How to diagnose and
treat sciatica

How do clinicians diagnose sciatica?

If you have pain running from your back down one leg, especially below the knee, your clinician may suspect sciatica (also called lumbar radicular pain). Diagnosis starts with your story: how and when the pain started, where the pain travels, what makes it worse, and how it affects your daily life.

Clinicians look for a pattern of leg-dominant pain, tingling, or weakness that matches a nerve pathway from the lower spine. They’ll ask about activities that trigger symptoms, like sitting, bending, or coughing, and about things that ease them, such as walking or lying flat or even about possible changes in bladder or bowel movements.

During a physical exam, they may:

• Check leg strength and reflexes (like your Achilles reflex).
• Test nerve tension using the straight-leg raise or slump test, which stretches the irritated nerve.
• Note any numbness or weakness that lines up with a specific nerve root.

Imaging such as MRI is not usually needed at first. It’s reserved for cases with “red flag” symptoms — like new bladder or bowel problems, severe or worsening weakness, fever, or history of cancer — or when results would change the treatment plan (for example, if surgery or injection is being considered)^{1 2}.

Electrodiagnostic tests may be used when it’s unclear whether symptoms come from a spinal nerve or another nerve issue².

Clinical insight

Large studies show that many people without pain have “abnormal” MRI findings such as disc bulges or degeneration. This means a scan alone cannot diagnose sciatica — what matters most is how your symptoms and physical exam fit together³.

What are the treatment options for sciatica?

Most people recover from sciatica with non-surgical care focused on adequate movement, education, and self-management. Care usually progresses step by step, starting with simple, active strategies and only considering injections or surgery if needed later^{2, 4}.

1. Education and activity Learning that movement is safe and beneficial helps manage stress and anxiety and reduce fear of pain. Gentle movement and gradual return to normal routines promote faster recovery⁴.
   
2. Exercise-based rehabilitation Structured exercise is the foundation of care. Programs often focus on:
   • Repeated movements that “centralize” pain (often gentle back extensions)
   • Core and hip strengthening
   • Nerve mobility work and walking or cycling for enduranceThese programs help restore confidence and function while easing pain^{2, 5}.
3. Medications
   • Anti-inflammatory drugs (NSAIDs) can offer short-term relief, but should be used sparingly due to stomach and kidney risks⁶.
   • Steroid pills show only modest short-term improvement and are not routinely recommended⁷.
   • Gabapentinoids, benzodiazepines, and opioids are not advised for chronic sciatica due to limited benefit and higher risk of harm^{2 8}.
4. Injections Epidural steroid injections may offer short-term pain relief (weeks to months) for severe cases, helping people re-engage with rehabilitation. Effects usually fade over time and risks, while low, include headache, temporary high blood sugar, local infection or tissue damage⁹.
   
5. Surgery If pain remains severe after 6–12 weeks of good conservative care, and MRI confirms a disc pressing on a nerve, microdiscectomy may relieve leg pain. Over the long term (1–5 years), people who choose surgery and those who continue non-surgical care tend to have similar outcomes¹⁰.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find pain relief for sciatica?

While you’re recovering, simple habits can make a real difference:

• Keep moving — even short walks can help circulation and mood.
• Alternate sitting and standing to avoid long periods in one position.
• Try lying on your stomach or doing gentle back bends if these ease your leg pain.
• Manage pain flares with heat, pacing, and breathing exercises — they don’t usually mean new injury.
• If pain or weakness gets worse or lasts beyond a few weeks, check with your clinician.

Regular activity, patience, knowledge and reassurance are key. Most people regain normal life with consistent movement and guided rehab^{2 5}.