Sciatica & nerve root pain

What it is

A nerve root leaving the lumbar spine becomes compressed or chemically irritated — commonly by a disc bulge, sometimes by narrowing of the canal. The nerve then reports pain along its whole distribution, which is why the calf and foot hurt when the problem is in the back.

What it feels like

• ·Sharp, electric or burning pain running from buttock to calf or foot
• ·Pain worse with coughing, sneezing or sitting
• ·Numbness or pins and needles in a defined strip of skin
• ·Weakness lifting the foot or pushing off — report this promptly

How we assess it

The examination localises the level: reflexes, power, sensation and nerve tension tests together usually identify the root involved. Imaging is used to confirm and to plan an injection, not to make the diagnosis on its own.

Treatment options

• ·A transforaminal nerve root injection at the confirmed level
• ·Epidural injection where more than one level is involved
• ·Neuropathic medication, trialled properly and reviewed rather than left running
• ·Graded movement rehabilitation once the pain allows

What recovery looks like

A large proportion of sciatica settles over weeks to months. Injection is used to make that period tolerable and to keep you moving, and to give a clear answer when the pain is not settling on its own.

Persistent or progressive weakness changes the conversation, and a surgical opinion is arranged without delay.

Risks and honest limits

An injection treats inflammation around the nerve; it does not remove a disc fragment. Where the anatomy means surgery is the better answer, we say so early rather than after repeated procedures.

New bladder or bowel disturbance, or numbness around the saddle area, is an emergency — attend an emergency department.