Why Does Sciatica Recur? Two Common Causes and Areas for Adjustment

It is not uncommon in clinics for sciatica, which was once treated and had improved, to flare up again after a few months.
A relapse does not mean previous treatments were in vain; it usually arises because the stress conditions on the lumbar spine have not changed.
This article explains the causes of recurrence, treatment paths after relapsing, and what you can realistically adjust in your daily life. To understand the causes of sciatica and the overall treatment options, please refer to the sciatica topic article on this site.

Why does sciatica recur?

The factors behind a relapse are related to two main things: the stability of the structures around the lumbar spine, and daily posture and loading habits.

The first factor is structural. A herniated disc is a common cause of sciatica, but the stability of the lumbar spine does not rely solely on the intervertebral discs; the surrounding ligaments, tendons, and facet joints also participate in supporting it. When these structures degenerate, the stability of the lumbar spine decreases, and nerves may become compressed again. The degeneration of discs and the aging of spinal structures brought on by age also increase the chances of recurrence.

The second factor is habit. Bending over to lift heavy objects, sitting, or standing for long periods all increase the burden on the lumbar spine and discs. If these movement patterns are not adjusted after treatment, the source of stress remains. The same applies to individuals who have not undergone surgery; improper posture or chronic, excessive pressure on the back can cause symptoms to reappear.

Why is there still pain after surgery?

Because surgery addresses only the specific segment where the nerve was being compressed at that time; it does not change the condition of the other structures in the lumbar spine.
Although removing the herniated disc can relieve compression at that site, if the surrounding ligaments, tendons, and facet joints continue to degenerate, the lumbar spine may still remain unstable, which in turn can cause nerve compression again.
If improper posture is maintained after surgery, it may also lead to a re-herniation of the disc or worsening compression.

However, this does not mean that surgery is meaningless, but rather that post-operative posture adjustment and strength training are also parts of the overall treatment.

How is treatment arranged after a relapse?

Treatment is managed differently depending on whether it is acute or chronic. The acute pain phase focuses mainly on rest, adjusting sleeping and sitting postures, and, guided by a physician's judgment, supplementing with medication, electrotherapy, or electromagnetic therapy to relieve symptoms. For chronic pain, long-term reliance on pain medication is not recommended to avoid accumulating side effects; instead, physical therapy and other procedures will be evaluated at this stage.

For injection therapies, prolotherapy (high-concentration dextrose solution, autologous platelet-rich plasma (PRP), amniotic fluid, or BMAC) is directed toward assisting in the repair of the ligaments around the lumbar spine, aiming to improve local stability. For pain caused by adhesiveness or compression around the nerves, nerve hydrodissection using a low-concentration dextrose solution is also available, which is one of the procedures performed by Dr. Lu. Each of these methods has its own indications, and whether to use them, as well as the site and frequency of injections, will be evaluated by the physician based on imaging and clinical conditions.

What other options are available when conservative treatment has limited effects?

When conservative treatment has limited effects and imaging shows obvious nerve compression, decompression surgery, such as a discectomy or spinal decompression, may need to be considered to relieve the compression.

For patients with obvious nerve compression who are temporarily unable to undergo decompression surgery, clinical evaluations of image-guided nerve blocks may be conducted to help manage the pain until surgery can be evaluated when conditions permit. Sian Medical's nerve blocks are performed by Director Lu Bing-sheng, using the same GE OEC 3D mobile C-arm as C-TAME, targeting the destination position under 3D stereoscopic image guidance with cone-beam CT (3D tomography) function.

In addition to nerve blocks, Dr. Lu also performs cooled radiofrequency neurotomy. This is a minimally invasive procedure that addresses pain signal transmission using radiofrequency, also targeting the destination nerves under image guidance. Its indications differ from those of nerve blocks, and suitability must be evaluated by a physician. This type of procedure requires high-precision imaging localization, which is why professional imaging interpretation affects the treatment plan.

To clarify a treatment boundary: TAME (Transcatheter Arterial Microembolization) addresses abnormal microvascular proliferation around chronic soft tissues and joints; sciatica caused by structural compression of nerve roots does not fall within its indications. If your back or leg pain is combined with chronic pain in tendons or joints, that portion will be evaluated separately by the physician.

What adjustments can be made in daily life?

We suggest the following three directions.
Posture: Maintain proper standing, sitting, and sleeping postures, avoid staying in the same position for a long time, and bend your knees instead of your waist when lifting heavy objects. Strength: Train core muscles, or assist lumbar stability through activities like yoga or Pilates. The intensity and choice of movements should be confirmed with a physician or therapist first to avoid worsening symptoms. Daily life: Maintain moderate activity (e.g., walking, swimming), avoid prolonged sitting and excessive loading, quit smoking if you smoke, and maintain a balanced diet.

The purpose of these adjustments is not to replace treatment, but to reduce the continuous stress on the lumbar spine. Follow-up consultations on a regular basis, as recommended by your physician, can help detect changes early.

What situations require immediate medical attention?

If you experience loss of bladder/bowel control or difficulty urinating, numbness in the perineum (groin, saddle area), obvious weakness in lower limbs, or rapid muscle wasting, please seek medical attention immediately; do not wait and observe. If none of these conditions are present, but radiating pain in the back and legs continues to show no improvement, early evaluation is also recommended. For related details, please refer to "How to Confirm Sciatica".

Would you like an evaluation?

You can undergo a preliminary evaluation via LINE, and bring past imaging materials (X-rays, MRI) and treatment records, including history of surgeries and injections, to your appointment. Sian Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da’an Dist., Taipei City. Visits are by appointment only. Phone: (02) 2366-0186.

Author: Dr. Lu Bing-sheng

Last updated: July 26, 2026

Disclaimer: This article provides educational information and cannot replace a doctor's diagnosis and treatment advice. The suitability of any treatment must be decided by a physician after evaluation. If any acute warning signs described in the text occur, please seek medical attention immediately.