Sciatica: what it is, what it feels like, and what to do about it
Think sciatica may be causing your pain?
The myBackPain assessment identifies how likely sciatica is based on your specific answers — and tells you what to do next. Results in minutes.
What is sciatica?
Sciatica is not a diagnosis in itself — it is a description of a symptom pattern. The term refers to pain that follows the path of the sciatic nerve: from the lower back, through the buttock, and down the back of the leg, sometimes reaching the calf or foot.
It is caused by irritation or compression of one or more of the nerve roots that make up the sciatic nerve, most often by:
- A herniated disc pressing against the nerve as it exits the spine
- A loss of height of the discs between the vertebrae, which can cause the spaces through which the nerves exit to narrow and pinch the nerve
- Various other complex processes that upset the harmony of the muscles, joints, and structures of the lumbar spine
In older adults, the gradual narrowing of the spinal canal — known as spinal stenosis — is a more common cause.
Sciatica is extremely common, affecting up to 40% of people at some point in their lives. It can be alarming when it first occurs — particularly because the leg pain is often more severe than the back pain. The good news is that the vast majority of cases resolve well without surgery, usually within 6–12 weeks with the right management. The disc material causing the irritation is gradually reabsorbed by the body over time, and the nerve irritation settles with it.
Several different spinal conditions can produce the sciatica symptom pattern. Understanding which one is causing it matters — because the most effective management differs depending on the underlying cause. The myBackPain assessment helps identify which cause is most likely based on your specific answers.
What does sciatica feel like?
The symptoms of sciatica vary from person to person, but most people describe some combination of the following:
- Shooting, burning, or electric pain travelling from the lower back or buttock into the leg
- Pain that follows a fairly clear path — typically down the back of the thigh and into the calf or foot
- Numbness or tingling in the leg, calf, or foot
- Weakness in the leg or foot in more significant cases
- Back pain that may be less severe than the leg pain — or absent altogether
- Pain that is worse with sitting, forward bending, coughing, or sneezing
- Pain that is worse first thing in the morning or after prolonged rest
- Some relief when walking or standing — though this varies
The specific path of the pain often gives a clue about which nerve root is affected. Pain and numbness running into the big toe and top of the foot tends to suggest the L4 or L5 nerve root. Pain running into the outer foot and little toe more commonly suggests S1. Your practitioner will use this information to guide their assessment.
If you develop sudden difficulty controlling your bladder or bowel alongside leg pain — or numbness between your legs in the saddle area — go to A&E immediately or call 999. This may indicate cauda equina syndrome, a spinal emergency that requires same-day treatment. Do not wait to see if it improves.
If you notice increasing weakness in your leg or foot — difficulty lifting your foot when walking, or leg giving way — see a GP or spinal practitioner urgently. Neurological deficit that is worsening needs prompt assessment.
What causes sciatica?
The most common cause of sciatica in adults under 50 is a herniated disc — where the soft inner material of a spinal disc pushes through its outer casing and presses on the nerve root next to it. In adults over 50, spinal stenosis — gradual narrowing of the spinal canal — becomes a more frequent cause, as the bony and soft tissue changes of age progressively reduce the space available for the nerve roots.
Other contributing factors include:
- Prolonged sitting or driving — which increases pressure within the discs
- Heavy or repetitive lifting, particularly with poor lifting technique
- Sudden awkward movements, especially lifting whilst twisting — though often the disc has been under cumulative stress for some time before an acute episode
- Age-related changes to the discs and joints of the spine
- Sedentary lifestyle and reduced core and gluteal muscle strength
- Diabetes — diabetic neuropathy can cause or significantly amplify nerve-related leg symptoms, and is worth considering particularly when the pattern of symptoms does not follow a clear dermatomal distribution
- Pregnancy — hormonal changes and postural shifts can produce a similar pattern of leg pain, though this more often originates from the sacroiliac joint rather than a nerve root
Many people describe their sciatica as starting without any obvious cause — simply waking up with it, or it developing gradually over days. This is common. The disc or spinal change that eventually produces symptoms is often the result of months or years of cumulative loading rather than a single event. The “trigger” may be something small — a sneeze, a bend to pick something up — that crosses a threshold already close to being reached.
