Sciatica: What Does It Feel Like and When Should You Get Help?

Part 2 of our Move Better, Feel Better: Pain & Movement Explained series

Written by Jessica Brown, Osteopath and Owner of One Health Osteopathy Clinic, Tunbridge Wells

Sciatica can be extremely uncomfortable and, when it first appears, sometimes quite alarming. You may feel a sharp, burning or electric pain travelling from your lower back or buttock into your leg. There may also be tingling, pins and needles, numbness or, in some cases, weakness.

Some people have significant back pain alongside it. Others have surprisingly little pain in their back and feel most of their symptoms in the buttock, thigh, calf or foot.

One of the questions we are frequently asked in clinic is:

“How do I know if this is actually sciatica?”

Sciatica has quite a specific meaning. It relates to irritation or compression of one of the nerve roots that contributes to the sciatic nerve. Not every pain travelling into the buttock or leg is sciatica, and distinguishing between nerve-related pain and pain arising from muscles, joints, tendons or the hip is an important part of your assessment.

At One Health Osteopathy Clinic in Tunbridge Wells, we assess people with sciatica, lower back pain and nerve-related leg symptoms from Tunbridge Wells, Tonbridge, Sevenoaks and surrounding areas of Kent.

This guide explains what sciatica feels like, why it happens, what you can do to help it and when you should seek professional or urgent medical advice.

Sciatica at a glance

Sciatica usually affects one leg. Symptoms may start in the lower back or buttock and travel into the thigh, calf, foot or toes.

Pain is not the only symptom. Tingling, pins and needles, numbness and weakness can also occur.

You do not have to have severe back pain. For some people the leg symptoms are much more noticeable than the back pain.

Not all leg or buttock pain is sciatica. Muscles, joints, tendons, the hip and other structures can produce similar symptoms.

Most cases improve without surgery. Symptoms commonly settle gradually over several weeks or months, although recovery varies and some people experience longer-lasting or recurring symptoms.

Movement usually forms part of recovery. This does not mean pushing through severe nerve pain. Finding the right amount and type of movement for your particular symptoms is important.

A small number of symptoms require urgent medical attention. Changes to bladder or bowel control, numbness around the saddle area or significant symptoms affecting both legs should never be ignored.

What exactly is sciatica?

The sciatic nerve is the largest nerve in the body. It is formed from nerve roots that leave the lower part of the spine and eventually combine before travelling through the buttock and down the leg.

Sciatica occurs when one or more of these nerve roots becomes irritated or compressed. You may also hear healthcare professionals use terms such as lumbar radicular pain, nerve root irritation or lumbar radiculopathy. Although these terms have slightly different clinical meanings, they all describe symptoms involving the nerves as they leave the lower spine. The important distinction is that sciatica is more than ordinary lower back pain. It usually involves symptoms travelling into the leg.

What does sciatica feel like?

Sciatica can feel different from person to person.

Typical symptoms include:

• sharp or shooting pain into the buttock or leg;
• burning or electric-type pain;
• pain travelling below the knee;
• pins and needles or tingling;
• numbness or altered sensation;
• a feeling of heaviness in the leg;
• weakness in certain movements;
• pain aggravated by particular positions or movements.

Symptoms can sometimes be aggravated by coughing or sneezing because this temporarily changes pressure around the spinal structures and nerve roots. For some people, sitting is particularly uncomfortable. Others find standing, walking, bending or moving from sitting to standing more difficult. The distribution of the symptoms can also give us useful information about which nerve may be irritated, although real-life symptoms do not always follow a perfect textbook pattern.

Clinical assessment is therefore important rather than trying to diagnose sciatica simply from where the pain is felt.

What causes sciatica?

There is not one single cause. The most common mechanism is irritation or compression of a nerve root in the lower back.

Disc-related sciatica

One common cause is a change to one of the discs between the vertebrae. A disc may bulge or protrude and irritate a nearby nerve root. Inflammation around the area may also contribute to nerve sensitivity.

It is important to remember that disc changes are common and do not automatically mean something serious has happened to your spine.

Discs are living, adaptable tissues and many disc-related episodes improve with conservative management and time.

Changes around the joints and spine

As we get older, normal changes can occur in the discs and joints of the spine. In some people these changes can reduce the available space around a nerve root. This may contribute to sciatica or other nerve-related symptoms. This becomes more common with increasing age and may sometimes be associated with spinal stenosis, where the spaces within the spine narrow and can place pressure on the nerves.

Irritation rather than severe compression

A nerve does not necessarily have to be dramatically “trapped” to produce symptoms. Nerves are sensitive structures. Chemical inflammation, mechanical irritation and changes in the surrounding tissues can all influence how a nerve behaves. This is why describing every episode of sciatica as simply a “trapped nerve” can be misleading.

