Why is my lower back pain shooting down both legs and what can I do about bilateral sciatica?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 28, 2025Updated: June 28, 2025

Summary

Bilateral sciatica—pain that travels from the lower back into both legs—is usually caused by a single condition compressing the sciatic nerves on both sides, such as a large central lumbar disc herniation, spinal stenosis, or cauda equina syndrome. While many cases improve with targeted exercise, anti-inflammatory measures, and time, sudden loss of bladder control, progressive leg weakness, or numbness in the saddle area need emergency care.

Could one spinal problem really cause pain in both legs?

Yes. When a disc bulges centrally or the spinal canal narrows, it can press on both sciatic nerve roots at the same spinal level, sending identical pain signals into each leg. “Bilateral sciatica almost always means the squeezing is happening in the middle, not off to one side,” explains the team at Eureka Health.

  • Central disc herniations affect both L5 or S1 rootsA midline herniation at L4–L5 or L5–S1 can pinch the nerve roots that form both sciatic nerves, producing symmetrical pain and tingling.
  • Spinal stenosis is common after age 60Degenerative bone overgrowth narrows the canal; up to 11 % of adults over 65 have imaging evidence of stenosis severe enough to cause bilateral symptoms.
  • Inflammatory conditions can mimic compressionDiseases like ankylosing spondylitis inflame the sacroiliac joints and nerve roots, leading to bilateral sciatica even without a disc problem.
  • Metabolic causes are rare but seriousDiabetic radiculoplexus neuropathy and vitamin B12 deficiency can produce burning pain down both legs that resembles mechanical sciatica.
  • Cauda equina red flags demand urgent careSudden bilateral leg pain accompanied by saddle numbness or bladder changes can signal cauda equina syndrome; the OwCHealth guide warns that this spinal emergency requires immediate surgery to avoid permanent nerve damage. (OwCHealth)
  • Sciatica strikes nearly half of Americans at some pointWestside Pain Specialists reports that up to 43 % of U.S. adults will experience sciatica during their lifetime, highlighting how widespread radiating leg pain from the spine is. (WPS)

References

Which red-flag signs mean I should go to the emergency room today?

Because the same type of compression that causes bilateral sciatica can also damage bowel, bladder, and sexual function, missing ‘red flags’ can lead to permanent disability. “If any neurological deficit is getting worse hour by hour, don’t wait—call emergency services,” warns Sina Hartung, MMSC-BMI.

  • New loss of bladder or bowel controlInability to start urinating or unexpected leakage is a classic sign of cauda equina syndrome and needs surgery within 24 hours for the best outcome.
  • Rapidly progressing leg weaknessIf you cannot rise on your toes or heels, the S1 or L5 roots may be failing; delays longer than 48 hours markedly reduce recovery rates.
  • Numbness in the groin or inner thighs‘Saddle anesthesia’ indicates compression of multiple roots in the cauda equina.
  • Fever or unexplained weight lossThese raise suspicion for spinal infection or metastatic cancer pressing on the nerves.
  • History of significant traumaA fall from height or motor-vehicle crash can fracture vertebrae and acutely compress both sciatic roots.
  • Sudden loss of sexual sensation or functionDifficulty achieving an erection or feeling genital numbness can accompany cauda equina compression and is considered an emergency, especially when bowel or bladder changes are also present. (Spine-health)

References

Why does bilateral sciatica hurt more when I stand or walk?

Standing extends the lumbar spine, further narrowing the already tight spaces around the nerves. Sitting or bending forward often opens the canal slightly, easing pain—this ‘shopping-cart sign’ strongly suggests spinal stenosis. The team at Eureka Health notes, “Patients often lean over a grocery cart instinctively because flexion gives nerve roots a few extra millimeters of room.”

  • Extension closes the neuroforaminaLumbar extension reduces foraminal cross-section area by up to 15 % in healthy adults and even more in those with degenerative changes.
  • Walking increases axial loadEach step transmits force equal to 1.4 × body weight through the lumbar discs, accentuating any protrusion.
  • Venous congestion worsens with standingPooling of blood in epidural veins can enlarge them and add extra pressure to nerve roots.
  • Hip flexor tightness tilts the pelvisShortened iliopsoas muscles pull the lumbar spine into hyperlordosis, further narrowing the canal.
  • Upright posture increases disc pressure on lumbar nerve rootsMayfield Brain & Spine notes that standing or walking puts additional pressure on the lower-back discs, which can pinch the sciatic nerve and make bilateral leg pain flare. (Mayfield)

References

What can I safely do at home to reduce bilateral sciatic pain?

Most people improve within 6–12 weeks with consistent self-care. Start gently, monitor symptoms, and stop any maneuver that increases leg numbness. “A small, disciplined routine beats an aggressive workout that flares the nerves,” advises Sina Hartung, MMSC-BMI.

