What Causes Sciatica and When Should You Get It Checked?
If you’ve ever felt a sharp, burning or electric-like pain travelling from your lower back or buttock down into your leg, you may already know how uncomfortable sciatica can be.
It can make sitting at your desk difficult. Walking can become uncomfortable. Getting in and out of the car can be a challenge. And sometimes, even finding a comfortable position in bed feels impossible.
The good news is that most cases of sciatica improve with time and appropriate conservative management, often over a period of several weeks to a few months. (nhs.uk)
But what actually causes sciatica? And how do you know when it’s something you can manage yourself versus something that needs professional assessment?
At Family Osteopathy in Hammersmith, we see people with lower back and leg pain regularly. Our role is to assess what’s happening, identify whether there is a musculoskeletal contribution to your symptoms, and help you understand the most appropriate next step.
What Is Sciatica?
Sciatica isn’t really a diagnosis in itself.
It’s a term used to describe pain caused by irritation or compression of nerves in the lower back that contribute to the sciatic nerve. NICE describes sciatica as leg pain associated with lumbosacral nerve-root pathology. (Nice)
The sciatic nerve is formed from several nerve roots in the lower spine. It travels through the buttock and down the back of the leg, with branches continuing towards the lower leg and foot.
When one of the nerve roots becomes irritated, you can experience symptoms along the pathway supplied by that nerve.
That’s why the pain isn’t always where you might expect it to be.
You might have relatively little lower back pain but significant pain in your buttock, calf or foot.
What Does Sciatica Feel Like?
Sciatica can feel very different from ordinary muscular lower back pain.
Common symptoms include:
Sharp, burning or electric-like pain travelling from the lower back or buttock into one leg
Pain that may extend towards the calf, ankle or foot
Tingling or pins and needles
Numbness
Weakness in the leg or foot
Pain that becomes worse with certain movements
Symptoms aggravated by coughing or sneezing
Difficulty sitting or finding a comfortable position
Sciatica usually affects one side of the body.
It’s also worth remembering that pain travelling into the leg doesn’t automatically mean you have sciatica. Other structures in the lower back, pelvis and hip can refer pain into the leg without involving a spinal nerve root. This is one reason why an appropriate assessment is important. (Nice)
What Causes Sciatica?
There isn’t always one simple explanation.
Sciatica generally occurs when a nerve root in the lower back becomes irritated or compressed. Several different conditions can contribute to this.
1. A Herniated or “Slipped” Disc
One of the most common causes of sciatica is a herniated disc.
The discs between the vertebrae act as cushions between the bones of your spine. If part of a disc protrudes and irritates a nearby nerve root, it can cause pain, tingling or numbness travelling into the leg.
Interestingly, disc changes are also common in people who have no pain at all.
So seeing a disc bulge or herniation on a scan doesn’t automatically mean it is the cause of someone’s symptoms.
The clinical picture matters.
2. Spinal Stenosis
Spinal stenosis is a narrowing of the spaces through which the spinal nerves travel.
This can place pressure on the nerves and may cause leg pain, numbness or weakness, particularly during standing or walking.
It becomes more common with age and can develop alongside other age-related changes in the spine. (nhs.uk)
3. Spondylolisthesis
Spondylolisthesis occurs when one vertebra moves forwards relative to the vertebra below it.
In some cases, this can reduce the available space around a nerve root and contribute to symptoms such as lower back and leg pain.
4. Previous Injury
A significant fall, road traffic accident or sporting injury can affect the structures around the lower back and may contribute to nerve irritation.
If your symptoms started after an injury, particularly a significant one, an appropriate assessment is important.
5. Pregnancy
Pregnancy can bring significant changes to how your body moves and distributes load.
Lower back and pelvic discomfort are common during pregnancy, and some people experience pain that travels into the buttock or leg.
However, not every episode of pregnancy-related leg pain is true sciatica.
If you’re pregnant and experiencing new, severe or persistent pain, it’s worth getting it assessed so that the cause can be properly understood.
