How Long Does Sciatica Last? Timeline and Recovery
The honest answer about sciatica recovery timelines, what to expect week by week, and when to adjust your treatment plan.
Dr. Marc Greenberg
Fellowship-Trained Spine Surgeon
Dr. Greenberg completed advanced fellowship training at Mayo Clinic, Johns Hopkins, and Brown University. He specializes in minimally invasive and motion-preserving spine surgery, with a focus on evidence-based care and shared decision-making.
The Short Answer
Most sciatica improves significantly within 6-8 weeks. About 70-80% of patients see substantial relief with conservative care during this timeframe.
However, "improvement" doesn't always mean complete resolution. Some patients have lingering mild symptoms, and others experience recurrent episodes.
The timeline varies based on the underlying cause, severity of nerve compression, your overall health, and how you manage the condition. Let me walk you through what the research shows and what I see in practice.
Natural History of Sciatica
When we talk about "natural history," we mean what happens if you don't have surgery. Here's what large studies show:
This is encouraging data. It tells us that most sciatica resolves on its own, given time and appropriate conservative management.
But here's the nuance: "better" doesn't always mean "back to normal." Some patients have residual numbness or occasional twinges. And about 20-30% of patients have recurrent episodes within 5 years.
Week-by-Week Timeline
Here's what I typically tell patients to expect:
Weeks 1-2: Acute Phase
What's happening: Inflammation is at its peak. Pain is often severe and unpredictable.
What to do: Activity modification, ice/heat, anti-inflammatories. Avoid prolonged sitting and heavy lifting. Short walks are usually okay.
Expected progress: Some patients feel better quickly; others plateau or worsen slightly before improving.
Weeks 3-6: Early Recovery
What's happening: Inflammation begins to subside. Nerve irritation decreases.
What to do: Start physical therapy if not already doing so. Gradually increase activity. Consider epidural steroid injection if symptoms remain severe.
Expected progress: Most patients notice improvement. Pain may shift from sharp/shooting to dull/achy. Numbness may persist even as pain improves.
Weeks 7-12: Continued Improvement
What's happening: Nerve healing continues. Function improves.
What to do: Progress PT exercises. Return to normal activities as tolerated. If symptoms remain severe or worsen, consider surgical evaluation.
Expected progress: 70-80% of patients are significantly better by week 12. If you're not improving, it's time to reassess.
Beyond 12 Weeks: Chronic Phase
What's happening: If symptoms persist beyond 12 weeks, the likelihood of spontaneous resolution decreases.
What to do: Surgical consultation is reasonable. MRI (if not already done) to identify the cause. Discuss risks/benefits of continued conservative care vs surgery.
Expected progress: Some patients still improve with more time, but many benefit from surgical decompression at this point.
What Affects Recovery Time?
Several factors influence how quickly sciatica resolves:
Faster Recovery
- Younger age
- First episode of sciatica
- Mild to moderate symptoms
- No significant weakness
- Active lifestyle
- Non-smoker
Slower Recovery
- Older age
- Recurrent episodes
- Severe pain or weakness
- Large disc herniation
- Sedentary lifestyle
- Smoking
When Recovery Stalls
If you're not improving as expected, consider these possibilities:
- Wrong diagnosis: Not all leg pain is sciatica. Piriformis syndrome, hip arthritis, and vascular claudication can mimic sciatica.
- Persistent compression: Large disc herniations or severe stenosis may not resolve without intervention.
- Inadequate treatment: Some patients need more aggressive PT, injections, or activity modification.
- Psychosocial factors: Chronic pain, fear-avoidance behavior, and work-related stress can prolong symptoms.
My threshold for surgical evaluation: If you're not significantly better after 8-12 weeks of appropriate conservative care, it's time to discuss whether surgery might offer a better outcome.
Can You Speed Recovery?
Somewhat. Here's what helps:
What doesn't help: Extended bed rest, passive treatments (massage, chiropractic manipulation), and waiting indefinitely for symptoms to resolve.
Sciatica Not Improving?
Let's figure out why and adjust your treatment plan.