Is all pain down the leg sciatica?

No, and this is an important distinction. Pain can travel into the buttock or leg for many reasons. The joints of the lower back can refer pain into the buttock or thigh. Muscles and fascia can produce local and referred discomfort. Hip problems can cause pain around the buttock, groin or thigh, while tendons around the hip can also become painful.

Less commonly, a nerve can be irritated elsewhere along its pathway. This is why we do not diagnose sciatica solely because someone has pain in their leg.

During an assessment we look at the pattern of your symptoms, sensation, strength, reflexes, spinal and hip movement and how the nervous system responds to specific clinical tests. That helps us establish whether your symptoms are most likely coming from a nerve root or from another musculoskeletal structure.

Can sitting cause sciatica?

Sitting itself is not inherently harmful to your spine, but prolonged sitting can aggravate symptoms in some people who already have an irritated nerve. You may notice that symptoms build after sitting at a desk, driving or travelling for a long time.

If this happens, repeatedly trying to maintain one “perfect” posture is not necessarily the solution.

Often it is more useful to:

• change position regularly;
• get up and move periodically;
• adjust the amount of time you spend sitting;
• find positions that are more comfortable during an acute episode;
• gradually rebuild your tolerance to sitting as symptoms improve.

We look at sitting and back pain in more detail later in this series in Is Sitting Really Bad for Your Back?

Why can sciatica be so painful?

Nerve pain can be particularly intense. A sensitive nerve may produce burning, shooting or electric sensations even when there has not been major tissue damage.

The nervous system is designed to protect us, so when a nerve becomes irritated it can become highly responsive to movement, pressure or stretch. Muscles surrounding the lower back, pelvis and hip may also tighten or guard in response to pain. Sleep can then become disrupted, normal movement decreases and understandably you may start to become anxious about positions or activities that trigger symptoms.

All of these factors can influence how intense the experience becomes.

This is why treatment should consider not only where the nerve is irritated, but also movement, strength, muscle tension, sleep, activity, confidence and what the symptoms are preventing you from doing.

Should you rest if you have sciatica?

A little more rest than usual can be very sensible when symptoms are highly irritable, especially if certain activities are clearly aggravating them.

However, there is an important difference between relative rest and prolonged inactivity.

Relative rest might involve reducing heavy lifting, shortening a walk, changing your exercise programme, taking more breaks from sitting or temporarily avoiding a particular movement that repeatedly triggers strong leg pain.

At the same time, gentle movement that is comfortable can help you maintain mobility and gradually return to normal activity. The right balance will be different for everyone.

Someone with mild symptoms may tolerate walking and normal daily activities well. Someone experiencing severe acute nerve pain may initially need considerably more modification. The aim is not to force movement regardless of pain.

It is to find what you can comfortably do now and gradually build from there, try to continue normal activities as much as possible and avoid long periods of sitting or lying down.

What movements and exercises help sciatica?

There is no single sciatica exercise that works for everybody. This is one reason generic online exercise programmes can be frustrating. A movement that feels helpful for one person may aggravate another person’s symptoms.

Depending on your presentation, rehabilitation might include:

• gentle spinal or hip movement;
• walking;
• exercises designed to improve nerve mobility;
• mobility work for surrounding areas;
• progressive strengthening;
• trunk and hip control exercises;
• gradual exposure to movements that have become difficult;
• progressive return to work, sport or exercise.

The response to movement gives us useful information.

For example, if certain movements repeatedly cause symptoms to travel further down the leg, we may modify them initially. Conversely, if an exercise makes the leg feel easier or symptoms become more localised, that can sometimes be a useful sign when considered alongside the rest of the assessment.

The important thing is that exercise should be individualised and progressed according to how you respond.

Do you need an MRI for sciatica?

Not necessarily.

Sciatica is primarily a clinical diagnosis, meaning that your history and physical examination are usually the starting point.

An MRI can show discs, nerve roots and other spinal structures, but it can also show findings that are present in people who do not have any symptoms.

For that reason, having sciatica does not automatically mean you need a scan.

Imaging may become appropriate if symptoms are persistent, there is significant or progressive weakness, there are unusual clinical features or the result would influence decisions about further treatment.

A good musculoskeletal assessment helps determine when further investigation is worthwhile and when it is unlikely to change the initial management.

When should you get sciatica assessed?

It may be worth seeking professional assessment if:

• your leg pain is significant or difficult to manage;
• symptoms are stopping you working, sleeping or doing normal activities;
• your symptoms are worsening rather than improving;
• pain persists for more than a few weeks;
• you are experiencing persistent tingling or numbness;
• you notice weakness in the leg or foot;
• the problem keeps returning;
• you are unsure how much you should move or exercise;
• you are avoiding normal activities because you are frightened of worsening the nerve;
• or you are unsure whether your symptoms are actually sciatica.

