GPAtlas🧭 When to suspect
Sciatica (lumbosacral radiculopathy) is leg pain arising from irritation or compression of a lumbosacral nerve root – most often by a herniated disc, but also by spinal stenosis or foraminal narrowing. The cardinal feature is unilateral leg pain that is worse than any accompanying back pain and radiates below the knee in a dermatomal distribution. It is typically neuropathic in quality – sharp, shooting, burning, or "electric shock"-like – and is often accompanied by paraesthesia, numbness, or weakness in the same leg.
Suspect sciatica when leg pain dominates over back pain, follows a nerve-root distribution, and is aggravated by coughing, sneezing, or sitting. The diagnosis is clinical. The two essential primary-care tasks are to recognise the radicular pattern and, at every contact, to exclude the serious mimics – above all cauda equina syndrome. Most cases settle within 6–12 weeks with activity and simple measures.
| Points towards radicular pain (sciatica) | Points towards non-specific low back pain |
|---|---|
| Leg pain worse than back pain, radiating below the knee | Pain centred on the back or buttock, not extending below the knee |
| Neuropathic quality (burning, shooting, electric); dermatomal numbness or tingling | Dull, aching, "mechanical" pain with no clear dermatomal sensory change |
| Positive straight leg raise or other nerve-tension sign | Negative tension signs; pain reproduced by back movement or palpation |
| May have myotomal weakness or a depressed reflex | Power, sensation and reflexes intact |
Source: NICE NG59
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