Common symptoms
- Pain from the buttock down the back of the leg
- Leg pain that is worse than back pain
- Burning, shooting or electric-shock pain
- Pins and needles in the leg or foot
- Numbness in part of the leg or foot
- Weakness in the leg, ankle or toes
- Pain worse when coughing, sneezing or sitting
Sciatica is the name for pain caused by irritation or compression of the sciatic nerve, the longest nerve in the body. It typically causes pain that travels from the buttock down the back of one leg, sometimes reaching the foot and toes, often with tingling, numbness or weakness.
It is a description of symptoms rather than a diagnosis in itself, so the key is finding out what is irritating the nerve and what calms it down. This guide explains the common causes, how it differs from ordinary back pain, what physiotherapy involves and the warning signs that need emergency care.
What is sciatica?
Several nerve roots leave the lower spine and sacrum, pass out between the bones and join inside the pelvis to form the sciatic nerve. The nerve then travels deep through the buttock, down the back of the thigh, and branches to supply the lower leg and foot.
When one of those nerve roots is irritated or squeezed, it becomes sensitive and can send pain along its path. Clinicians often call this “radicular pain”, meaning pain that comes from a nerve root. Because each root supplies a particular strip of skin and group of muscles, the exact location of your symptoms gives your physiotherapist useful clues about which level of the spine is involved.
Common causes of sciatica
According to the NHS, the most common cause is a slipped disc, where the soft tissue between the bones of the spine bulges outwards and presses on or inflames a nearby nerve root. Other causes include:
- Spinal stenosis: a narrowing of the spaces the nerves travel through, more common in older adults. Leg symptoms often build up with walking or standing and ease with sitting or bending forwards.
- Spondylolisthesis: when one vertebra slips slightly forward on the one below, which can narrow the space around a nerve root.
- Back injury: a fall or accident can occasionally irritate the nerve roots.
Buttock and leg pain can also come from other places. Deep hip joint problems and irritated tissues around the buttock can mimic nerve pain, so we always check for hip pain as part of your assessment. Rarely, a nerve root is irritated by an infection or a growth, which is why the red flags later on this page matter.
Sciatica symptoms and how they differ from back pain
The hallmark of sciatica is leg pain, often felt below the knee, which is usually more troublesome than any back pain. Symptoms can include:
- sharp, shooting, burning or electric-shock-like pain in the buttock and leg
- pins and needles or numbness in the leg or foot
- weakness, such as difficulty rising onto your toes or lifting your foot
- pain that gets worse when you cough, sneeze, strain or sit for long
Some people have no back pain at all. Others have both, which is why sciatica and lower back pain are often discussed together even though they behave differently. The NHS puts it simply: if back pain is all you have, you probably do not have sciatica.
| Feature | Non-specific back pain | Sciatica |
|---|---|---|
| Main location | Lower back, sometimes buttock or thigh | Buttock and leg, often below the knee |
| Type of pain | Dull ache, stiffness or catching pain | Sharp, burning, shooting or electric |
| Nerve symptoms | Usually none | Tingling, numbness or weakness are common |
| Usually worse with | Certain movements or positions | Sitting, bending, coughing or sneezing |
Pain at the back of the thigh after a sprint or a sudden stretch is more likely to be a hamstring strain, but the two can be confused. A careful assessment tells them apart.
How sciatica is diagnosed
Sciatica is diagnosed clinically, from your history and a physical examination, rather than from a scan. Your physiotherapist will ask where your symptoms travel, what eases and aggravates them and how they have changed. They will then test your strength, reflexes and sensation, and check how well the nerve tolerates movement, for example with a gentle straight leg raise.
Most people do not need a scan. NICE guidance advises against routine imaging for low back pain with or without sciatica in non-specialist settings. An MRI scan may be arranged by a doctor or specialist if red flag symptoms are present, if weakness is getting worse, or if severe symptoms are not improving and treatments such as injections or surgery are being considered.
Physiotherapy for sciatica
The aim of physiotherapy is to calm the irritated nerve, keep you as active as possible and gradually restore your strength and confidence. Care follows the NICE guideline on low back pain and sciatica, which supports exercise, self-management and, where helpful, manual therapy as part of a treatment package. At Tylurs com, your plan typically includes the elements below.
Understanding your pain
Nerve pain can be intense and frightening, but severe pain does not mean severe damage. Knowing what is happening, what the warning signs are and what a normal recovery looks like helps many people feel more in control and move with less fear.
