At a glance
What it is
Pain radiating down the leg along the sciatic nerve, from a compressed nerve root in the lumbar spine.
Typical signs
Sharp shooting pain down one leg, often with numbness, tingling, or weakness in the foot.
How we treat it
Physiotherapy first; targeted injection when pain is severe or persistent; surgery reserved for progressive weakness or true emergencies.
What sciatica is
Sciatica is a symptom, not a diagnosis. It refers to pain that radiates along the sciatic nerve — the largest nerve in the body — which forms from the lower lumbar and upper sacral nerve roots and travels through the buttock and down the back of the leg.
In most cases the pain is caused by a herniated disc compressing one of those nerve roots as it exits the spine. Less commonly, the compression comes from spinal stenosis, piriformis muscle spasm, or a mass along the nerve's path. Identifying which root and what is compressing it is the point of the first consultation.
How it presents
The classic pattern is a sharp, electric-shock-like pain that shoots from the buttock down the back or side of one leg, sometimes reaching the foot. The pain often follows a specific dermatome — the strip of skin supplied by one nerve root — and knowing that strip lets the clinician predict which root is affected before imaging confirms it.
Numbness, tingling, or weakness in the leg or foot changes the plan: those symptoms indicate the nerve is not just irritated but functionally impaired, and urgent evaluation is warranted if weakness is progressive.
Two things sciatica is often confused with
The word 'sciatica' gets applied loosely. Two conditions look similar but have different treatment paths — telling them apart is done at the physical examination, not on the scan.
Condition A
Radicular sciatica
- Pain follows a nerve-root dermatome — buttock, thigh, calf, foot.
- Straight-leg-raise test reproduces the pain.
- MRI shows disc compression on the matching nerve root.
Condition B
Piriformis syndrome
- Pain localised to the buttock, sometimes referred to the thigh.
- Tenderness on deep buttock palpation; SLR often negative.
- MRI of the spine is normal; diagnosis is clinical.
What we see in clinic
80%
Cases that resolve within 6 weeks with conservative care
60%
Improve substantially after a single targeted epidural injection
5%
Require surgical decompression at first review
Key facts
How it is treated
The stepped plan mirrors back pain: start conservative, escalate when the evidence supports it, and reserve surgery for defined indications.
Movement + medication
Weeks 1 to 4
- Stay active; short walks better than lying down
- Simple analgesia (paracetamol, NSAIDs)
- Short course of neuropathic-pain medication where indicated
Physiotherapy
Weeks 2 to 8
- Nerve gliding exercises
- Core and glute strengthening
- Postural re-education
Targeted injection
For persistent or severe pain
- Transforaminal epidural steroid injection
- Interlaminar epidural steroid injection
- Selective nerve root block (diagnostic + therapeutic)
Surgery
Defined indications only
- Progressive motor weakness
- Cauda equina syndrome (emergency)
- Persistent disabling pain unresponsive to 6+ weeks of full conservative care
The plan is written and shared with the patient and the referring clinician at the end of the first visit; imaging is arranged only when the exam demands it.
Related reading
Back pain
Most back pain is mechanical and settles in weeks. The first visit identifies the few cases that need imaging, injections or surgery, without over-treating.
Fibromyalgia and myofascial pain
Widespread muscle pain that routine scans don't explain. Most of it comes from muscle and fascia, and is treatable once the source is found.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about sciatica and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.