Sciatica and Lower Back Pain: Symptoms, Causes and How Physiotherapy May Help
Lower back pain is common, but when the pain starts travelling into your buttock or down one leg, it can feel very different. You may also notice tingling, pins and needles, numbness or weakness.
You might already have been told that you have sciatica. Or you may simply be searching for help with back pain because you are not sure what is causing the symptoms in your leg.
Some people with sciatica have relatively mild symptoms and can carry on with most of their usual activities. For others, sitting, walking, sleeping, driving or working can become difficult.
Sciatica can affect people in different ways. The cause, symptoms and what makes them better or worse can vary, so the same advice or exercises will not suit everyone.
What is sciatica?
Sciatica happens when a nerve in the lower part of your spine becomes irritated or compressed.
Some of the nerves from the lower back join together to form the sciatic nerve. This nerve runs from the lower back, through the buttock and down the leg towards the foot.
Sciatica usually affects one side.
You may have lower back pain as well, although for some people the pain in the buttock or leg is much more noticeable than the back pain itself.
Depending on which nerve is affected, the symptoms may travel through the buttock, thigh and calf and sometimes into the ankle, foot or toes.
Pain travelling into the leg does not automatically mean that you have sciatica. Problems around the hip, muscles and other structures can sometimes cause similar symptoms. An assessment can be useful if the cause is not clear.
What does sciatica feel like?
The symptoms can vary quite a lot.
You may notice:
- sharp, burning or shooting pain down one leg
- tingling or pins and needles
- numbness
- weakness in part of the leg or foot
- pain that changes when you move or change position
- pain that becomes worse when coughing or sneezing
For some people, the symptoms are there most of the time. Others notice them mainly when sitting, standing, bending or walking.
We often see people who say they can manage reasonably well while moving around, but sitting in the car or at a desk brings the pain on. Others tell us they can walk for a short distance before the pain or tingling starts travelling further down the leg.
Looking at where your symptoms travel, when they appear and what makes them better or worse can help a physiotherapist understand whether the problem is likely to be coming from the lower back.
When does back pain or sciatica need urgent medical attention?
Most lower back pain and sciatica are not emergencies.
There are, however, some symptoms that need urgent hospital assessment rather than a routine physiotherapy appointment.
Go to A&E or call 999 if you develop:
- sciatica affecting both sides
- severe or worsening weakness or numbness in both legs
- numbness around your genitals, inner thighs or bottom
- difficulty starting to pass urine, being unable to pass urine or new loss of bladder control
- new loss of bowel control or not knowing when you need to open your bowels
These symptoms can occasionally happen when the nerves at the bottom of the spine become severely compressed. This is called cauda equina syndrome and needs urgent hospital assessment.
Do not drive yourself to A&E if you have these symptoms.
You should also seek medical advice if your back or leg pain started after a significant accident, you feel generally unwell or feverish, you have unexplained weight loss, have a history of cancer, or your symptoms are getting rapidly worse.
What causes sciatica?
A common cause is a change in one of the discs in the lower back.
Discs are the softer cushions that sit between the bones of your spine. If part of a disc pushes out, it may irritate or put pressure on a nearby nerve. You may hear this described as a slipped disc, disc prolapse or herniated disc.
Sciatica can also be linked with spinal stenosis, where the space available for the nerves becomes narrower, or spondylolisthesis, where one of the bones in the spine moves forwards in relation to the one below it.
Changes in the spine that become more common with age and some lower back injuries can also cause sciatica.
Sometimes symptoms that feel similar to sciatica come from somewhere other than a spinal nerve. This is why it is not always possible to work out the cause simply from where the pain is felt.
How long does sciatica usually last?
Sciatica often improves over a few weeks to a few months, although it can sometimes take longer.
Recovery is not always steady. You may have a few better days, increase what you are doing and then have a temporary flare up. That does not necessarily mean that you have damaged your back again.
It can be more useful to look at the overall change.
Are you gradually walking further? Can you sit for longer? Are you sleeping more comfortably? Is the leg pain becoming less intense or happening less often?
Those changes can show that things are moving in the right direction, even if you still have some discomfort.