An assessment can also be helpful earlier if you simply want to understand what is happening and have a clearer plan for managing it.

When is sciatica an emergency?

Most sciatica is not an emergency.

There are, however, certain neurological symptoms that require immediate medical assessment.

Go to A&E or call 999 if you develop:

• sciatica affecting both sides;
• severe or worsening weakness or numbness in both legs;
• new numbness around your genitals, anus or saddle area;
• difficulty starting to urinate;
• inability to urinate;
• new loss of bladder control;
• new loss of bowel control;
• or loss of normal awareness of when you need to empty your bowel.

These symptoms can indicate significant compression of the nerves at the bottom of the spinal canal, known as cauda equina syndrome, and need urgent hospital assessment.

These situations are uncommon, but knowing the warning signs is important.

Can an osteopath help with sciatica?

Osteopaths are regulated healthcare professionals trained to assess musculoskeletal conditions, including lower back pain, sciatica and nerve-related symptoms. All our osteopaths are trained to Masters level and have completed further PostGraduate training.

At One Health, assessment starts by understanding exactly how your symptoms behave.

We may ask about:

• where your pain starts and where it travels;
• whether you have tingling or numbness;
• positions or movements that aggravate symptoms;
• changes in strength;
• previous episodes of back pain or sciatica;
• your work and exercise;
• sleep and general health;
• any other symptoms that could change how your condition should be managed.

Your physical assessment may include examining your back and hips, movement, muscles and joints, together with neurological testing of strength, sensation and reflexes where appropriate.

Specific tests may also be used to assess how the nerves respond to movement.

If your symptoms suggest that further medical investigation is required, we will discuss this with you and refer appropriately.

Osteopaths are trained to examine joints, muscles and other tissues, assess mobility and nerve function, recognise signs requiring medical referral and provide treatment and self-management advice.

Our osteopathic approach to sciatica

Sciatica rarely exists in isolation from the rest of the body.

A sensitive nerve may be the primary source of the leg symptoms, but the way you move, muscle tension, joint mobility, strength, activity levels and other areas of the body may influence how you are functioning.

Our osteopathic approach therefore considers both the irritated nerve and the wider musculoskeletal picture.

Where appropriate, treatment may include:

• gentle joint mobilisation and articulation;
• soft-tissue techniques;
• myofascial techniques;
• muscle energy techniques;
• movement and mobility work;
• neural mobilisation or neurodynamic exercises;
• stretching where appropriate;
• neuromuscular and movement retraining;
• progressive strengthening;
• advice about sitting, work and daily activities;
• strategies for managing flare-ups;
• and gradual rehabilitation back to exercise or sport.

Treatment is always adapted to the individual.

When a nerve is particularly sensitive, aggressive stretching or repeatedly provoking strong nerve symptoms is not necessarily helpful. Sometimes treatment initially needs to be relatively gentle, with movement and exercise progressed as the nerve becomes less irritable.

The General Osteopathic Council describes osteopathic care as combining manual approaches with exercise, lifestyle and self-management advice, with the aim of improving mobility and function and helping patients take an active role in their recovery.

How long does sciatica take to improve?

There is no exact timetable.

Many people improve over a few weeks to a few months, although sciatica can sometimes take longer to settle and may recur.

Recovery can depend on several factors, including:

• how irritated the nerve is;
• whether there is numbness or weakness;
• how long symptoms have been present;
• the underlying cause;
• previous episodes;
• general health and physical capacity;
• activity and work demands;
• sleep;
• stress;
• and how easily you can find comfortable ways to remain active.

Improvement is not always perfectly linear.

You may have several good days followed by a flare after doing more than usual. This does not automatically mean you have damaged the nerve again.

Part of good rehabilitation is learning how to respond to these changes without becoming either too fearful of movement or repeatedly doing more than your current capacity allows.

Does sciatica always need surgery?

No.

Most people with sciatica are initially managed without surgery, and many improve with time and conservative care. Evidence reviews describe exercise, appropriate manual care, pain management and maintaining function as common elements of conservative management.

Surgical opinion may be appropriate when there is significant or progressive neurological loss, when symptoms remain severe despite appropriate conservative management, or where imaging and clinical findings indicate that surgery may be beneficial.

If your symptoms are not progressing as expected, part of our role is recognising when it is appropriate to seek further medical or specialist assessment.

