- The sciatic nerve is the thickest and longest peripheral nerve in the body.
- Sciatic pain refers to pain that radiates to or is located in the leg, regardless of the underlying cause.
- Over 90% of so called sciatic pain where pain is radiating to lower extremity is caused by non-structural disorders in the joints, muscles, and connective tissue.
The course of the sciatic nerve
The sciatic nerve is the longest and thickest nerve in the body and is responsible for innervating the muscles of the buttocks, calves, and feet, as well as almost the entire lower limb.
Causes of sciatic pain
Sciatic pain refers to pain that radiates down the leg. Various non-structural so called functional disorders of the joints, muscles, and connective tissue, as well as referred pain, cause over 90% of sciatic pain. The most common problems are in the low back, pelvis, and/or buttocks. These various non-structural functional disorders include SI joint dysfunction, low back facet joint syndrome, and various trigger points in the gluteal muscles. In other words, relatively few cases of pain radiating to the leg or other sensations are caused by chemical irritation or mechanical pressure on the sciatic nerve.
Less commonly, sciatic pain can also be caused by structural factors in the gluteal or hamstring muscles, such as a bulging disc or pinching of the sciatic nerve in the buttocks, i.e., piriformis syndrome, or in the back of the thigh, i.e., hamstring syndrome. In people over the age of 60, sciatic pain can also be caused by spinal stenosis, in which the narrowing of the spinal canal begins to press on the nerve roots.
In general, functional disorders are characterized by pain and possibly mild sensory changes, but not by clear and permanent sensory changes and/or muscle weakness, as in structural disorders.
Symptoms of sciatic pain
- Radiating pain from the lower back and/or buttocks down the leg
- May be accompanied by sensory changes or muscle weakness, depending on the underlying cause
- Usually worsens with exertion
- In general, symptoms vary rapidly in non-structual functional causes
- In general, in structural causes, the symptoms are more stable and continuous also at rest
Causes of prolonged sciatic pain
Prolonged symptoms are usually caused by a combination of several factors rather than just one of the factors listed below.
- Physiological strain due to previous injuries, premature wear, or functional disorders, especially in the lower back, hip, knee, ankle, and foot on the same side.
- Insufficient or excessive physical strain.
- Structural factors, such as vertebral displacement, narrowing of the spinal canal, the course of the sciatic nerve in relation to the piriformis muscle, etc.
- Psychological factors, such as anxiety, depression, and/or excessive mental strain, commonly known as stress.
- Lifestyle factors, such as too little or too repetitive exercise, insufficient or poor-quality sleep, and a diet that promotes mild inflammation.
- Local or central nervous system sensitization of the pain system.
- Social factors, such as insufficient support from the environment or dissatisfaction with family or work matters.
Treatment and rehabilitation of sciatic pain
Treatment usually includes:
- Manual therapy to treat joint, muscle, and fascia dysfunctions.
- Neurological rehabilitation to address individual neurological deficits like nerve mobilization exercises.
- Individual exercises to improve posture and movement.
- Acupuncture to treat pain and pain sensitization.
- Lifestyle guidance to improve exercise, sleep, rest, and eating habits.
Read more about related pain syndromes:
Low back intervertebral disc problems
Hip flexor pain (Psoas syndrome)
Viimeksi päivitetty 13.10.2025