6. Age-Related Changes
As we get older, changes naturally occur in the discs, joints and other structures of the spine.
These changes don’t automatically mean you’ll develop sciatica.
In fact, many people have completely normal lives despite having age-related changes visible on imaging.
What matters is whether those changes are relevant to your symptoms.
7. Repetitive Loading and Reduced Movement
Your back is designed to move.
Long periods of sitting, repetitive lifting, sudden increases in exercise or returning to physical activity too quickly can all contribute to lower back and leg symptoms in some people.
Rather than thinking about one particular posture being “bad”, it’s often more useful to think about how much variety and movement your body gets throughout the day.
Sciatica or Just Back Pain?
This is an important distinction.
If you have pain exclusively in your lower back, you probably don’t have sciatica.
Sciatica generally involves pain travelling into the buttock and leg, often accompanied by neurological symptoms such as tingling, numbness or weakness. (nhs.uk)
That doesn’t mean back pain can’t be severe.
It simply means that different types of pain can have different causes and may require different approaches.
When Should You Get Sciatica Checked?
Not every episode of sciatica needs immediate treatment.
In many cases, symptoms gradually improve with staying active, appropriate exercise and time. The NHS recommends continuing normal activities as much as possible and avoiding prolonged periods of sitting or lying down. (nhs.uk)
However, it’s sensible to seek professional advice if:
Your symptoms are getting progressively worse
Your pain isn’t improving after a few weeks
The pain is preventing you from carrying out normal activities
You develop persistent numbness or weakness
Your symptoms keep returning
Your symptoms began following a significant injury
You’re unsure whether your symptoms are actually sciatica
An assessment can help determine whether your symptoms are appropriate for conservative musculoskeletal care or whether you need further medical investigation.
When Is Sciatica an Emergency?
There are some symptoms that should not be managed by waiting for an osteopathic appointment.
Seek emergency medical attention if you experience:
Numbness around your genitals, inner thighs or buttocks
Difficulty starting urination or an inability to pass urine
New loss of bladder control
New loss of bowel control
Severe or rapidly worsening weakness or numbness in both legs
Sciatica affecting both legs alongside neurological symptoms
These can be signs of cauda equina syndrome, a rare but serious condition involving compression of the nerves at the bottom of the spinal canal. It requires urgent assessment. (nhs.uk)
If you’re experiencing these symptoms, go to A&E or call 999 rather than booking a routine osteopathy appointment.
How Can Osteopathy Help With Sciatica?
The first step isn’t necessarily treatment.
It’s assessment.
At Family Osteopathy in Hammersmith, we’ll begin by taking the time to understand your symptoms and how they’ve developed.
We’ll want to know:
Where your pain started
Where it travels
Whether you have tingling, numbness or weakness
What movements make it better or worse
Whether coughing or sneezing changes your symptoms
How you’re managing everyday activities
Whether you’ve experienced any previous back injuries
What you’ve already tried
We’ll then carry out an appropriate physical assessment.
This may include looking at your spinal and joint movement, muscle function, neurological symptoms and the way you move.
The aim isn’t simply to find something that’s “out of alignment”.
It’s to build a clearer picture of what may be contributing to your symptoms and whether osteopathic care is appropriate.
What Does Osteopathic Treatment for Sciatica Involve?
If osteopathic treatment is appropriate, your treatment plan will depend on your individual presentation.
Treatment may include:
Gentle soft tissue techniques
Joint mobilisation
Appropriate manual therapy
Movement-based techniques
Advice around activity and load management
Exercise and rehabilitation guidance
Advice on returning gradually to normal activities
We don’t believe that everyone with sciatica needs the same treatment.
And you don’t necessarily need to be completely pain-free before you start moving again.
In fact, maintaining appropriate levels of activity is an important part of recovery for many people with sciatica. (nhs.uk)
What About Exercises for Sciatica?
Exercise can form an important part of managing sciatica.
The right exercise, however, depends on what’s happening with your symptoms.