If the pain is becoming worse, is stopping you doing normal activities or has not started improving after a few weeks, it is sensible to get advice.
What can you do yourself for lower back pain and sciatica?
When back or leg pain is severe, it is understandable to want to stop moving altogether. At the other extreme, some people try to carry on with everything and push through increasing pain.
Usually, a more measured approach works better.
Keep moving as much as you reasonably can
Try to continue with normal activities where possible rather than spending long periods sitting or lying down.
You do not need to force yourself through severe pain.
You may find that shorter walks, changing position regularly and doing smaller amounts of activity more often are easier to manage.
If walking helps, keep doing it. If a long walk makes the leg significantly worse, shorten the distance for a while and build it up gradually.
The aim is to keep moving without repeatedly causing a large and lasting increase in your symptoms.
Change position regularly
There is no single perfect posture for everyone with back pain or sciatica.
If sitting for a long time increases your pain, get up and move regularly. If standing becomes uncomfortable, change position or sit down for a while.
Being able to move and change position comfortably is often more useful than trying to hold yourself rigidly in what you think is the correct posture.
Heat may help with discomfort
Some people find a heat pack soothing around the lower back or buttock.
It will not remove the cause of sciatica, but it may make the area feel more comfortable for a while.
Protect your skin by wrapping the heat pack appropriately, and avoid using heat over an area where your sensation is reduced.
Be careful with sciatica exercises you find online
There are many exercises and stretches online labelled as exercises for sciatica or lower back pain.
They are not all suitable for everyone.
A movement that helps one person may aggravate another person’s symptoms. You do not need to force a stretch simply because it has been described as good for sciatica.
Gentle movement is usually encouraged. If an exercise causes a clear and lasting increase in leg pain, numbness, tingling or weakness, stop that exercise and consider getting individual advice.
What about pain relief?
If you need advice about pain relief, speak to a pharmacist, your GP or another appropriate healthcare professional.
Medication for sciatica is not always straightforward, and some medicines that have been used for nerve pain in the past are not routinely recommended for sciatica.
If you are already taking prescribed medication, do not stop it suddenly without speaking to the healthcare professional who prescribed it.
Do you need an MRI scan for back pain or sciatica?
Most people with straightforward lower back pain or sciatica do not need an MRI scan straight away.
This can be surprising. If pain is travelling down your leg, you may naturally feel that a scan is needed to find out exactly what is pressing on the nerve.
In many cases, however, your symptoms and a physical assessment provide enough information to decide how the problem should initially be managed.
During an assessment, a physiotherapist may look at how your back moves, where the pain or tingling travels, which movements change your symptoms, your leg strength and sensation, and how you walk and carry out normal movements.
Reflexes and specific tests of nerve sensitivity may also be checked where appropriate.
An MRI may become useful if the symptoms are not following the expected pattern, there are clinical findings that need further investigation, the problem is not improving as expected, or a specialist is considering treatment where the scan result could change what happens next.
Not having a scan at the start does not mean that your symptoms are not being taken seriously.
How can physiotherapy help with sciatica and lower back pain?
Physiotherapy starts with working out what is happening and how the problem is affecting you.
Someone coming in with lower back pain only may need a different approach from someone whose pain is travelling down the leg with numbness or weakness.
People often come to us saying they are not sure what they should be doing. Some have stopped exercising because they are worried about making the pain worse, while others have tried several stretches or exercises they found online without knowing whether they are right for them.
During your assessment, the physiotherapist will usually ask how the problem started, where you feel the symptoms, what makes them better or worse and how they are affecting your daily life.
Your movement, strength and nerve function may then be checked as appropriate.
If physiotherapy is suitable, treatment may include advice about keeping active, exercises chosen for your individual symptoms, gradual strengthening and help with returning to normal activities.
You may also be given advice about sitting, walking, bending, lifting, work, exercise or sport depending on what is causing difficulty.
Hands on treatment, such as joint mobilisation or soft tissue techniques, may be appropriate for some people. Where it is used for lower back pain or sciatica, it should form part of a wider programme that includes exercise and active rehabilitation rather than being the only treatment.
