Understanding Pinched Nerves in the Low Back (Sciatica)
Lumbar radiculopathy happens when a nerve root in your low back (lumbar spine) becomes irritated, inflamed, or compressed. This is often called “sciatica” because the pain frequently follows the path of the sciatic nerve, which runs from the low back down through the buttock and leg. Lumbar radiculopathy is common, and most people improve significantly with the right combination of treatments; surgery is needed in only a small number of cases.
Causes
A pinched or irritated nerve root in the low back can be caused by several conditions, often occurring together:
Herniated or bulging disc: the soft cushion between spinal bones pushes out and presses on a nearby nerve.
Spinal stenosis: narrowing of the space around the spinal nerves, often from age-related wear and tear.
Bone spurs (osteophytes): extra bone growth from arthritis that can crowd the space where nerves exit the spine.
Degenerative disc disease: discs lose height and cushioning over time, which can narrow nerve pathways.
Spondylolisthesis: one spinal bone slips forward over another, which can pinch a nerve root.
Less commonly: injury/trauma, spinal infection, or a growth pressing on a nerve.
Symptoms
Symptoms vary depending on which nerve root is affected, but commonly include:
Sharp, shooting, burning, or electric-shock-like pain that travels from the low back into the buttock, thigh, calf, and sometimes the foot.
Numbness or tingling (“pins and needles”) along the path of the affected nerve.
Muscle weakness in the leg or foot; for example, difficulty lifting the front of your foot (foot drop).
Pain that worsens with sitting, bending forward, coughing, sneezing, or straining.
Low back pain that may be mild compared to the leg pain, or absent altogether.
Seek emergency care right away if: You experience new loss of bladder or bowel control, numbness in the groin/inner thighs (“saddle numbness”), or rapidly worsening leg weakness. These can be signs of a rare but serious condition called cauda equina syndrome. Also seek prompt care for back pain with fever, unexplained weight loss, a history of cancer, or after significant trauma.
Imaging Studies to Consider
Imaging helps confirm the cause of nerve irritation and guides treatment planning. Your doctor may order:
MRI of the lumbar spine (without contrast) is the best test for visualizing discs, nerves, and soft tissue; usually the first choice.
MRI with contrast is sometimes used if you’ve had previous back surgery, to distinguish scar tissue from a new disc herniation.
CT scan is used when MRI isn’t possible (for example, if you have certain implanted devices) or to look closely at bone detail.
X-rays show spinal alignment, bone spurs, disc space narrowing, or instability; sometimes taken bending forward and backward.
Electromyography (EMG) and nerve conduction studies are not imaging, but a helpful add-on test that measures how well a nerve is working.
Physical Therapy, Home Exercise & Other Conservative Techniques
Non-invasive treatments are typically tried first, especially early in the course of nerve-related leg pain:
Physical Therapy
Nerve gliding (neural mobilization) exercises.
Core stabilization training.
Directional-preference (McKenzie-based) exercises, often emphasizing extension.
Home Exercise Program
Gentle nerve glide exercises as directed by your therapist.
Core stabilization exercises.
A graded walking program.
Other Studied Techniques
Activity modification, avoiding prolonged sitting and repeated bending.
Positional relief exercises specific to your directional preference.
Interventional Treatment Options
When symptoms don’t improve enough with activity modification, physical therapy, and medication, a range of minimally invasive, non-opioid treatments can target the source of the pain directly:
Epidural steroid injection: An anti-inflammatory steroid medication is injected into the space around the irritated nerve root (using an interlaminar, transforaminal, or caudal approach) to reduce swelling and pain, often under x-ray guidance.
Selective nerve root block: A targeted injection at a specific nerve level, used both to treat pain and to help pinpoint which nerve is the source of symptoms.
Percutaneous disc decompression: A minimally invasive procedure that removes a small amount of disc material to relieve pressure on a nerve, for select contained disc herniations.
Minimally invasive lumbar decompression (MILD): A small-incision procedure that removes excess ligament and bone tissue to open space for compressed nerves in spinal stenosis.
