Patient information · Musculoskeletal
Sciatica
severe pain, and usually a good outcome
Sciatica is pain travelling down the leg from an irritated nerve root in the lower back, usually from a disc bulge. It is often more severe than the back pain itself and can be genuinely disabling — and the great majority of cases settle without surgery, though it can take longer than people expect.
Call 999 or go to an emergency department if you have
- numbness or tingling around the genitals, buttocks or back passage
- difficulty passing urine, or loss of sensation when you do
- loss of control of bladder or bowels
- numbness or weakness in both legs, or weakness that is worsening
- new loss of sexual sensation
- a foot that drops, or a leg that is rapidly becoming weaker
These indicate possible cauda equina syndrome, which needs surgery within hours to avoid permanent damage to bladder, bowel and sexual function. Do not wait to see whether it settles. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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.
Scans early do not help
MRI is not recommended in the first six weeks unless there are red flags or a plan to intervene, because almost everyone over 30 has disc changes on imaging that are unrelated to their symptoms. Finding a bulging disc rarely changes treatment early on, and can make people more fearful and less active — which measurably worsens 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.
Book an appointment if leg pain is severe, has lasted more than six weeks, or you have any weakness or numbness. We offer assessment, MRI arranged quickly through our CQC-registered imaging partners where it is indicated, image-guided nerve root injection, physiotherapy and spinal surgical referral.
Fast MRI access and image-guided injection
Seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.