Sciatica

What is Sciatica?

Sciatica is a symptom rather than a diagnosis in itself — it describes the pattern of pain caused by irritation or compression of the sciatic nerve or its nerve roots. The most common cause is a herniated (slipped) disc in the lumbar spine pressing on a nerve root. Other causes include spinal stenosis, piriformis syndrome (where the piriformis muscle in the buttock irritates the sciatic nerve), and, less commonly, tumour or infection.

True sciatica involves radiating leg pain (radiculopathy) rather than simply lower back pain with referred pain into the buttock or thigh. The distinction matters because true sciatica involving nerve compression may require different management and, in a small number of cases, medical intervention.

Signs and symptoms

Typical symptoms of sciatica include:

• Radiating pain from the lower back through the buttock and down the back of one leg
• Pain that may extend into the calf or foot
• Pain often described as sharp, shooting, burning or electric
• Numbness or tingling in the leg or foot
• Muscle weakness in the affected leg
• Pain that worsens with sitting, coughing or sneezing
• Some relief from walking or lying down

Seek urgent medical attention if sciatica is accompanied by bladder or bowel dysfunction, numbness in the groin or inner thighs, or severe progressive weakness in both legs — these may indicate cauda equina syndrome, a medical emergency.

How therapy can help

Most cases of sciatica resolve naturally within 4–12 weeks. The following therapies can help speed recovery and manage symptoms:

• Physiotherapy — specific exercises to reduce nerve compression, improve mobility and strengthen supporting muscles are central to sciatica management. Neural mobilisation techniques are commonly used
• Osteopathy and chiropractic — manual therapy to address spinal mechanics and reduce nerve root irritation
• Acupuncture — has evidence for pain reduction in sciatica
• Massage therapy — particularly for piriformis-related sciatica, soft tissue work in the gluteal region can directly reduce nerve compression
• Pain management approaches — for persistent sciatica, CBT-based approaches that address fear-avoidance and activity restriction can be important alongside physical treatment

Staying as active as possible within pain limits is important — bed rest worsens outcomes. Anti-inflammatory medication (where medically appropriate) can help manage acute symptoms.

Seeking help

For mild to moderate sciatica, a physiotherapist is usually the most appropriate first port of call. Your GP can also advise on pain management and, if needed, refer for imaging or specialist assessment. If symptoms have not improved after 4–6 weeks of conservative management, or are severe, medical review is warranted.

Surgery (microdiscectomy) is considered for a small proportion of people with persistent sciatica due to disc herniation who have not responded to conservative treatment after 6–12 weeks.

Therapies that may help with Sciatica