What sciatica is, and how physiotherapy treats it
Pain that travels from the back or buttock down the leg, often with pins and needles. It is a description of a symptom rather than a diagnosis, which is why the assessment matters.
Leg pain that outweighs the back pain
The word sciatica describes irritation of the sciatic nerve or of the nerve roots that feed it. In practice people describe a pain that runs from the lower back or buttock into the back of the thigh, sometimes past the knee and into the calf or foot.
It often comes with pins and needles, numbness in a patch of skin, or a burning or electric quality that ordinary back pain does not have. Sitting, driving, coughing and bending forwards commonly make it worse. Many people find their back barely hurts at all and the leg is the whole problem.
Not every pain down a leg is sciatica. Referred pain from the joints of the lower back, from the hip, or from the muscles around the buttock can follow a similar route without a nerve being involved, and it is treated differently. Telling those apart is a large part of what the first appointment does.
Symptoms that need emergency care, not an appointment
Sciatica is common and usually settles. A small number of symptoms alongside it are different, and they are the reason this section sits near the top of the page rather than at the bottom.
- Go to an emergency department or call 999 straight away if you have numbness or tingling around your back passage, genitals or inner thighs, sometimes described as saddle numbness, difficulty passing urine or a loss of the feeling that you need to, loss of control of your bladder or bowels, weakness or numbness spreading in both legs, or a sudden change in sexual function.
- Together those can indicate compression of the nerves at the base of the spine, which is treated as a medical emergency and is time critical. Do not wait for a physiotherapy appointment, and do not wait to see whether it settles overnight.
- Contact a GP promptly, or call NHS 111, if leg weakness is getting noticeably worse, if pain follows a significant fall or accident, or if it comes with a fever, unexplained weight loss or a history of cancer. These are uncommon. Saying so plainly is more useful than leaving you to guess.
Usually irritation rather than damage
The most common cause is a disc in the lower back bulging enough to irritate a nearby nerve root. That sounds alarming and generally is not: disc material changes over time, and the majority of these settle over weeks to months without any surgery.
Narrowing of the space the nerves pass through, which becomes more common with age, is another. It typically produces leg symptoms that build when you walk or stand and ease when you sit or lean forwards. Tight or irritable muscles around the buttock can also contribute.
Triggers are the familiar ones: a lift done awkwardly, a long drive, a spell of much more sitting than usual, or nothing identifiable at all. As with back pain generally, a scan finding does not automatically explain a symptom, and plenty of people with disc changes on an image have no leg pain whatsoever.
What treatment involves at this clinic
For ordinary sciatica the aim is to settle the nerve's irritability, keep you moving, and rebuild what the last few weeks have taken away.
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Assessment
Where the pain travels, what provokes and eases it, how it has changed, and a screen of the symptoms listed above. Then testing movement in the back and hip, nerve sensitivity, and strength and sensation in the leg, so the picture is a nerve problem or is not.
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Hands-on treatment and movement
Soft tissue work and joint mobilisation where they help, alongside specific movements that tend to ease leg symptoms and draw them back towards the spine. Finding which direction of movement your back prefers is often the most useful thing the first appointment produces.
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A graded plan
Walking distance, sitting tolerance and strength built back in stages, with clear guidance on what to do when symptoms flare. Nerve pain often improves in steps rather than a straight line, and knowing that in advance makes the middle of it easier.
Typical aims are less leg pain, more tolerance for sitting and walking, and a return to normal activity. If symptoms are not improving as expected, or leg weakness is progressing, the right next step is a GP or a specialist opinion and you will be told that rather than booked in for more sessions.
Reasonable things to do while you wait
Stay as active as the symptoms allow. Bed rest was standard advice decades ago and is not any more: prolonged rest tends to leave sciatica more sensitive rather than less. Short, frequent walks usually beat one long attempt.
Break up sitting, which is often the least comfortable position. Getting up every twenty minutes or so, and standing for phone calls, tends to help more than any particular chair.
Pain relief has a genuine role here, because a leg that hurts less is a leg you will keep moving. A pharmacist or GP can advise on what is suitable for you, particularly since nerve pain sometimes responds to different medication from ordinary aches.
All general guidance. The specific movements that help depend on your assessment, and getting them wrong can make things briefly worse.
Book an assessment
If symptoms are limiting sleep, work or walking and you would rather not wait for routine care, a private assessment is available. New or worsening weakness, bladder or bowel changes, or numbness around the saddle area need urgent medical help. Appointments are usually available within days, weekdays to 20:00 and Saturday afternoons from 14:00.
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