Sciatica treatment in Tunbridge Wells

If you are experiencing sciatica, pain travelling down your leg, tingling, numbness or recurring lower back pain, a thorough assessment can help establish what may be contributing to your symptoms and what your next steps should be.

One Health Osteopathy Clinic is based in central Tunbridge Wells and welcomes patients from Tunbridge Wells, Tonbridge, Sevenoaks and surrounding areas of Kent.

Our registered osteopaths regularly assess and manage people with:

• sciatica;
• lower back and leg pain;
• nerve-related symptoms;
• disc-related back problems;
• persistent and recurring lower back pain;
• back stiffness;
• work and desk-related pain;
• and difficulty returning to normal activity following back pain or injury.

Our approach combines careful clinical assessment with hands-on osteopathic treatment where appropriate, movement, education and individual rehabilitation.

We want you to understand your symptoms, know what you can safely do and feel confident gradually returning to the activities that matter to you.

Frequently asked questions about sciatica

Is sciatica the same as a trapped nerve?

People often use the phrase “trapped nerve” to describe sciatica. A lumbar nerve root may be compressed in some cases, but nerve symptoms can also involve inflammation and irritation. The nerve does not always need to be severely physically trapped for sciatica to occur.

Can you have sciatica without back pain?

Yes. Some people experience very little back pain and mainly notice pain, tingling, numbness or other symptoms in the buttock and leg.

Does sciatica cause pain below the knee?

It can. Pain travelling below the knee, particularly when accompanied by tingling, numbness or weakness, can make nerve-root involvement more likely, although a clinical assessment is needed to determine the cause.

Is walking good for sciatica?

Walking can be helpful for many people, but the appropriate amount depends on your symptoms. If a long walk significantly increases your leg pain, temporarily reduce the distance and gradually build back up rather than assuming you must either stop completely or push through.

Should you stretch the sciatic nerve?

Not necessarily. Nerves are not the same as muscles, and aggressively stretching an irritable nerve can sometimes aggravate symptoms. Gentle neural mobility exercises may be useful for some people, but they should be selected according to your presentation.

Is massage good for sciatica?

Soft-tissue treatment may help with associated muscle tension and discomfort, but sciatica involves irritation of a nerve root rather than simply tight muscles. Treatment therefore needs to consider the nerve, spine, surrounding tissues, movement and rehabilitation rather than relying on massage alone.

Can sciatica come back?

Yes. Some people experience more than one episode. Understanding your individual triggers, gradually building physical capacity and knowing how to manage an early flare may help you feel more confident if symptoms recur.

Should I see an osteopath for sciatica?

An osteopath can assess whether your symptoms are consistent with sciatica, carry out relevant musculoskeletal and neurological testing, screen for symptoms requiring medical investigation and, where appropriate, provide hands-on treatment, movement and rehabilitation advice.

Coming next

Is Sitting Really Bad for Your Back?

Part 3 of our Move Better, Feel Better: Pain & Movement Explained series.

The Move Better, Feel Better: Pain & Movement Explained series

1. Lower Back Pain: What Causes It and When Should You Get It Checked?
2. Sciatica: What Does It Feel Like and When Should You Get Help? (you are here)
3. Is Sitting Really Bad for Your Back?
4. Neck and Shoulder Pain: What Could Be Causing It and What Actually Helps?
5. Knee Pain: Common Causes and When Should You Get It Assessed?
6. Hip Pain: Is It Coming From Your Hip, Back or Somewhere Else?

About the author

Jessica Brown is a registered osteopath and owner of One Health Osteopathy Clinic in Tunbridge Wells.

Jessica holds a Master’s degree in Osteopathy from the University College of Osteopathy, where she received awards for academic achievement and her dissertation. She also has postgraduate training in women’s health osteopathy.

Her clinical approach combines careful assessment, hands-on osteopathic treatment where appropriate, movement, rehabilitation and clear, evidence-informed advice. She is particularly interested in helping people understand their symptoms, regain confidence in their bodies and return to the activities that matter to them.

Evidence and further reading

This article is informed by current UK health information and published evidence relating to the assessment and management of sciatica.

NHS. Sciatica: symptoms, self-management, treatment and when to seek urgent medical help.

Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. British Medical Journal. The review describes sciatica as a clinical diagnosis based on radiating leg symptoms, with examination and neurological findings helping to establish nerve-root involvement.

General Osteopathic Council. Information on osteopathic assessment, treatment and the role of registered osteopaths in managing musculoskeletal conditions including sciatica.

Clinical evidence continues to evolve, and this article should be reviewed periodically as new research becomes available.

One Health Osteopathy Clinic
Oxford House, 15–17 Mount Ephraim Road
Tunbridge Wells, Kent TN1 1EN

This article provides general health information and does not replace an individual medical assessment.

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