Sciatica: What It Is, Causes, Symptoms, Treatment

Written by Dr. Simon Khela MBChB MRCGP, GMC Registered Doctor

Last reviewed: 04-08-2026

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A patient once described their sciatica to me as “like an electric shock running down the back of my leg every time I stood up.” That description sticks with me because it captures something important: sciatica very often isn’t really a back problem in the way people expect; it’s a leg problem caused by irritation further up, in the nerve roots of the lower spine.

Sciatica is one of the most common reasons patients come to see me about pain, and also one of the most misunderstood. This guide explains what sciatica actually is, what causes it, the symptoms to recognise, which exercises genuinely help, and, just as importantly, the small number of red-flag symptoms that mean you should seek emergency care rather than wait it out.

What Is Sciatica? A Quick Answer

Sciatica is pain caused by irritation or compression of the sciatic nerve, which runs from your lower back, through your buttock, and down the back of each leg. It typically causes a sharp, burning or shooting pain down one leg, sometimes with tingling, numbness or weakness, and is most often triggered by a slipped disc pressing on a nerve root. Most cases improve within a few weeks to a few months with movement, gentle exercise and pain relief; only a small minority need injections or surgery. Rarely, sciatica-type symptoms affecting both legs, or affecting bladder or bowel control, are a medical emergency.

What Causes Sciatica?

Sciatica happens when something presses on or irritates the sciatic nerve or one of its nerve roots in the lower spine. Common causes include:

• A slipped (herniated) disc, the most common cause, where the soft cushioning tissue between the bones of the spine pushes out and presses on a nerve
• Spinal stenosis, narrowing of the part of the spine where nerves pass through, more common with age
• Spondylolisthesis, when one of the bones in the spine slips out of position
• A back injury, such as from heavy lifting or a fall
• Piriformis syndrome, tightness or spasm in a deep buttock muscle that sits close to the sciatic nerve

A question I am frequently asked is why some people get sciatica and others doing similar jobs or activities don’t. Risk factors include increasing age, being overweight, occupations involving heavy lifting or long periods of sitting, and smoking, which is thought to affect blood supply to the discs in the spine. None of these guarantee sciatica will develop, but they do make it more likely.

Sciatica Symptoms

Symptoms typically affect one buttock and the back of one leg, sometimes reaching as far as the foot and toes. They can come on suddenly or build up gradually. Common symptoms include:

• A sharp, burning pain running down the back of the leg
• Tingling, similar to pins and needles
• Numbness
• Weakness in the leg or foot

Many patients are surprised to learn that back pain is often the least prominent symptom; the leg pain is usually worse. If you only have back pain, without any pain travelling down the leg, you probably don’t have sciatica.

What Does Sciatica Pain Feel Like?

One of the most common concerns I see in practice is a patient worried that severe pain means something is seriously wrong. Sciatica pain is often described as sharp, burning or like an electric shock, and it typically gets worse with movement, sneezing or coughing. It can be intermittent or constant, and the intensity doesn’t necessarily reflect how serious the underlying cause is , some of the most painful episodes settle completely within weeks.

Red Flags: When Sciatica Needs Emergency Care

Rarely, symptoms similar to sciatica can be a sign of cauda equina syndrome, a serious condition caused by significant compression of the nerves at the base of the spine. This needs emergency treatment to prevent permanent damage.

Go to A&E or call 999 if you have sciatica-type symptoms alongside:

• Symptoms affecting both legs at the same time
• Severe or worsening weakness or numbness in both legs
• Numbness around or under your genitals, or around your back passage
• New difficulty starting to urinate, or loss of bladder control
• Loss of bowel control, or not noticing when you need to go

These symptoms are rare, but they're the one situation where sciatica genuinely can't wait for a routine appointment.

How Is Sciatica Diagnosed?

Sciatica is usually a clinical diagnosis, based on your description of the pain and a simple physical examination, often including the straight leg raise test, where lifting the affected leg while lying down reproduces the pain. NICE guidance recommends against routine imaging for most people, since scans don't usually change initial management and a great many adults have disc changes visible on a scan without any symptoms at all.

An MRI scan is generally only arranged if symptoms aren't improving after several weeks, if surgery or a specialist nerve injection is being considered, or if there's any suggestion of a red-flag cause. If your case is more complex or persistent, a referral to a specialist, usually a spinal or orthopaedic specialist, allows more detailed assessment and access to further treatment options.

