Sciatica treatment starts with staying active, exercise therapy and pain relief, and most people improve within weeks to a few months. UK NICE guidelines advise against gabapentin-type drugs, oral steroids and benzodiazepines for sciatica. Injections help some people; surgery is for red flags or pain that will not settle.
What causes sciatica
Usually a herniated disc or spinal stenosis pressing on a nerve root in the lower back. Pain runs from the buttock down the back of the leg, often below the knee.
Back or leg pain for more than 6 weeks? Get the free guide and a doctor review of your scan.
Sciatica treatment options
| Treatment | Notes |
|---|---|
| PRP / stem cellsRecommended | Minimally invasive alternative to surgery |
| Stay active | Bed rest slows recovery |
| Sciatica exercises | Nerve glides, gentle extension, walking |
| Physiotherapy | Tailored programme |
| NSAIDs | Short courses if safe |
| Epidural steroid injection | NICE: consider for acute severe sciatica |
| Surgery | Red flags or persistent severe pain |
How long does sciatica last?
Many cases ease within 4 to 6 weeks; some take several months. Pain that is not improving after 3 months should be reviewed with an MRI.
Symptoms of sciatica
- Pain from the buttock down the back or side of the leg, often below the knee
- Leg pain that is worse than back pain
- Numbness or pins and needles in the leg or foot
- Weakness in the foot or ankle in some people
- Pain worse with sitting, coughing, sneezing or bending forward
Pain usually affects one leg. Pain in both legs, or with bladder or bowel changes, needs urgent assessment.
Back or leg pain for more than 6 weeks? Get the free guide and a doctor review of your scan.
What causes sciatica
About 9 in 10 cases come from a herniated disc in the lower back pressing on or irritating a nerve root (usually L5 or S1). Other causes include spinal stenosis, a slipped vertebra (spondylolisthesis), and, less often, a tight piriformis muscle in the buttock. Rare causes such as infection or tumour are why red flags matter.
Medicines: what helps and what does not
UK NICE guidelines advise against gabapentin, pregabalin and other antiepileptic drugs, oral steroids and benzodiazepines for sciatica, because trials show little benefit and real side effects. Short courses of NSAIDs can help some people if safe for them. Opioids are not recommended for long-term use. That leaves exercise, activity, time and, for severe cases, injections or surgery as the core of treatment.
When to consider an MRI
- Pain not improving after about 6 weeks
- Before an injection or surgery
- Any red flag symptoms (urgently)
Recovery timeline
Many people notice real improvement within 4 to 6 weeks and are much better by 3 months. A smaller group has pain that lasts longer. If you are in that group, it is worth getting an MRI review to see whether an epidural, PRP, stem cells or surgery could fit.
Common questions
Should I rest in bed with sciatica? No. Short walks and staying as active as you can speed recovery.
Can sciatica go away on its own? Often, yes, as the disc settles and inflammation calms.
Heat or ice? Either can ease pain; use whichever feels better.
