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Sciatica (lumbar radiculopathy) - Management
How do I know my patient has it?

To diagnose sciatica:

  • Rule out serious pathology — see Assessing for serious risks - red flags.
  • Confirm that the symptoms and signs are those of sciatica (radiculopathy) by checking that:
    • Unilateral leg pain radiates below the knee to the foot or toes.
    • Low back pain, if it is present, is less severe than the leg pain.
    • There are symptoms and signs of nerve root compression — numbness, tingling (paraesthesia), weakness, or loss of tendon reflexes — all in the distribution of a nerve root.
      • Symptoms and signs of nerve compression are (usually) limited to one nerve root.
      • Numbness and paraesthesia are in the same distribution.
    • Raising the leg whilst it is straight causes greater leg pain and/or more nerve compression symptoms.
  • Exclude other causes of similar symptoms and signs — see Differential diagnosis.
    • Examination of the hips, knees, and trochanteric bursae will reveal most of the conditions with symptoms similar to sciatica.
  • Do not routinely X-ray the spine, as imaging is seldom indicated or useful, and a focused history and the brief clinical examination described is generally sufficient for diagnosis in most people with sciatica [Waddell, 2004; Koes et al, 2007].
  • Arrange magnetic resonance imaging (MRI) if:
    • There are red flags — imaging will help to confirm or exclude underlying specific conditions.
    • Surgery is contemplated — imaging will help decide if surgery is indicated, for example for a herniated lumbar disc.
  • For more information on when to arrange MRI, see Referral.

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