Sciatica

First: sciatica is a symptom, not a diagnosis

"Sciatica" describes pain travelling down the path of the sciatic nerve. It tells you where the pain is, not what's causing it. The cause matters, because it determines the treatment.

A lot of pain people call sciatica isn't nerve pain at all. Muscles and joints in the low back, buttock and hip can refer pain down the leg in a very similar pattern.

Does this sound like you?

• Pain that runs from your low back or buttock down the back of your leg
• Pins and needles, numbness, or a burning or electric quality
• It's worse when sitting, and sometimes eased by walking or standing
• Coughing or sneezing shoots pain down your leg
• Your leg feels heavy or weak

The last three are more suggestive of genuine nerve involvement.

What causes it

The most common cause is an irritated disc in the low back pressing on or inflaming a nerve root. This is more common in people under 50.

In people over 60, the more common cause is narrowing of the space the nerves pass through. The giveaway is that walking distance is limited, and leaning forward (such as on a trolley or up a hill) makes walking easier.

Buttock muscles can also irritate the nerve where it passes through the hip.

How I can help

Chiropractic can help with sciatica.

I'll examine you to establish whether the pain is genuinely nerve-related and, if so, where it's being irritated. That includes testing the nerves in your leg, reflexes, sensation and strength. From there we'll agree a plan of hands-on treatment and specific movement advice. One technique I may use is flexion-distraction, a gentle manual technique involving controlled movement and traction of the lower back.

What treatment looks like

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How long does it take?

Sciatica is slower than ordinary back pain, and this is worth knowing up front so you don't panic when it doesn't clear in a fortnight.

Most disc-related sciatica does settle over weeks to months. Recovery is often stepwise rather than smooth: better, then a bad day, then better again. A bad day doesn't mean you're back to square one.

Recovery time varies considerably from person to person. Many patients start noticing changes during the early stages of care, typically involving 1-2 sessions a week whilst increasing your ability to do more, accompanied by homework to help you keep up your own progress. We would then start a loading phase to get your back more supportive involving strengthening and coordination work. Education is also very important for sciatic pain that is not resolving fully. I'll give you a realistic estimate after assessing you.

Do I need a scan or surgery?

Usually neither.

Most sciatica improves without either. Scans become relevant when symptoms aren't settling as expected, or when there's progressive weakness or a red flag, because that's when the result would actually change the plan. I'll tell you if I think you've reached that point.

When I'm not the right person

What you can do right now

• Keep gently moving. Complete rest slows recovery.
• Find your easing position and use it, but don't live in it.
• Note what makes it better and worse; that pattern tells me a lot.