What sciatica is
Sciatica is a description of a symptom rather than a diagnosis in itself. It means pain referred along the distribution of the sciatic nerve, which runs from the lower back through the buttock and down the back of the leg, dividing below the knee to supply the calf, shin and foot.
True sciatica, more precisely called lumbar radiculopathy, involves irritation or compression of a nerve root as it leaves the spine, most often at L4/L5 or L5/S1. It typically produces sharp, electric or burning pain that travels below the knee, often with pins and needles or numbness in a specific band of skin.
A great deal of leg pain that gets called sciatica is actually referred pain from the joints or muscles of the lower back and hip, which produces a duller, more diffuse ache that tends to stop around the thigh or knee. The two behave differently and respond to different work, which is the main thing an assessment sorts out.
What causes it
The most common cause is a lumbar disc herniation, where the softer inner material of a disc pushes out and contacts a nerve root. The pain comes from a combination of mechanical pressure and chemical irritation of the nerve, which is why it can be so intense while the actual compression is modest.
In people over about 50, narrowing of the space the nerve travels through, known as lumbar spinal stenosis, becomes a more common cause. This tends to produce leg symptoms that come on with walking and standing and ease within a minute or two of sitting down or leaning forward.
Common sources of sciatic pain
- Lumbar disc herniation, most often at L4/L5 or L5/S1
- Lumbar spinal stenosis, particularly over the age of 50
- Degenerative changes narrowing the foramen the nerve root exits through
- Deep gluteal syndrome, where the nerve is irritated as it passes the deep hip rotators
- Referred pain from the lumbar facet joints or the sacroiliac joint, which mimics the pattern without involving the nerve
- Rarely, a space-occupying lesion, which is what the red flag list screens for
Straight-leg raise reproduction below 45 degrees, pain that travels past the knee, and a matching band of altered sensation together make a nerve root cause far more likely than referred pain. One practical distinction: true radicular pain usually gets worse with a cough or sneeze, because that briefly raises pressure inside the spinal canal. Referred pain from a joint or muscle generally does not react to a cough at all.
What the evidence says
The natural history is genuinely reassuring. Around 75 per cent of people with disc-related sciatica improve substantially within twelve weeks with conservative treatment, and follow-up imaging frequently shows herniations shrinking or resolving on their own, with larger extrusions often reducing the most.
Trials comparing early surgery with conservative care for disc-related sciatica find that surgery relieves leg pain faster over the first few months, while outcomes at one and two years are broadly similar between the groups. That makes the timing of surgery a decision about how long the pain is tolerable rather than a race to prevent permanent damage, provided there is no progressive neurological deficit.
Exercise, education and manual therapy make up the mainstay of conservative treatment. Nerve mobilisation techniques, sometimes called neural gliding, have reasonable evidence for reducing leg pain and improving straight-leg raise range.
For pain relief, ordinary painkillers work less predictably on nerve pain than on musculoskeletal pain. Gabapentinoids are commonly prescribed and the evidence for them in sciatica is weaker than their prescribing rate suggests, which is worth discussing with your GP.
Recovery timeline
The typical arc runs from severe leg-dominant pain in the first two to three weeks, through gradually reducing leg symptoms over four to eight weeks, to a residual ache and stiffness that clears over the following month or two. Numbness is often the last thing to resolve and can lag the pain by several months.
A useful sign of progress is centralisation: the pain retreating up the leg toward the back over successive sessions. Pain moving from the calf to the thigh to the buttock is improvement, even if the overall intensity has not dropped much yet.
| Stage | ✓ Do this | ✗ Avoid this |
|---|---|---|
| Weeks 1–2 | Find and use the positions that ease leg pain. Frequent short walks. Discuss pain relief with your GP. | Prolonged sitting, deep forward bends, or pushing into sharp leg pain |
| Weeks 2–6 | Nerve gliding, hip and trunk work in tolerable ranges, hands-on treatment for the guarding around it. | Aggressive stretching of the hamstring while the nerve is irritable |
| Weeks 6–12 | Progressive strengthening, graded return to loading and to running or lifting. | Assuming the job is done because the leg pain has gone |
| Beyond 12 weeks | If leg pain and neurological signs persist, ask for a specialist opinion and imaging. | Continuing an unchanged plan that has produced no change in three months |
How we treat it at Kingsway
What a sciatica session involves
The first job is deciding whether this is genuine nerve root pain or referred pain, because the treatment differs. That takes a neurological screen alongside the movement assessment.
- Neurological screen: power, reflexes and sensation in the affected leg
- Directional preference testing to find the movements that centralise your pain
- Neural mobilisation, dosed carefully so it settles rather than provokes the nerve
- Soft tissue release through the glutes, deep hip rotators and lumbar paraspinals
- Joint mobilisation of the lumbar spine and hip where movement is restricted
- A home programme built around your directional preference, reviewed each session
Sciatica generally needs a longer course than simple back pain, commonly six to ten sessions over two to three months. Sessions are spaced more widely as the leg pain retreats, with the emphasis shifting from settling the nerve to rebuilding the strength that protects it.
When to get it checked
Book an assessment for any leg pain that travels below the knee, or for back pain accompanied by pins and needles, numbness or weakness. Get seen the same week if you have noticed the leg giving way, a foot that drags or catches, or numbness that is spreading.
See a doctor or go to A&E if
- Loss of bladder or bowel control, or a change in the sensation of needing to go
- Numbness around the groin, genitals or inner thighs
- Weakness or new numbness in both legs
- A foot that drops or catches when walking, or clear new weakness pushing off
- Severe unremitting night pain, unexplained weight loss or fever alongside the leg pain
Common questions
How long does sciatica take to settle?
Most disc-related sciatica improves substantially within six to twelve weeks. Leg pain usually eases before back stiffness does, and numbness can take several months more to fade.
If there has been no meaningful change by twelve weeks of proper conservative treatment, that is the point to ask for a specialist opinion.
Should I stretch my hamstring?
While the nerve is irritable, aggressive hamstring stretching often makes symptoms worse, because the stretch tensions the nerve as well as the muscle.
Gentle nerve gliding, which moves the nerve without sustained tension, is usually better tolerated in the early phase. Hamstring flexibility work becomes appropriate once the leg pain has calmed down.
Can acupuncture or dry needling help?
Both are commonly used for the muscular guarding that develops around a painful nerve, particularly in the glutes and deep hip rotators, and many people get useful short-term relief from that.
Neither changes the underlying disc contact. They are worth using as part of a plan whose main components are movement and progressive loading.
Is walking good or bad for sciatica?
Walking is usually helpful, in short and frequent bouts rather than one long effort. Many people find they can walk more comfortably than they can sit.
If leg symptoms come on reliably after a few minutes of walking and ease when you sit or lean on a trolley, mention that specifically, because it points toward stenosis rather than a disc.