Adapting activity, not stopping it
Rather than resting completely, we help you find a level of activity your nerve can tolerate. That might mean shorter walks, sitting for less time, changing how you get in and out of the car or adjusting your workstation for a few weeks.
Graded exercise
As symptoms settle, we introduce exercises for your back, hips and legs, starting gently and progressing steadily. Early exercises might include walking, pelvic tilts and positions that ease leg pain. Later stages build strength so you can return to lifting, sport and work. You can find some safe starting points in our guide to exercises for lower back pain.
Nerve mobility exercises
Sometimes called nerve glides or sliders, these are gentle movements that help the sciatic nerve move more freely without being stretched hard. They should feel mild and comfortable. If an exercise brings on lasting pins and needles, it needs adjusting.
Hands-on treatment
Manual therapy, such as spinal mobilisation and soft tissue work, can reduce pain and muscle guarding in the short term. We use it to help you move and exercise more comfortably, never as a replacement for your exercise programme.
Easing sciatica at home
Alongside your treatment, these self-help steps often make a difference:
- Keep moving. The NHS advises continuing your normal activities as much as possible and starting gentle exercise as soon as you can.
- Avoid long spells of sitting or lying. Get up and move every 20 to 30 minutes, even briefly.
- Use heat for muscle spasm. A wrapped heat pack on the lower back or buttock can ease tension. See our guide on ice or heat for an injury for how to use each safely.
- Find positions of ease. Lying on your back with your calves resting on a chair, or on your side with a pillow between your knees, often helps.
- Speak to a pharmacist or GP about pain relief. The NHS points out that paracetamol is unlikely to help sciatica, and that it is unclear how much anti-inflammatory painkillers help, so get advice on what suits you.
NICE also advises against gabapentin-type medicines, oral steroids and opioids for sciatica, because the evidence points to more harm than benefit. If something you have been prescribed is not helping, go back to the prescriber rather than taking more of it.
Physio tip: watch where your leg pain reaches, not just how strong it is. If the pain retreats from your foot towards your buttock over the following days, that is usually a sign the nerve is settling, even if your back feels a little sore.
How long does sciatica last?
The NHS says sciatica usually improves within a few weeks to a few months, although it can last longer and may come back. Many people notice steady improvement within the first several weeks, with leg pain easing before any numbness or tingling fully settles. Nerves recover slowly, so some altered sensation can linger after the pain has gone.
Recovery is rarely a straight line. Good days and bad days are normal, and a short flare-up does not mean you are back to square one. What matters is the overall trend over a few weeks.
If sciatica does not settle
If severe symptoms persist despite physiotherapy and self-management, your GP or a spinal specialist may discuss other options. NICE suggests that epidural steroid injections can be considered for acute, severe sciatica, and that surgery to relieve pressure on the nerve can be considered when other treatment has not helped and scan findings match your symptoms. These decisions are made with a doctor, and your physiotherapist can share their findings with your GP and help you understand the options if this becomes relevant.
When to seek urgent medical help
Most cases are not dangerous, but a small number of people develop cauda equina syndrome, where the nerves at the base of the spine are severely compressed. This is a medical emergency.
Call your local emergency number or go to your nearest emergency department immediately if you have:
- sciatica in both legs, or numbness or weakness in both legs that is severe or getting worse
- numbness around your genitals, bottom or inner thighs (the “saddle” area)
- new difficulty passing urine, being unable to pass urine, or loss of bladder control
- loss of bowel control
- changes in sexual function, such as loss of sensation
See a GP the same day, or contact an urgent care service, if you have a foot that is dragging or slapping as you walk, weakness that is getting worse, a high temperature, a history of cancer, unexplained weight loss, or pain that began after a significant fall or accident.
Book sciatica physiotherapy at Tylurs com
If sciatica is stopping you from sitting, sleeping, working or exercising comfortably, a physiotherapy assessment can give you a clear explanation and a plan to calm the nerve and rebuild your strength. Tylurs physiotherapists screen carefully for warning signs, tailor your programme to how your symptoms behave and adjust it as you improve. Our wider back and neck pain treatment also covers the back pain that often accompanies it.
Book a sciatica assessment and get expert support from the start.
This page is for general information and does not replace a personal assessment. If you have severe, sudden or worsening symptoms, seek medical advice promptly.