Sciatica Symptoms: When to See a Doctor
Not all leg pain needs urgent attention. Here's how to know when to call, when to wait, and when to head to the ER.
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.
I get this question multiple times a day: "I have leg pain shooting down from my back. Should I come in right away, or can this wait?"
The answer depends on what else is happening. Most sciatica improves with time and conservative care, but certain symptoms require prompt evaluation. Here's how I help patients decide.
Typical Sciatica Symptoms
Sciatica usually presents as:
- Sharp, shooting pain that travels from your lower back or buttock down the back of your leg
- Numbness or tingling in specific areas (outside of calf, top of foot, bottom of foot)
- Pain that worsens with sitting, bending forward, or coughing/sneezing
- One-sided symptoms (though occasionally both legs are affected)
These symptoms are uncomfortable but not necessarily urgent. The natural history of sciatica is favorable — about 70-80% of patients improve significantly within 6-8 weeks with conservative care.
When You Can Wait and See
If your symptoms include:
- Pain and numbness but normal strength in your leg
- Symptoms that started within the past few days
- No bowel or bladder changes
- No fever or unexplained weight loss
- No history of cancer
Reasonable first steps: Try activity modification, over-the-counter anti-inflammatories (if safe for you), ice or heat, and gentle movement. Avoid prolonged sitting and heavy lifting. If you're not improving after 7-10 days, call your primary care doctor.
When to Call My Office (Non-Urgent)
Schedule an appointment within 1-2 weeks if:
- Symptoms have persisted 6-8 weeks despite conservative care
- Pain is severe enough to interfere with work, sleep, or daily function
- You've had multiple episodes of sciatica over the past year
- You're considering an epidural steroid injection or other interventions
- You want to discuss whether imaging or surgery might be appropriate
These situations don't require same-day evaluation, but they do warrant a conversation about next steps.
When to Go to Urgent Care (Same Day)
Seek same-day evaluation if you notice:
- New weakness in your leg (foot drop, trouble standing on toes or heels)
- Progressive numbness that's spreading or worsening rapidly
- Symptoms in both legs simultaneously
- Pain following significant trauma (fall, car accident)
These symptoms suggest possible nerve compression that may benefit from urgent imaging and evaluation. Urgent care can initiate the workup and refer you appropriately.
When to Go to the ER Now
Go to the emergency room immediately if you experience:
- Loss of bowel or bladder control (new incontinence or inability to urinate)
- Saddle anesthesia (numbness in the groin, inner thighs, or rectal area)
- Severe weakness in both legs or inability to walk
- Fever with back pain (possible infection)
- Back pain with history of cancer (possible metastasis)
These are red flags for cauda equina syndrome, spinal infection, or tumor — conditions that require emergency imaging and possible urgent surgery.
What to Expect at Your Visit
When you come to my office for sciatica evaluation, here's what happens:
History
I'll ask about symptom onset, distribution, aggravating/relieving factors, and any red flags. I want to understand the pattern and severity.
Physical Exam
I'll test strength, sensation, and reflexes in both legs. The straight-leg raise test helps confirm nerve root irritation. I'm looking for objective findings that match your symptoms.
Imaging Decision
If symptoms are recent and improving, we may defer imaging. If symptoms are severe, progressive, or persistent beyond 6-8 weeks, I'll order an MRI to identify the cause.
Treatment Plan
We'll discuss conservative options (PT, medications, activity modification), injection timing, and surgical candidacy based on your specific situation.
Experiencing Sciatica Symptoms?
Let's determine the right timing and approach for your situation.