateral leg pain more severe than low back pain

  • Pain most commonly radiating posteriorly at the leg and below the knee

  • Numbness and/or paraesthesia in the involved lower leg

  • Positive neural tension test with provocation of pain in the affected leg (straight leg raise test/femoral nerve test/slump test)

  • Neurological deficit associated with the involved nerve root …

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