How to Ease Sciatica Pain Yourself

The first few weeks of self-care genuinely matter, and the advice here often surprises people because it runs against instinct:

• Keep moving and carry on with normal activities as much as you can; this is one of the most consistent pieces of advice across UK guidance
• Avoid long periods sitting or lying down; even if moving hurts, it isn't causing harm
• Start gentle movement and sciatica-specific exercises as early as possible
• Try heat packs on the painful area
• Ask a pharmacist about painkillers; paracetamol alone is unlikely to help much, and it isn't entirely clear how much anti-inflammatories such as ibuprofen help either, so it's worth a proper conversation rather than guessing

Many patients are surprised to learn that bed rest, the instinctive response to severe pain, tends to slow recovery rather than speed it up. If over-the-counter painkillers genuinely aren't touching the pain, a private prescription for something stronger may be appropriate for a short period, alongside continuing to stay as active as possible.

Sciatica Exercises

Gentle, regular movement is one of the most evidence-supported things you can do for sciatica. The NHS exercise videos for sciatica demonstrate this well, but commonly recommended stretches include:

• Knee-to-chest stretch, lying on your back, gently pulling one knee toward your chest and holding briefly
• Piriformis stretch (figure-four), lying on your back with knees bent, crossing one ankle over the opposite knee and gently pulling the uncrossed thigh toward your chest
• Seated piriformis stretch, sitting upright, crossing one ankle over the opposite knee and leaning gently forward
• Pelvic tilts, lying with knees bent, gently flattening your lower back against the floor and releasing

Start gently, hold each stretch for around 20–30 seconds, and stop if a movement sharply increases your pain rather than easing it. If you're not sure whether an exercise is right for you, or your symptoms are severe, it's worth checking with a GP or physiotherapist before starting a new routine, particularly if you have other health conditions.

Medical Treatment for Sciatica

For most people, sciatica improves with the self-care measures above. When more is needed, options include:

• Physiotherapy, including exercise advice and manual therapy techniques such as massage

Psychological support, to help with coping when pain is persistent; a confidential mental health assessment is a legitimate part of managing chronic pain well, not a sign that the pain “isn't real”

If pain is severe and these measures haven't helped, a hospital specialist may consider further options:

• Radiofrequency denervation, a procedure that seals off specific nerves so they stop sending pain signals
• An epidural or other targeted painkilling injection
• Decompression surgery, an operation to relieve pressure on the affected nerve, generally reserved for persistent or severe cases

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The right starting point depends on how severe your symptoms are and how long they've lasted , there's no need to jump to the bottom of this list, and most people never need to.

How Long Does Sciatica Last, and Can It Come Back?

Most sciatica improves within a few weeks to a few months, though it can occasionally last longer. If you've had it once, there's a genuine chance it could happen again, but there are things that reduce the likelihood:

• Staying generally active, rather than becoming sedentary once symptoms settle
• Using a safe technique when lifting heavy objects
• Maintaining good posture when sitting, standing and working at a computer
• Losing weight if you're overweight, since extra weight increases pressure on the discs in your lower spine; a weight management programme can make this more achievable than attempting it alone
• Not smoking, which is linked to a higher risk of developing sciatica

One of the most common concerns I see in practice is a patient whose sciatica keeps recurring without ever having the wider contributing factors looked at together. If that sounds familiar, a broader health assessment can be a useful way to review weight, activity levels and general health in one place, rather than only treating each flare-up in isolation.

Common Myths About Sciatica

• Myth: Bed rest is the best way to recover. Fact: Staying as active as possible, even when it's uncomfortable, tends to speed recovery rather than slow it.
• Myth: Sciatica is a diagnosis in its own right. Fact: Sciatica describes a pattern of nerve pain, not a specific disease; it's caused by an underlying issue such as a slipped disc, which is what’s actually being treated.
• Myth: You need a scan to confirm sciatica. Fact: Diagnosis is usually clinical. Scans are reserved for cases that aren't improving, or where surgery or a specialist injection is being considered.
• Myth: Sciatica always ends up needing surgery. Fact: The large majority of people recover with self-care, exercise, and time. Surgery is reserved for a small minority.
• Myth: Once you've had sciatica, your back is permanently damaged. Fact: Most people make a full recovery, though there's a genuine chance of it recurring, which is different from ongoing damage.

When to See a GP

Beyond the emergency red flags above, it's worth speaking to a GP if:

• Your pain hasn't improved after trying self-help measures for a few weeks
• Your symptoms are getting worse rather than better
• Pain is stopping you from doing your normal daily activities
• You're unsure whether your symptoms fit the pattern of sciatica at all

An online GP consultation is often a reasonable first step to discuss your symptoms properly and agree on next steps, whether that's further self-care advice, physiotherapy, or onward referral.

Conclusion

Sciatica is painful, disruptive, and usually far less serious than it feels in the moment. Staying active, using sensible pain relief, and giving it time resolves the large majority of cases without any need for injections or surgery. The exception is the small number of red-flag symptoms covered above, which genuinely do need same-day assessment.

At Private Medical Clinic, our GPs regularly assess patients with sciatica and can arrange further investigation or specialist referral where it's needed. If your symptoms aren't settling, you're welcome to contact our clinical team directly.

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