Sciatic Nerve Pain
Sciatica
Sciatica is nerve pain that travels from the lower back down through the buttock and leg, caused by irritation or compression of the sciatic nerve. Most cases improve with conservative treatment, but persistent or severe sciatica needs evaluation by a spine specialist. At Aptiva Health, our board-certified orthopedic spine surgeons and double board-certified pain management physician treat sciatica with physical therapy, epidural injections, and — when needed — minimally invasive spine surgery across Louisville, Lexington, Northern Kentucky, Elizabethtown, Mt. Washington, and Indianapolis, with same-day appointments available.
Medically reviewed by Jaideep Chunduri, MD, Michael Casnellie, MD, David McConda, MD, and Steven Ganzel, DO. Last reviewed: May 2026.
What is sciatica?
Sciatica is the common name for nerve pain that follows the path of the sciatic nerve — the longest nerve in the body, which begins in the lower back, runs through the hips and buttocks, and travels down the back of each leg.
Medically, sciatica is a symptom of an underlying condition called lumbar radiculopathy. It happens when something compresses, pinches, or irritates one of the nerve roots in the lower spine that bundles into the sciatic nerve. Common causes include a herniated disc, bone spur, spinal stenosis, or piriformis muscle dysfunction.
True sciatica is one-sided. Pain that travels from the lower back into one buttock, down the back of the thigh, and sometimes past the knee into the calf or foot is classic sciatica. Pain that stays only in the lower back is usually something else — which is why getting an accurate diagnosis from a spine specialist matters.
What does sciatica feel like?
Sciatica symptoms vary depending on which nerve root is involved and how severely it is being compressed. The most common symptoms are:
Sharp, burning, or electric pain that radiates from the lower back into one buttock and down the leg.
Numbness or tingling in the buttock, thigh, calf, or foot on the affected side.
Weakness in the leg or foot — for example, a foot that feels heavy or that drags when walking.
Pain that worsens when sitting, coughing, sneezing, or bending forward.
Pain that improves when lying down or standing.
In severe cases, loss of bladder or bowel control — this is a medical emergency requiring immediate care.
Sciatica almost always affects only one side of the body. Pain on both sides at the same time is rare and may signal a more serious condition called cauda equina syndrome, which requires emergency evaluation.
What causes sciatica?
Sciatica is caused by anything that irritates or compresses one of the nerve roots in the lumbar spine. The most frequent causes our spine team evaluates are:
Herniated lumbar disc — when the soft inner material of a spinal disc pushes through its outer wall and presses against a nerve root. The most common cause of sciatica in adults under 50.
Lumbar spinal stenosis — narrowing of the spinal canal due to age-related changes. The most common cause of sciatica in adults over 60.
Bone spurs (osteophytes) — bony overgrowths that develop with arthritis and can pinch nerve roots.
Spondylolisthesis — when one vertebra slips forward over another, narrowing the space where the nerve exits.
Piriformis syndrome — when the piriformis muscle in the buttock spasms or tightens around the sciatic nerve.
Pregnancy — the weight of the growing baby and changes in posture can compress the sciatic nerve.
Trauma — a fall, motor-vehicle accident, or sports injury that injures the lumbar spine.
How is sciatica diagnosed at Aptiva Health?
Diagnosing sciatica is a process of identifying what is compressing the nerve, not just confirming that the nerve is the source of pain. At Aptiva Health, your evaluation typically includes:
A detailed medical history. Your provider will ask about when the pain started, what triggered it, where it travels, what makes it better or worse, and any history of back injuries or surgeries.
A focused physical and neurologic exam. This includes the straight-leg raise test, reflex testing, strength testing of specific muscle groups, and sensation testing — together these often pinpoint exactly which nerve root is involved.
Imaging when indicated. MRI is the most common imaging study for sciatica because it shows soft tissue including discs, nerves, and the spinal canal. X-rays are helpful for evaluating bony alignment, fractures, and spondylolisthesis. Some sciatica causes (like piriformis syndrome) do not show on standard imaging at all.
X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the shape and size of the spinal canal, its contents and the structures around it.
Magnetic resonance imaging (MRI): A diagnostic test that produces 3D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas as well as enlargement, degeneration and tumors.
Myelogram: An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury or whether there is another site of nerve compression. This test is infrequently ordered.
How is sciatica treated?
Non-Surgical Treatments
Most sciatica resolves with conservative treatment within six to twelve weeks. The Aptiva Health spine team treats sciatica using a stepped-care approach — we always start with the least-invasive options that match your specific cause and severity, and only progress to more advanced interventions when conservative care is not enough.
Non-surgical sciatica treatment
First-line care is almost always non-surgical. Aptiva Health's spine team coordinates these options under one roof, so you don't have to coordinate care across separate practices:
Physical therapy — Aptiva's in-house physical therapy team uses targeted exercises, manual therapy, dry needling, and pelvic traction to reduce nerve irritation and strengthen the muscles that support the lumbar spine.
Activity modification — short-term avoidance of the postures and movements that worsen your specific sciatica pattern.
