Sciatica: Symptoms, Treatment and When to See a Physiotherapist

Meta summary: Sciatica can cause sharp, burning pain, tingling, numbness or weakness that travels from the lower back or buttock into the leg. Learn what sciatica feels like, what can help, when to seek urgent care, and how online physiotherapy can support recovery.

If pain is travelling from your lower back or buttock down one leg, you may be wondering whether you have sciatica. It can be uncomfortable and sometimes alarming, but in many cases symptoms improve with time and appropriate management.

This guide explains the common signs of sciatica, practical steps that may help, and when your symptoms need urgent medical assessment.

What is sciatica?

Sciatica describes symptoms caused by irritation or compression of the sciatic nerve or one of the nerve roots that contributes to it. The sciatic nerve runs from the lower back through the buttock and down the leg.

According to the NHS guidance on sciatica, symptoms commonly affect the bottom and the back of one leg and may extend into the foot and toes.

What does sciatica feel like?

Sciatica is more than ordinary lower back pain. Common symptoms can include:

• sharp or burning pain travelling down the back of the leg;
• pins and needles or tingling;
• numbness;
• weakness in the affected leg or foot;
• symptoms that become more noticeable with certain movements, coughing or sneezing.

You can have sciatica with relatively little back pain. If your symptoms are limited to the lower back without pain or neurological symptoms travelling into the leg, they are less likely to represent sciatica.

What causes sciatica?

A common cause is irritation of a nerve root associated with a disc problem in the lower back. Other possible causes include spinal stenosis and spondylolisthesis. However, symptoms and examination findings matter more than trying to diagnose yourself from a single scan finding.

A physiotherapy assessment can help establish how your symptoms behave, whether there are signs of nerve involvement, what activities you can safely continue and whether further medical assessment is appropriate.

What can you do for sciatica?

1. Keep moving where possible

Long periods of complete bed rest are generally not recommended. The NHS advises continuing normal activities as much as possible and introducing gentle exercise. Short walks and regular changes of position can be a useful starting point if they are tolerable.

2. Modify aggravating activities rather than stopping everything

You may temporarily need to reduce movements or loads that strongly aggravate your leg symptoms. That does not necessarily mean avoiding all activity. The aim is usually to find a manageable level of movement and build from there.

3. Use exercises that suit your presentation

There is no single “best sciatica exercise” for everyone. An exercise that feels helpful for one person may aggravate another person's symptoms. Your programme should take account of symptom location, irritability, strength, mobility and the activities you want to return to.

4. Build activity back gradually

As symptoms settle, gradually rebuilding walking, strength, work tasks and sport can help restore confidence and physical capacity. Progression should be based on your response rather than an arbitrary timetable.

How long does sciatica last?

Recovery varies considerably. NHS guidance notes that sciatica usually improves within a few weeks to a few months, although it can last longer or recur. Persistent symptoms do not automatically mean that you need surgery, but symptoms that are worsening, significantly limiting normal activities or failing to improve should be assessed.

Do you need a scan for sciatica?

Not everyone with sciatica needs an MRI scan. A healthcare professional can first assess your symptoms, strength, sensation, movement and overall clinical picture. Imaging may be considered when the findings could change management, particularly when symptoms are severe, progressive or not responding as expected.

When should you seek urgent medical help?

Most sciatica is not a medical emergency. However, go to A&E or call 999 urgently if you develop symptoms such as:

• sciatica affecting both sides;
• severe or worsening weakness or numbness in both legs;
• new numbness around the genitals, anus or saddle area;
• difficulty starting urination, inability to urinate, or new loss of bladder control;
• new loss of bowel control or inability to tell when you need to open your bowels.

These can indicate a serious spinal problem requiring urgent assessment. You can read the current NHS sciatica red-flag advice.

Can online physiotherapy help with sciatica?

Many elements of a physiotherapy assessment can be carried out by video consultation. At YourPhysio, your physiotherapist can discuss the history of your symptoms, observe your movement, guide appropriate functional and movement tests, identify factors that may need medical review and create a personalised rehabilitation programme.

If you also have lower back pain, our guide to relieving lower back pain explains additional practical strategies for staying active and rebuilding capacity.

This article provides general information and is not a substitute for an individual medical assessment. Clinical guidance source: NHS. Images: YourPhysio/Pexels and original YourPhysio visual artwork.