Private sciatica clinic in London, same-day physiotherapy.

What sciatica actually is

True sciatica follows a nerve root: pain travelling below the knee, often into the calf, foot or toes, frequently with pins and needles, numbness or weakness in a defined area. It is commonly worse on sitting, coughing, sneezing or straining.

Pain confined to the buttock and back of the thigh, without travelling below the knee and without neurological symptoms, is usually referred pain from the back or hip rather than sciatica. The distinction matters, because the treatments differ.

Managing it

• Keep moving within tolerance. Short frequent walks, changing position often. Bed rest delays recovery and does not reduce pain.
• Find the positions that ease it — often lying with knees bent and supported, or standing and walking rather than sitting. Use them, and avoid prolonged sitting.
• Pain relief matters, because it enables movement. Anti-inflammatories, and paracetamol. Codeine may be used briefly but causes constipation, which worsens everything.
• Medicines for nerve pain such as gabapentin or amitriptyline have disappointing evidence in sciatica specifically and are no longer routinely recommended, though they are sometimes tried.
• Heat for muscle spasm; some people prefer cold.
• Physiotherapy with graded movement and nerve mobilisation, and a return-to-activity plan.
• Stay at work if you can, with adjustments. Prolonged absence predicts worse outcomes.

If it does not settle

• Nerve root injection under imaging guidance can substantially reduce pain and buy time for natural recovery.
• Surgery — microdiscectomy — is considered where severe pain persists beyond six to twelve weeks despite conservative treatment, or where there is significant progressive weakness. It relieves leg pain quickly and reliably in well-selected people.
• At one to two years the outcomes of surgery and conservative treatment are broadly similar for most people — surgery gets you there faster. That is a genuine choice rather than a foregone conclusion.