Anti-inflammatory medication — NSAIDs such as ibuprofen or naproxen for inflammation around the nerve root.
Muscle relaxants — short-course use to break the cycle of muscle spasm that often accompanies sciatica.
Heat and cold therapy — alternating ice (for inflammation) and heat (for muscle relaxation) at home.
sciatica injection treatments
When physical therapy and oral medication are not enough, Dr. Steven Ganzel — our double board-certified Physical Medicine & Rehabilitation and Interventional Pain Management physician — performs targeted injections under fluoroscopic (live X-ray) guidance:
Lumbar epidural steroid injection — anti-inflammatory medication delivered directly to the inflamed nerve root, often providing significant relief that lets you fully engage with physical therapy.
Selective nerve root block — a more targeted injection used both diagnostically (to confirm which nerve is responsible) and therapeutically.
Facet joint injection — when the small joints between vertebrae are contributing to the pain pattern.
Lumbar sympathetic block — for select cases of complex regional nerve pain.
Surgical treatment for severe sciatica
Surgery is considered when sciatica does not improve with conservative care after six to twelve weeks, when there is progressive weakness or numbness, or when the underlying anatomy clearly will not improve without surgical decompression. Aptiva Health's orthopedic spine surgeons — Dr. Michael Casnellie, Dr. David McConda, and Dr. Jaideep Chunduri — are all board-certified and specialize in minimally invasive spine surgery, which uses smaller incisions and muscle-splitting (rather than muscle-cutting) techniques to speed recovery.
Common surgical options for sciatica include:
The benefits of surgery should be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help.
A patient may be considered a candidate for spinal surgery if:
Radicular pain limits normal activity or impairs quality of life
Progressive neurological deficits develop, such as leg weakness and/or numbness
Loss of normal bowel and bladder functions
Medication and physical therapy are ineffective
The patient is in reasonably good health
Lumbar laminectomy, also called open decompression, is a surgical procedure performed to treat the symptoms of central spinal stenosis or narrowing of the spinal canal. The surgery involves removal of all or part of the lamina (posterior part of the vertebra) to provide more space for the compressed spinal cord and/or nerve roots.
Lumbar discectomy is a type of surgery to fix a disc in the lower back. This surgery uses smaller cuts (incisions) than an open lumbar discectomy. During a minimally invasive lumbar discectomy, an orthopedic surgeon takes out part of the damaged disc. This helps ease the pressure on the spinal cord. Your surgeon can use different methods to do this. With one method, your surgeon inserts a small tube through the skin on your back, between the vertebrae and into the space with the herniated disc. He or she then inserts tiny tools through the tube to remove a part of the disc. Or a laser may be used to remove part of the disc. Unlike an open lumbar discectomy, the surgeon makes only a very small skin incision and does not remove any bone or muscle.
Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. A MAS® TLIF achieves this by using a less invasive approach to fuse one or more vertebrae together to reduce their motion. In a MAS® TLIF procedure, rather than starting from the middle of the back and spreading the muscles to the sides like in a traditional back surgery, the MAS® TLIF approach starts off to one side of the back and splits (rather than cuts) the back muscles in one direction. This allows the surgeon to make a smaller incision with less muscle injury, which may result in less postoperative pain and a quicker recovery. This approach has proven to reduce blood loss, minimize scarring, reduce length of hospital stay, and allow for patients to recover quicker than conventional lumbar fusions. At Aptiva Health, our orthopedic spine surgeons specialize in the MAS® TLIF procedure.
Most Aptiva Health sciatica surgeries are performed on an outpatient or short-stay basis. Most patients return to non-strenuous work within two to four weeks and to full activity within two to three months, depending on the procedure.
When should you see a doctor for sciatica?
Most sciatica improves within a few weeks of conservative care. See a spine specialist sooner if you experience any of the following:
Sciatica pain that has lasted more than two weeks without improvement.
Pain severe enough that it interferes with sleep, work, or daily activity.
Numbness, tingling, or weakness that is getting worse rather than better.
Sciatica that follows an injury or accident.
Pain on both legs at the same time.
Get to an emergency room immediately if you have new loss of bladder or bowel control, saddle anesthesia (numbness in the area that would touch a saddle), or sudden severe weakness in both legs. These can be signs of cauda equina syndrome, a surgical emergency.
For non-emergency sciatica, Aptiva Health offers immediate spine appointments at most locations, plus free 24/7 virtual access to our orthopedic providers through the HURT! app — so you do not have to wait weeks to find out what is causing your pain.
Why choose Aptiva Health for sciatica treatment?
Most patients with sciatica end up coordinating care across three or four separate practices: a primary care office for the referral, a spine clinic for the evaluation, an imaging center for the MRI, a pain clinic for the injection, and a separate physical therapy practice for rehab. Aptiva Health is built differently. Every step happens under one roof:
Three board-certified orthopedic spine surgeons — Dr. Casnellie, Dr. McConda, Dr. Chunduri — for surgical evaluation when needed.
A double board-certified pain management physician — Dr. Steven Ganzel — for fluoroscopy-guided injections.
In-house physical therapy with dry needling, manual therapy, and post-operative rehab.
