Sciatica: what it is, what helps and when to see a doctor

Sciatica is pain that travels from the lower back or buttock down the back of the leg, sometimes to the foot. It may come with tingling, numbness or a feeling of weakness in the leg. It can be very painful, but most people get better with time, staying active and the right exercises.

What causes it

Sciatica happens when a nerve root in the lower back is irritated or pressed on. The most common cause is a disc in the spine bulging out (often called a "slip disc"), which commonly improves over time on its own. Narrowing of the spaces in the spine, more common in older people, is another cause.

The leg pain is often worse than the back pain, and can be worse when sitting, bending forward, coughing or sneezing.

Warning signs: get urgent medical help if

• you have numbness around your genitals, inner thighs or buttocks (the "saddle" area)

• you have new difficulty passing urine, or loss of control of your bladder or bowels

• you have sudden or worsening weakness in your leg or foot, such as a foot that drags

• sciatica is in both legs at once

• you have a fever, feel unwell or have lost weight without trying

These can be signs of serious nerve pressure, which needs urgent treatment.

What helps

• Keep moving, gently. Short walks through the day, as comfort allows.

• Avoid long bed rest. It tends to slow recovery.

• Change position often. Many people find sitting hardest; get up every 20 to 30 minutes.

• Find comfortable positions for rest, such as lying on your side with a pillow between your knees, or on your back with pillows under your knees.

• Heat on the lower back may ease muscle spasm.

• Pain relief, as advised by your doctor, can help you stay active.

How physiotherapy helps

A physiotherapist will check the warning signs, test the strength, sensation and reflexes in your legs, and look at which movements ease or worsen your pain. Treatment is likely to include:

• movements and positions that ease the leg pain, which often differ from person to person

• gentle nerve mobility exercises, when appropriate

• strengthening for the back, hips and legs as the pain settles

• hands-on treatment to ease pain and stiffness

• advice on sitting, lifting, sleep and work

• a gradual return to normal activities and exercise

Your physiotherapist will tell you if your symptoms suggest you need to see a doctor, or a scan.

Recovery

Many people improve noticeably within a few weeks, though some take longer. Numbness and tingling often settle more slowly than pain. Once you are better, keeping up regular exercise and strength work helps prevent it coming back.

Find a physiotherapist near you

Search for physiotherapists who treat back pain and sciatica on PhysioDesk Reach and contact them directly. Many offer home visits, which can help when sitting in traffic is painful.

This article is general information, not medical advice. If you have any of the warning signs above, seek medical help immediately.