Rather than giving everyone the same list of stretches, we’d rather understand what movements you can currently tolerate and gradually build from there.
Depending on your presentation, this might involve:
Gentle movement
Walking
Mobility exercises
Strengthening exercises
Gradually increasing your normal activities
Specific exercises based on your symptoms and goals
The NHS also recommends staying active and beginning gentle exercise as soon as you can, rather than spending long periods resting. (nhs.uk)
If an exercise significantly increases your symptoms or you’re unsure whether it’s appropriate for you, get individual advice from a suitably qualified healthcare professional.
Sciatica During Pregnancy
Pregnancy deserves its own consideration.
Your body changes significantly throughout pregnancy, and lower back, pelvic and leg symptoms can become more noticeable as your posture, movement patterns and load distribution change.
If you’re pregnant and experiencing pain travelling into your leg, an assessment can help determine whether you’re experiencing true nerve-related symptoms or another type of musculoskeletal pain.
At Family Osteopathy, we take a gentle and individualised approach to pregnancy-related musculoskeletal problems.
The aim isn’t to force your body into a particular position.
It’s to help you move as comfortably as possible while taking your stage of pregnancy and individual circumstances into account.
What Can You Do at Home?
If you have uncomplicated sciatica, there are several simple things you can try.
Keep Moving
It can be tempting to stay in bed when your leg hurts.
But prolonged rest isn’t generally helpful.
Try to keep moving within what you can comfortably tolerate. Short walks and regular changes of position can be more useful than spending the entire day lying down. (nhs.uk)
Don’t Stay in One Position for Too Long
If sitting aggravates your symptoms, change position regularly.
Stand up.
Walk around.
Try working for a while standing if that’s comfortable.
Your aim isn’t to find one perfect posture — it’s to avoid spending hours in one position.
Pace Yourself
You don’t have to stop everything.
But you may need to temporarily reduce activities that significantly aggravate your symptoms.
Then gradually build them back up as things improve.
Keep Exercising Where Appropriate
Gentle exercise can be helpful during recovery.
The important thing is finding an appropriate starting point rather than trying to push through severe symptoms.
Don’t Panic About the Pain
Sciatica can be incredibly painful.
That doesn’t necessarily mean you’re causing ongoing damage every time you move.
Understanding what’s happening and gradually returning to normal activity can be an important part of recovery.
If you’re unsure what you should or shouldn’t be doing, get individual advice.
Can Sciatica Come Back?
Unfortunately, yes.
Having had sciatica once can mean you’re more likely to experience it again in the future. (nhs.uk)
But that doesn’t mean you need to spend the rest of your life protecting your back.
Regular physical activity, gradually building strength, using sensible lifting techniques and avoiding long periods of inactivity can all support your general back health. (nhs.uk)
The goal isn’t to create a life where your spine is never challenged.
It’s to build a body that is capable of handling the demands you place on it.
So, Should You See an Osteopath for Sciatica?
If you’re experiencing pain travelling from your lower back or buttock into your leg and you’re unsure what’s causing it, an assessment can be a useful place to start.
At Family Osteopathy in Hammersmith, we’ll listen to your symptoms, assess what’s going on and explain what we find.
If your presentation appears appropriate for osteopathic care, we’ll work with you on a personalised plan that may include hands-on treatment, movement advice and exercise.
If your symptoms suggest that you need medical investigation or a different type of care, we’ll tell you that too.
Good healthcare isn’t about treating everyone the same way.
It’s about understanding what’s happening and choosing the right approach for you.
Living With Sciatica in Hammersmith?
If you’re dealing with lower back and leg pain, you don’t have to guess what’s causing it.
Family Osteopathy in Hammersmith can assess your symptoms and help you understand whether there is a musculoskeletal component that may respond to osteopathic care.
We’ll take the time to listen, assess and explain what’s going on — without promising a quick fix or assuming that every case of leg pain is the same.
If you’d like to find out whether osteopathy is appropriate for your symptoms, book an assessment with Family Osteopathy in Hammersmith.
