What is sciatica?
Sciatica is pain that travels along the sciatic nerve pathway. This nerve is the longest in your body, starting in your lower back and running through your buttocks, then branching down each leg. When something presses on or irritates this nerve, it sends pain signals down the affected leg.
The key thing to understand is that sciatica is a symptom, not a diagnosis. It describes what you are experiencing (sciatic nerve pain down the leg), but the underlying cause varies from person to person. The pain is typically one-sided, affecting only one leg. Many people describe it as electrical, burning, shooting, or tingling rather than just a dull ache.
Common causes
Herniated disc (most common)
The most frequent cause of sciatica is a herniated, slipped, or bulging disc in the lower spine. The gel inside a spinal disc can leak out and press directly on the nerve root, causing pain and inflammation. This accounts for the majority of sciatica cases and often improves with safe activity and movement.
Spinal stenosis
Spinal stenosis is the narrowing of the spinal canal, the space where your nerves travel. This narrowing can squeeze the sciatic nerve and nearby roots, leading to sciatica. Stenosis often develops gradually over time and may be related to age-related changes in the spine.
Piriformis syndrome
Your piriformis is a small muscle deep in your buttocks. When this muscle becomes tight or goes into spasm, it can irritate or pinch the sciatic nerve, which runs beneath or through it. Prolonged sitting, sports, or certain movements can trigger piriformis syndrome.
Spondylolisthesis
Spondylolisthesis occurs when a vertebra slips forward out of proper alignment. This displacement can compress the nerve roots, including the sciatic nerve, and trigger pain down the leg. It can happen due to trauma, wear and tear, or structural weakness.
Other causes
Less commonly, sciatica can result from pregnancy-related weight shifts, sitting on an object or wallet for long periods, or direct trauma to the nerve. In some cases, sciatica groin pain can occur when nerve irritation radiates into the groin area, which can sometimes be confused with other conditions. In rare cases, a tumour or infection near the nerve may be responsible.
Symptoms to watch for
- Shooting or burning pain starting in the lower back into the buttocks and radiating down one leg, often described as sciatic leg pain
- Numbness or tingling in the foot, ankle, or toes
- Weakness in the leg or foot, sometimes making it difficult to lift the foot (foot drop)
- Pain that worsens when sitting, coughing, sneezing, or bending forward
- Symptoms that improve with lying down or gentle walking
- Pain that usually affects only one side of the body
The intensity of pain varies widely. Some people experience mild discomfort, while others have severe pain that makes daily activities difficult. The pain may come and go or be constant.
When to see a doctor
Most people recover from sciatica without medical intervention within weeks or a few months. However, you should see a doctor if pain persists beyond 6 weeks, if you cannot manage daily activities, or if your symptoms worsen despite self-care.
Certain warning signs require urgent medical attention. Numbness in the saddle area (the region between your legs), loss of bladder or bowel control, weakness in both legs that is rapidly worsening, or severe pain that is completely unmanageable may indicate cauda equina syndrome. Fever combined with back and leg pain also warrants urgent evaluation.
These signs need immediate assessment at A&E or require calling 999.
Treatment options
Conservative treatment
Most sciatica improves with conservative care. In the first few weeks, stay active and avoid prolonged sitting, which can aggravate symptoms. Gentle walking is often beneficial. Over-the-counter paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Applying heat or cold, stretching, and maintaining good posture all support recovery and provide sciatica pain relief without medication. Contrary to older advice, bed rest typically delays improvement.
Medical treatment
If conservative measures do not resolve symptoms after 4-6 weeks, your doctor may recommend nerve pain medication such as gabapentin or pregabalin. Gabapentin for sciatica is commonly prescribed because it specifically targets nerve pain and can provide meaningful relief when standard painkillers are insufficient. Structured physiotherapy, guided by a trained professional, helps strengthen muscles supporting the spine and improve flexibility.
A qualified healthcare provider may also recommend an epidural steroid injection. This involves injecting anti-inflammatory medication around the nerve root to reduce swelling and alleviate pain. Injections can provide significant relief, particularly when combined with physiotherapy.
Surgical treatment
Surgery is considered only when conservative and medical treatments have failed to resolve symptoms after several months of consistent care. The most common procedure is a microdiscectomy, a minimally invasive keyhole surgery that removes the part of the herniated disc pressing on the nerve. Decompression surgery may also be performed to widen the spinal canal if stenosis is the underlying cause. Your specialist will discuss whether surgery is appropriate for your specific situation.
Recovery and prevention
Most people recover from sciatica within 6-12 weeks when they follow appropriate treatment. The key is staying active and avoiding positions that aggravate symptoms. Maintaining core strength through exercises recommended by a physiotherapist helps prevent recurrence.
To reduce your risk of developing sciatica in the future, maintain good posture, take regular breaks from sitting, and engage in gentle exercise. Lifting heavy objects correctly (bending at the knees, not the back) and managing stress can also help. Maintaining a healthy weight reduces strain on your spine. If you have a previous history of sciatica, regular stretching and strengthening exercises may help prevent flare-ups.
How SABA Health Clinic can help
If sciatica is affecting your daily life, our doctors at SABA Health Clinic in Bishop’s Stortford can help you find answers and a sciatica treatment plan that fits you. Same-day and next-day appointments are available.
- Consultant-led assessment of sciatica and nerve-related pain by a specialist orthopaedic and spinal surgeon
- Expert guidance on conservative care, medication, and injection therapy
- Imaging referral and specialist review where needed
- No GP referral needed
- Same-day and next-day appointments available
- Book an appointment online or contact us today
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