How is sciatica identified?
Sciatica is primarily identified from the pattern of symptoms — not from a scan. An experienced practitioner will ask about the character, location, and behaviour of your pain, how it started, what makes it better or worse, and whether you have any numbness, tingling, or weakness. Simple neurological tests — checking reflexes, sensation, and muscle strength in the leg — help identify which nerve root is affected and how significantly.
Imaging such as MRI can confirm the underlying cause and identify the level of the spine involved, but it is not always necessary and does not change the initial management approach in most cases. It is worth knowing that disc changes are extremely common in people with no symptoms at all — a positive MRI finding needs to be interpreted alongside your clinical presentation, not in isolation.
Scans frequently show bulging or degenerated discs in people who have no pain whatsoever. Equally, significant sciatica can occur with relatively modest changes on MRI. The symptoms tell the more important story.
The myBackPain assessment asks the same structured questions an experienced practitioner would ask in a clinical consultation — and identifies how likely a disc-related or nerve root cause is based on your specific answers. It also screens for symptoms that need urgent medical attention, and guides appropriate next steps based on your individual presentation.
What helps?
Most cases of sciatica improve significantly without surgery. The most effective approaches depend on the underlying cause, the severity of symptoms, and how long the episode has lasted — but the following applies to the majority of presentations.
Stay active
Rest makes sciatica worse in most cases. Gentle walking is usually well tolerated and beneficial. The aim is to stay as active as possible within tolerance — not to push through severe pain, but not to stop moving altogether.
Positions of relief
Many people find lying on their back with a pillow under their knees reduces leg pain. Side lying with a pillow between the knees and a folded towel under the waist can also significantly ease nerve irritation at night.
Avoid aggravating positions
Sustained sitting, prolonged driving, and forward bending typically aggravate disc-related sciatica. Short, frequent movement breaks are more effective than long rest periods followed by activity.
Anti-inflammatory medication
Ibuprofen or naproxen, if tolerated and not contraindicated, can reduce nerve irritation and are generally more effective for sciatica than paracetamol alone. Discuss with your GP or pharmacist before starting.
Manual therapy
Two to four sessions with an experienced spinal practitioner — osteopath, physiotherapist, or chiropractor — can significantly accelerate recovery. Manual therapy helps break the pain-spasm cycle, restore movement confidence, and guide a specific exercise programme. Neural mobilisation — gentle techniques that encourage the nerve to move more freely within its canal — can be useful for sciatica in some presentations, though the evidence is moderate rather than definitive.
Exercise and rehabilitation
Extension-based exercises — gentle backward bending — are often effective for disc-related sciatica, as they encourage the disc material to move away from the nerve. This approach is well evidenced for acute disc presentations. The specific exercises that help depend on the underlying cause — generic “back exercises” are less effective than a programme tailored to your presentation.
The myBackPain exercise library includes a specific programme for disc and nerve root presentations, developed by an experienced spinal care practitioner. Available as a one-off addition to your personalised report.
How long does sciatica last?
Most people with acute sciatica improve significantly within 6–12 weeks. The majority do not need surgery. Cases lasting longer than 12 weeks without meaningful improvement warrant further assessment and possibly imaging to guide management. Surgical consultation is appropriate where there is significant or worsening neurological deficit — foot drop, progressive leg weakness — or where symptoms have not responded to well-managed conservative care over several months.
If your sciatica is not improving after 4–6 weeks of appropriate management, if the leg pain is severe and unresponsive to any position, or if you are experiencing significant weakness in the leg or foot, a GP review is appropriate. They can arrange imaging, consider medication options including short-term nerve pain medication, and refer you to a specialist if needed.
PDF — a printable summary to share with your GP or practitioner
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