Sciatica
Sciatica: At a Glance
What it is: Sciatica is pain caused by irritation or compression of the sciatic nerve, which runs from the lower back down the legs.
How it affects people: It often causes shooting pain, tingling, or weakness in the leg, usually on one side of the body.
Key concern: Persistent pain or progressive weakness that impacts daily life.
Diagnosis: Confirmed with clinical examination and imaging tests such as MRI scans or CT scans.
Treatment options: Non-surgical care such as physical therapy, medication, and injections; surgical treatment for sciatica if symptoms persist.
Outlook: With expert care, most patients recover fully or achieve long-term relief.
What is Sciatica?
Sciatica refers to symptoms caused by irritation or compression of the sciatic nerve, the largest nerve in the body. The pain can start in the lower back and radiate into the buttock, thigh, calf, or even the foot.
Although very common, the severity of sciatica varies. Some patients experience mild discomfort that resolves with rest, while others develop severe pain or nerve-related symptoms requiring specialist treatment.
Types of Sciatica
Doctors often classify sciatica based on what causes the nerve irritation or where along the sciatic nerve the problem occurs:
Acute sciatica: Short-term pain that develops suddenly, often after a specific injury, strain, or slipped disc. It usually improves within a few weeks with conservative treatment.
Chronic sciatica: Long-term or recurring nerve pain that persists for more than 12 weeks, often linked to ongoing issues such as spinal degeneration or disc herniation
Alternating sciatica: Pain that shifts between both legs, typically caused by sacroiliac joint dysfunction or spinal instability.
Bilateral sciatica: Pain in both legs at the same time. This is rare and may suggest a more serious underlying condition, such as spinal canal narrowing (stenosis) or nerve compression.
Sciatica can also be described based on its underlying cause. The most common is lumbar disc herniation, where a slipped or bulging disc presses on the sciatic nerve. Another frequent cause is spinal stenosis, which involves narrowing of the spinal canal and compression of the nerve roots. In some cases, piriformis syndrome may be responsible, where the sciatic nerve becomes compressed by the piriformis muscle in the buttock.
Sciatica Symptoms
Typical sciatica symptoms include:
Sharp, shooting pain in the buttock, thigh, or leg
Tingling, pins and needles, or burning sensations
Muscle weakness in the affected leg
Pain that worsens with sitting, coughing, or sneezing
Emergency / red flag symptoms
Loss of bladder or bowel control
Severe weakness in the legs
Sudden inability to walk or stand
Call 999 immediately if you experience these symptoms.
Causes and Who Is at Risk
The most common cause of sciatica pain is a herniated disc in the lower back that presses on the nerve roots.
Other causes include:
Spinal stenosis (narrowing of the spinal canal)
Degenerative disc disease
Spondylolisthesis (slippage of one vertebra over another)
Traumatic injury
Rarely, spinal tumours or infections
In very rare cases, cauda equina syndrome, which requires urgent medical attention
Reducing Your Risk
You may not be able to prevent all cases of sciatica, but you can reduce your risk by:
Maintaining a healthy weight
Exercising regularly, especially core-strengthening routines
Practising good posture when sitting or lifting
Avoiding smoking, which reduces blood flow to spinal tissues
Getting a Diagnosis
A diagnosis of sciatica begins with a clinical examination, including testing reflexes, strength, and sensation in the legs.
MRI scans can reveal nerve compression from a disc, bone overgrowth, or other issues putting pressure on the nerves.
X-rays may show changes in alignment or narrowing of the lumbar spine.
Nerve conduction studies can help confirm sciatic nerve irritation.
Treatment Options for Sciatica
Treatment for sciatica depends on the cause, severity, and duration of symptoms. Most patients improve with non-surgical care, but some may require surgery if symptoms persist or worsen.
Lifestyle Adjustments
Activity modification, ergonomic adjustments, and avoiding prolonged sitting or heavy lifting can relieve strain on the spine and support long-term recovery.
Pain Management
Medications such as anti-inflammatories or pain relievers can help reduce discomfort and inflammation around the affected nerve.
Physiotherapy and Exercise
Targeted physiotherapy for sciatica relief focuses on core-strengthening and mobility exercises that support the spine, improve posture, and prevent recurrence.
Steroid Injections
Steroid injections around the irritated nerve roots may be used to reduce inflammation and provide temporary pain relief.
Surgical Intervention
Surgery, such as microdiscectomy or decompression, may be considered for patients with severe or long-lasting symptoms, particularly if there is weakness, loss of bladder or bowel control, or nerve compression causing significant pain.
Mr Kailaya-Vasan, a consultant neurosurgeon, is highly experienced in managing complex spinal conditions. Recognised as one of the best neurosurgeons in London for sciatica, he provides both non-surgical care and advanced surgical options.
Living with Sciatica
While sciatica can be painful, most people recover with the right combination of care. Regular activity, weight management, and tailored rehabilitation exercises can help prevent recurrence.
Patients should be reassured that long-term outcomes are excellent for the majority, and surgery is only necessary in a small number of cases.
Book a consultation with Mr Ahilan Kailaya-Vasan
Receive a clear diagnosis and a tailored treatment plan from a leading consultant neurosurgeon. Appointments are available at top London hospitals, with remote options for international patients.
Seeking a second opinion?
If you have already received a diagnosis elsewhere, Mr Kailaya-Vasan can provide an independent review of your scans and medical notes, and explain the safest and most effective next steps.
FAQs about Sciatica
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They include lower back and leg pain, tingling, and muscle weakness, often worse when sitting or bending.
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A herniated disc is the most common cause, though spinal stenosis, degenerative changes, or bone spurs can also lead to symptoms.
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Sciatica is diagnosed clinically. To find the underlying cause may warrant an MRI scan.
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Treatment often starts with physical therapy, medication, or injections, but spine surgery may be needed if symptoms don’t improve.
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Surgical treatment for sciatica is considered if pain is severe, long-lasting, or associated with progressive weakness. Surgery is also indicated as an emergency if there is loss of bladder or bowel control. Common operations include microdiscectomy and decompression procedures, which relieve pressure on the nerves.
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Yes, sciatica can recur even after successful treatment, particularly if the underlying cause isn’t fully resolved. However, lifestyle changes, rehabilitation, and ongoing care can significantly reduce the risk of recurrence.
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Many patients benefit from applying heat or ice packs, using ergonomic chairs, and gentle stretching exercises. Sleeping on a supportive mattress and avoiding prolonged sitting often reduce discomfort.
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For many patients, symptoms improve within a few weeks of conservative care. Some recover fully within 6–12 weeks, though others may need longer treatment or surgery if symptoms persist.
If you have any further questions, please get in touch.