Lower back
Sciatica
Sciatica is pain that travels from the lower back or buttock down the back of the leg, caused by an irritated sciatic nerve root. Common in adults aged 30–60.
Common symptoms
- Sharp, burning or electric pain running from the buttock down the back of one leg
- Pins and needles or numbness in the leg, calf or foot
- Leg pain that is worse than the back pain
- Pain aggravated by sitting, coughing, sneezing or bending forward
- Weakness in the leg, such as difficulty lifting the foot or pushing off when walking
- Difficulty standing up straight after sitting
Overview
Sciatica is not a diagnosis in itself but a description of symptoms: pain, tingling, numbness or weakness that runs along the path of the sciatic nerve, from the lower back or buttock, down the back or side of the thigh, and sometimes into the calf and foot. The sciatic nerve is the largest nerve in the body, formed by nerve roots that leave the spine in the lower lumbar region. When one of those roots is squeezed or inflamed, you feel symptoms along the nerve's territory rather than at the spine itself.
The most common cause is a bulging or herniated lumbar disc pressing on a nerve root, usually at the L4/5 or L5/S1 level. In older adults, narrowing of the spinal canal (stenosis) is a frequent cause. Less often, the nerve is irritated further down its path, in the buttock, by a tight piriformis muscle.
Sciatica can be frightening because the pain is often sharp, electric and unpredictable. However, most cases improve over weeks to a few months as the irritation settles, and the majority of people recover without surgery.
Causes and risk factors
- Lumbar disc herniation or bulge pressing on a nerve root (most common)
- Lumbar spinal stenosis, mainly in people over 50
- Spondylolisthesis (one vertebra slipping forward on another)
- Piriformis syndrome in the buttock
- Prolonged sitting, driving or heavy lifting with a bent spine
- Smoking, being overweight and a sedentary lifestyle
How we may be able to help
We start with a thorough assessment to work out which nerve root is involved and what is irritating it. This includes testing reflexes, strength and sensation in your leg, nerve tension tests such as the straight-leg raise, and examining your lumbar spine and hips. We screen carefully for cauda equina signs and refer urgently if needed.
Treatment is tailored to the cause. Our physiotherapists use manual therapy to reduce load on the irritated nerve, nerve-mobilising ("flossing") techniques, and a graded exercise programme that often includes direction-specific movements to centralise the leg pain back towards the spine. Our chiropractor may use mobilisation or carefully selected manipulation of adjacent stiff segments, avoiding the irritated level.
Dry needling can help with the protective muscle spasm in the buttock and back that often accompanies sciatica. Interferential therapy may be used in the painful early stage to help with pain and muscle tension. If leg symptoms are severe, not improving, or there is any weakness, we can arrange an online private GP consultation to discuss medication options and whether an MRI referral is appropriate.
What you can do at home
- Keep walking little and often; avoid long periods of sitting or driving
- When sitting, use a firm chair, keep your hips slightly higher than your knees, and get up every 20–30 minutes
- Try lying on your back with your knees bent over a pillow, or on your side with a pillow between the knees
- Apply heat to the lower back or buttock for 15–20 minutes to ease muscle guarding
- Avoid heavy lifting and deep bending while the nerve is irritated
- Note any change in bladder, bowel or saddle sensation and seek urgent care if it occurs
When to seek urgent help
If you have any of the following, call us straight away for an urgent same-day appointment — we can examine you and arrange fast-track X-ray or MRI through our imaging partner. If you cannot reach us, go to A&E. For loss of bladder or bowel control, numbness around the groin, chest pain, a sudden severe headache or rapidly worsening weakness, call 999 or go to A&E immediately:
- Numbness or tingling around the genitals, back passage or inner thighs, new difficulty controlling your bladder or bowels, or new problems with sexual function — go to A&E immediately (possible cauda equina syndrome)
- Sciatica in both legs at the same time, or rapidly worsening leg weakness or foot drop
- Leg symptoms after a major fall, accident or other significant trauma
- Back and leg pain with fever, feeling unwell or unexplained weight loss
Frequently asked questions
Do I need an MRI for sciatica?
Not usually in the first few weeks, because most sciatica improves and a scan would not change the plan. We would discuss imaging if symptoms are severe, there is significant or worsening weakness, or things are not improving after a reasonable course of treatment. We can arrange a private GP consultation for a referral when it is appropriate.
Can I still go to the gym or run?
Often yes, with changes. Walking, swimming and upper-body work are usually fine. We would typically pause heavy lifting, deep squats, sit-ups and long cycling sessions while the nerve is irritated, then rebuild them step by step.
Is spinal manipulation safe with sciatica?
Our chiropractor assesses each case individually. Manipulation is generally avoided at the irritated level, especially with significant nerve signs, but gentle mobilisation of nearby stiff joints may be used. We will always explain what we are doing and why.
Is sciatica the same as a slipped disc?
Not quite. A slipped (herniated) disc is the most common cause of sciatica, but sciatica can also come from stenosis, spondylolisthesis or piriformis syndrome. Part of our assessment is working out which one applies to you.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.
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