Immediate appointments — no two-month wait for a consultation.
Free virtual access through the HURT! app for after-hours guidance.
Transparent cash-pay pricing for patients without insurance, plus in-network coverage with Anthem, Aetna, Cigna, Humana, United Healthcare, Medicare, and most Medicaid plans.
Schedule your appointment today!
We treat sciatica across Kentucky & Indiana!
Spine Center of Excellence: 3615 Newburg Road, Louisville, KY 40218
Louisville - East: 10100 Linn Station Road, Suite 1A, Louisville, KY 40223
Concussion & Sports Medicine Institute: 3611 Newburg Road, Louisville, KY 40218
Elizabethtown: 529 Westport Road, Suite 2, Elizabethtown, KY 42701
Indianapolis: 6801 Gray Road, Indianapolis, IN 46237
Louisville - Downtown: 300 South 13th Street, Louisville, KY 40203
Louisville - Middletown: 401 N English Station Road, Suite 1A, Louisville, KY 40223
Lexington Physical Therapy: 152 W Tiverton Way, Suite 180, Lexington, KY 40503
Mount Washington: 737 N Hwy 31e Byp, Suite 2, Mt. Washington, KY 40047
Northern Kentucky: 2093 Medical Arts Drive, Hebron, KY 41048
Frequently asked questions about sciatica
What is the fastest way to relieve sciatica pain?
Most people get fastest relief from a combination of short-term rest, ice or heat applied to the lower back, an over-the-counter anti-inflammatory like ibuprofen, and gentle stretching of the piriformis and hamstring muscles. If pain has lasted more than a week or is severe, a focused course of physical therapy and — when needed — a fluoroscopy-guided epidural steroid injection performed by an interventional pain specialist usually produces faster relief than continuing self-care alone.
How long does sciatica usually last?
Acute sciatica typically improves within four to twelve weeks of conservative treatment. About 80 to 90 percent of patients fully recover without surgery. Sciatica that persists beyond twelve weeks despite physical therapy, medication, and at least one targeted injection is usually evaluated for a structural cause that may benefit from minimally invasive surgery.
Can sciatica heal on its own without treatment?
Yes, mild sciatica from a small disc herniation can resolve on its own as the body reabsorbs disc material and inflammation settles. However, sciatica that includes progressive weakness, worsening numbness, or pain that interferes with sleep should not be left untreated, because untreated nerve compression can lead to permanent nerve damage.
Is sciatica covered by insurance?
Yes. Sciatica evaluation, imaging, physical therapy, injections, and surgery are covered by most commercial insurance plans, Medicare, and Medicaid. Aptiva Health is in-network with Anthem, Aetna, Cigna, Humana, United Healthcare, Kentucky Medicaid (for orthopedics), VA, and Humana Military, and we offer transparent cash-pay pricing for patients without insurance.
What is the difference between sciatica and a pinched nerve?
Sciatica is a specific type of pinched nerve. The medical term is lumbar radiculopathy, which means a pinched nerve root in the lower spine. Sciatica is what we call lumbar radiculopathy when it produces the classic pain pattern down the buttock and leg along the path of the sciatic nerve.
Do I need an MRI for sciatica?
Not always. Most sciatica is initially evaluated with a thorough history and physical exam by a spine specialist, who can often identify the likely cause without imaging. An MRI is typically ordered when symptoms have not improved with several weeks of conservative care, when symptoms are severe, when there is progressive weakness, or when the spine specialist suspects a cause that requires more advanced treatment.
Can sciatica come back after treatment?
Yes. Sciatica from a disc herniation can recur if the disc re-herniates, and sciatica from spinal stenosis or arthritis can recur as those underlying conditions progress with age. Continuing the core-strengthening exercises learned in physical therapy, maintaining a healthy weight, and avoiding the postures and movements that triggered the original episode are the most effective ways to reduce the chance of recurrence.
Should I see a chiropractor or a doctor for sciatica?
For mild, recent-onset sciatica with no red-flag symptoms (no progressive weakness, no bladder or bowel changes, no severe pain), either approach can be reasonable. For sciatica that has lasted more than two to three weeks, that is severe, or that is associated with numbness or weakness, evaluation by a board-certified spine physician — followed by physical therapy, injections, or surgery as indicated — is the more thorough pathway.
How quickly can I be seen at Aptiva Health for sciatica?
Aptiva Health offers same-day and walk-in appointments for sciatica at most locations across Louisville, Lexington, Northern Kentucky, Elizabethtown, and Mt. Washington. The HURT! app also provides free, 24/7 virtual access to an Aptiva orthopedic provider for after-hours guidance.
Where can I get sciatica treatment near me in Kentucky or Indianapolis?
Aptiva Health treats sciatica at four Louisville locations, our Lexington clinic, Northern Kentucky (Hebron), Elizabethtown, Mt. Washington, and our new Indianapolis location opening on May 21, 2026. Click any location on this page to see the address, phone, and online scheduling for that office.
Stop guessing what's causing your sciatica. Aptiva Health's board-certified spine team can evaluate your symptoms, image the source of the pain, and start treatment — often within the same week.