  • Daily flexion-based stretchesKnee-to-chest and seated forward folds open the lumbar canal; hold 20 seconds, repeat 5 times.
  • Short bouts of walking on flat groundTwo to three 10-minute walks per day keep blood circulating without prolonged extension.
  • Cold packs in the first 48 hoursApply a wrapped ice pack for 15 minutes every 2 hours to limit inflammatory swelling around the nerve roots.
  • Heat and gentle massage after the acute phaseHeat increases blood flow and relaxes paraspinal muscles, while light massage reduces spasm.
  • Sleep with a pillow under the kneesFlexing the hips 30–45 degrees decreases lumbar lordosis overnight and can reduce morning pain.
  • Side-lying “static opener” widens nerve spaceLie on the non-painful side with a pillow between rib cage and pelvis for 3-minute holds (total 15 minutes daily); opening the intervertebral foramen this way leads to symptom relief in about 80 % of patients treated in Dean’s clinic. (DrDean)
  • Seated nerve-flossing sets mobilize the sciatic nerveUp to five times a day, slump the spine and straighten the leg for 15 painless reps to gently glide the nerve, improve flexibility, and calm irritation without increasing numbness. (DrDean)

References

Which tests and medications are usually considered for bilateral sciatica?

Imaging and drug therapy are tailored to severity and duration. “Don’t insist on an MRI on day one, but do get one if red flags appear or pain limits your life after six weeks,” says the team at Eureka Health.

  • MRI of the lumbar spineDetects disc herniation, stenosis, tumors, or infection with 95 % sensitivity; gadolinium contrast is added if infection or cancer is suspected.
  • Electrodiagnostic studiesEMG and nerve conduction tests help confirm radiculopathy and rule out peripheral neuropathy when imaging is inconclusive.
  • NSAIDs as first-line pharmacologic optionIbuprofen or naproxen can reduce pain by up to 30 % within one week; use the lowest effective dose and protect the stomach.
  • Oral corticosteroid tapers for short-term reliefA 5-day prednisone burst can modestly improve leg pain scores but does not change long-term outcomes.
  • Epidural steroid injections when conservative care failsFluoroscopic injections produce 50 % pain relief in about half of properly selected patients for up to three months.
  • CT imaging is a useful alternative when MRI is not possibleA lumbar CT scan—or CT myelogram with contrast—can still visualize disc herniation, stenosis, or tumors compressing both sciatic nerves in patients who cannot undergo MRI due to devices, claustrophobia, or metal fragments. (Mayo)
  • Opioids are reserved for short-term use in refractory severe painStrong analgesics may be prescribed only briefly when bilateral sciatica remains disabling after NSAIDs, steroids, or injections because of their addiction potential and diminishing benefit over time. (Mayo)

References

How can Eureka’s AI doctor streamline my next steps?

Eureka’s AI doctor gathers your symptom history in everyday language, highlights red-flag patterns, and suggests evidence-based next actions in minutes. “Our system flags any mention of bladder changes or saddle numbness and immediately directs the user to emergency care,” notes Sina Hartung, MMSC-BMI.

  • Symptom triage within the chatInteractive questions focus on onset, leg strength, and sensory changes to gauge urgency.
  • Personalized exercise plan generationAlgorithms suggest flexion-based stretches or core stability routines matched to pain triggers and fitness level.
  • Lab and imaging recommendationsIf red flags are absent but pain persists, the AI can draft an MRI order request for physician review.

Why do users with bilateral sciatica rate Eureka so highly?

People with chronic nerve pain value quick answers and privacy. Among users who logged sciatic symptoms for four weeks, 88 % reported clearer treatment goals and rated Eureka 4.7 out of 5 stars.

  • Always-available chat supportYou can update pain scores at 2 a.m. and receive immediate feedback without waiting for clinic hours.
  • Safe prescription workflowRequests for NSAIDs stronger than over-the-counter doses are screened by licensed physicians before approval.
  • Progress tracking dashboardGraphs show pain intensity versus exercise adherence, making it easier to see what helps.
  • Data privacy by designAll health data are encrypted end-to-end and never sold to third parties.

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Frequently Asked Questions

Can sitting on a wallet cause bilateral sciatica?

A thick wallet usually irritates one sciatic nerve at a time, so it rarely explains pain in both legs.

How long should I try home care before asking for imaging?

If you have no red flags, most clinicians suggest six weeks of guided exercise and NSAIDs before ordering an MRI.

Is yoga safe for bilateral sciatica?

Gentle, flexion-focused yoga poses are helpful, but avoid deep backbends that extend the spine until pain settles.

Could a vitamin deficiency be behind my pain?

Severe B12 deficiency can mimic radiculopathy; a simple blood test can rule this out.

Do lumbar support belts work?

Short-term use (less than two weeks) may ease pain during heavy activity, but long-term wear weakens core muscles.

Are inversion tables recommended?

Brief inversion can reduce nerve root pressure temporarily, but evidence for lasting benefit is limited and contraindicated in glaucoma or hypertension.

Why does coughing worsen my leg pain?

Coughing spikes cerebrospinal fluid pressure, briefly forcing a bulging disc further into the nerve roots.

Can bilateral sciatica resolve without surgery?

Yes. About 70 % of patients with disc-related bilateral sciatica improve with non-surgical care within six months.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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