Acupuncture: A technique using thin needles at specific points to help reduce pain and improve function; often used alongside other treatments instead of in place of them.
Epidural platelet-rich plasma (PRP): Studied as an alternative to epidural steroid, with mixed results from studies at high risk of bias. It may be considered in select cases following a discussion with your healthcare provider.
Surgical referral: For severe, progressive weakness, cauda equina syndrome, or symptoms that don’t respond to conservative and interventional care, referral to a spine surgeon for procedures like microdiscectomy or laminectomy may be appropriate.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
For chronic radicular pain that persists despite other treatments (including, in some cases, prior back surgery), neuromodulation uses gentle electrical signals to change how pain is processed, without opioids:
Spinal cord stimulation (SCS): A small device implanted near the spinal cord sends mild electrical pulses that interrupt pain signals before they reach the brain. A trial period is done first to confirm it helps before a permanent device is placed.
Dorsal root ganglion (DRG) stimulation: A specialized form of neuromodulation that targets a cluster of nerve cells just outside the spinal cord, often very effective for focal leg or foot pain from a single nerve root.
Peripheral nerve stimulation (PNS): A small electrode is placed near a specific peripheral nerve to calm localized pain signals, useful when pain is concentrated along one nerve’s path.
How Strong Is the Evidence?
For clinicians and interested patients, here is a summary of the evidence supporting key interventional and neuromodulation treatments for this condition:
How to read this: Strong means consistent results from multiple high-quality studies. Moderate means generally favorable results with some limitations. Mixed or early means results so far are inconsistent or still emerging. Limited means few or lower-quality studies; these options can still be considered in select cases following a discussion with your healthcare provider.
Transforaminal epidural steroid injection: Moderate evidence.
Interlaminar epidural steroid injection: Moderate evidence.
Selective nerve root block: Mixed or early evidence.
Spinal cord stimulation (refractory/post-surgical radicular pain): Strong evidence.
Acupuncture (adjunctive): Moderate evidence.
Platelet-rich plasma (PRP), epidural: Mixed or early evidence.
Evidence reviewed November 2026. These ratings summarize published research and major medical society guidelines available at that time. Research continues to evolve, and we will go over the most current evidence for your situation at your visit.
Pain Psychology Techniques
Chronic nerve pain affects mood, sleep, and daily function, and the brain plays a real role in how pain is experienced. Pain psychology techniques are an evidence-based part of comprehensive care, not a sign that pain “isn’t real”:
Cognitive behavioral therapy (CBT) for pain helps identify and reframe thought patterns that intensify pain and disability.
Acceptance and commitment therapy (ACT) builds skills to stay engaged in meaningful activities despite pain.
Pain neuroscience education: understanding how pain signals work can reduce fear and improve outcomes.
Mindfulness-based stress reduction: present-focused awareness practices that can lower pain intensity and stress.
Relaxation training and diaphragmatic breathing calms the nervous system and reduces muscle tension.
Biofeedback uses real-time body signals (like muscle tension or heart rate) to teach self-regulation skills.
Graded activity pacing is a structured approach to gradually increasing activity without triggering flare-ups.
Non-Opioid Medication Options
Many non-opioid medications can effectively reduce inflammation and calm irritated nerves:
Anti-inflammatory medications
NSAIDs like ibuprofen, naproxen, or meloxicam can reduce inflammation around the nerve.
Acetaminophen can help with pain, often used alongside other medications.
A short oral steroid taper is sometimes used for a brief period during a severe flare.
Nerve pain (neuropathic) medications
Gabapentin or pregabalin calm overactive nerve signaling.
Duloxetine is an SNRI antidepressant also approved for chronic musculoskeletal and nerve pain.
Muscle relaxants (short-term)
Cyclobenzaprine or tizanidine is used briefly when muscle spasm contributes to pain.
Topical treatments
Lidocaine patches or gel numb the painful area locally.
Topical NSAID gels: anti-inflammatory effect with minimal whole-body absorption.
Capsaicin cream can reduce localized pain signaling with regular use.
Related Procedures
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Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
