Sciatica: leg pain from a trapped nerve

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.

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.

Private physiotherapy for sciatica in London

Sciatica causes pain, tingling or numbness down the leg from an irritated nerve, and most improves with staying active and targeted treatment. Our private physiotherapy clinic in London can assess and treat you, and our musculoskeletal and orthopaedic team can arrange an MRI scan where symptoms persist. Numbness around the saddle area, loss of bladder or bowel control, or worsening leg weakness is an emergency — call 999 or attend A&E. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.

Sciatica in London: common questions

How is sciatica treated?

With staying active, targeted exercises, and pain relief; most cases settle over weeks. Injections or surgery are for selected cases.

What are the emergency signs?

Numbness around the saddle area, loss of bladder or bowel control, or worsening weakness in both legs is a medical emergency.

Do I need an MRI?

Not usually early on; imaging is used where symptoms persist, are severe, or surgery is being considered.

Can physiotherapy help sciatica?

Yes — guided exercises and load management are central to recovery for most people.

Fast MRI access and image-guided injection

7 days a week, 9am–7pm, on Whitechapel Road.

Book an appointment or call 020 7916 0029

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