11/17/2025
Sciatica: Your Body’s Largest Nerve
Sciatica affects up to 40% of us during our lifetime. The sciatic nerve is the largest nerve in the human body (up to 2cm in diameter) extending from the lower lumbar spine through the buttocks and down the entire leg. Formed by nerve roots L4-S3, this massive neural highway controls both motor + sensory functions throughout the posterior thigh, leg, and foot. True occurs when the sciatic nerve becomes compressed/irritated, causing characteristic radiating pain that extends below the knee. While ~90% of sciatica cases result from herniated lumbar discs, other causes include spinal stenosis, spondylolisthesis, piriformis syndrome, epidural abscess, or even pregnancy-related compression.
Sciatica often presents w/ unilateral leg pain that exceeds back pain in intensity + burning sensations, electric shock-like discomfort, and paresthesias. The straight leg raise test, performed by healthcare providers, helps confirm the diagnosis when positive between 30 and 70 degrees of hip flexion. Sciatica peaks during the 4th decade of life and affects all genders equally, with occupational risk factors including truck driving, machine operation, and jobs requiring awkward physical positions.
Current evidence strongly supports staying active vs. bed rest. Conservative management includes NSAIDs, physical therapy, and proper posture education. Most patients experience substantial improvement within 3mos w/ 70% recovering completely (within 1yr). Imaging is reserved for cases with red flags (persistent pain >6-8wks) or when surgery is being considered. Surgery typically benefits patients with severe symptoms unresponsive to conservative care, though research indicates that while surgical intervention may provide faster initial relief, long-term outcomes at one to two years show minimal differences compared to conservative management.
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