Physiotherapy cannot promise to remove sciatica within a certain number of appointments, and the aim is not to “put the nerve back in place”.
It may help you understand what is contributing to your symptoms, find ways to move more comfortably and gradually rebuild the movement, strength and confidence needed for everyday life.
Some people improve without physiotherapy. An assessment may be more useful when you are unsure what you should be doing, symptoms keep returning, movement has become restricted, or pain is getting in the way of work, walking, sleep or normal activities.
Getting back to normal activity
Back pain and sciatica can make you cautious about movement.
After several painful episodes, it is easy to start avoiding bending, lifting, walking or exercise because you are worried that you will make the problem worse.
Some activities may need to be changed for a short time, particularly while the symptoms are very irritable. Avoiding movement altogether for too long, however, can make getting back to normal life more difficult.
As your symptoms settle, you can gradually work towards the things that matter to you. That might mean sitting comfortably at work, walking further, using stairs, driving, gardening, returning to the gym or getting back to running or another sport.
The pace will be different for everyone.
When should you see a physiotherapist or GP?
Consider getting your back or leg pain assessed if it is becoming worse rather than gradually settling, has not improved after a few weeks, keeps coming back or is interfering with normal daily life.
Persistent numbness, noticeable weakness in the leg or foot, difficulty walking, or uncertainty about what activity is safe are also good reasons to seek advice.
A physiotherapist can assess many common causes of lower back pain and sciatica.
If the assessment suggests that you need to see your GP, have further investigations or get a specialist opinion, your physiotherapist should explain why and advise you on the next step.
Physiotherapy for sciatica and back pain in Kent
At Physios ‘R’ Us, we assess people with sciatica, lower back pain and pain travelling into the leg at our physiotherapy clinics in Ashford, Folkestone, Hythe and New Romney.
Your first appointment starts with talking through your symptoms and how they are affecting your day to day life. We can then assess your movement and, where appropriate, strength, sensation and nerve function.
We will explain what we think may be contributing to the problem, what you can reasonably keep doing and whether physiotherapy may be appropriate for you.
Our physiotherapists are HCPC registered and members of the Chartered Society of Physiotherapy, with more than 25 years of combined clinical experience.
If you are looking for a physio for back pain or sciatica in Kent, you can book a private physiotherapy appointment directly without needing a GP referral.
If you are using private medical insurance, check whether your insurer requires authorisation or a referral before treatment.
Phone: 01303 487200
Email: enquiries@physiosrus.co.uk
Contact form: https://www.physiosrus.co.uk/contact-us/
FAQs
Can physiotherapy help with sciatica?
Physiotherapy may help some people with sciatica through appropriate exercise, movement advice and a gradual return to normal activity. The treatment should be based on your individual symptoms rather than using the same exercises for everyone.
Can a physiotherapist help with lower back pain?
Physiotherapy can be appropriate for many common types of lower back pain. An assessment can help identify how your back is moving, what activities are causing difficulty and whether exercise, movement advice or other treatment may be suitable.
Is walking good for sciatica?
Walking can be helpful for many people with sciatica if it does not cause a lasting increase in symptoms. Start with a distance you can manage comfortably and gradually increase it as the leg settles.
What are the best exercises for sciatica?
There is no single best exercise for everyone with sciatica. The most appropriate exercises depend on your symptoms, movement and which activities make the pain better or worse.
Do I need an MRI scan for sciatica?
Most people with uncomplicated sciatica do not need an MRI scan straight away. Imaging is generally considered when the result is likely to change treatment or when symptoms or examination findings need further investigation.
When is sciatica an emergency?
An emergency assessment for Sciatica is needed if it affects both sides or is accompanied by severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or new bladder or bowel problems. Go to A&E or call 999 if these symptoms occur.
Disclaimer
This article provides general information about lower back pain, sciatica and physiotherapy. It does not replace individual medical advice, diagnosis or treatment.
If you develop sciatica affecting both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or new bladder or bowel problems, seek emergency medical help. For other severe, unexplained or worsening symptoms, contact your GP, NHS 111 or another appropriate healthcare service.
