CONDITIONS
Sciatica is one of the most common reasons people seek help from a pain specialist. It can range from a mild, occasional discomfort to severe pain that affects walking, sleeping and everyday activities. Although sciatica often improves with time, some people continue to experience persistent symptoms long after the original problem has settled. Understanding why this happens is the first step towards finding the right treatment. At Wye Sanctuary, we aim not only to identify the cause of your sciatica but also to understand how it is affecting your life and develop a treatment plan that is tailored to your individual needs.
Sciatica describes pain caused by irritation or inflammation of one or more of the nerves that travel from the lower back into the leg. The sciatic nerve is the largest nerve in the body. It is formed from several nerve roots in the lower spine before travelling through the buttock and down the back of the leg into the foot. When one of these nerve roots becomes irritated or compressed, pain can travel along the course of the nerve.
People often describe sciatica as sharp or shooting pain, burning pain, electric shock-like sensations, pain travelling from the buttock into the leg, tingling, pins and needles, numbness or weakness in the leg or foot. The pain usually affects one leg, although occasionally both legs can be involved. Many people find the leg pain is worse than the back pain.
Disc prolapse
A lumbar disc can bulge or herniate, placing pressure on a nearby nerve root. This is one of the commonest causes of sciatica, particularly in younger adults.
Spinal stenosis
As we get older, the spaces around the nerves can become narrower. This narrowing may compress the nerves, particularly during walking or standing.
Degenerative changes
Arthritis affecting the joints and discs of the spine can sometimes narrow the spaces where nerves leave the spine.
Spondylolisthesis and less common causes
One vertebra may slip forwards over another, reducing the space available for nerve roots. Less common causes include previous spinal surgery, scar tissue around nerves, cysts, inflammatory conditions and, rarely, infection or tumours.
No. Many people with straightforward sciatica improve without needing an MRI scan. Imaging may be recommended if symptoms are severe, weakness develops, symptoms persist despite treatment, surgery or injections are being considered, or there are concerns about an alternative diagnosis. MRI scans often show disc bulges in people with no pain at all, and some people have severe pain with only minor scan changes, so findings must always be interpreted alongside symptoms and examination.
Most episodes of sciatica gradually improve as inflammation settles and the irritated nerve recovers. However, some people continue to experience pain long after the original compression has improved. This may happen because the nerve remains sensitive after healing, inflammation changes how the nerve functions, the nervous system becomes more protective, movement reduces and muscles become weaker or stiffer, or fear of pain leads to activity avoidance. Persistent sciatica is often a combination of ongoing nerve sensitivity and nervous system changes rather than continued nerve damage.
Although most sciatica is not dangerous, certain symptoms require immediate assessment. Seek emergency medical attention if you develop loss of bladder or bowel control, numbness around the buttocks or genitals, rapidly worsening weakness in one or both legs, difficulty walking because of severe weakness, or severe pain associated with fever or feeling generally unwell. These symptoms may indicate cauda equina syndrome, a rare but serious condition requiring urgent hospital assessment.
Education and staying active
Understanding what is happening often reduces fear and helps people remain active. Short rests may help during severe flare-ups, but prolonged bed rest is generally unhelpful.
Physiotherapy
A tailored exercise programme can help improve mobility, strength, flexibility and confidence in movement. Rehabilitation should progress gradually according to symptoms.
Medication
Medication may help reduce pain while the nerve recovers, including simple pain relief, anti-inflammatory medication where appropriate, or nerve pain medication for selected patients.
Epidural steroid injection or nerve root block
For some patients with significant leg pain that has not responded to conservative treatment, an epidural steroid injection or selective nerve root block may reduce inflammation around the irritated nerve and make rehabilitation easier.
Surgery
Most people do not require surgery. It may be recommended if severe weakness develops, symptoms remain severe despite appropriate treatment, quality of life is significantly limited, and imaging shows compression likely to benefit from surgery.
Sciatica is about far more than what appears on an MRI scan. We take time to understand the cause of your symptoms, the health of your nervous system, how pain is affecting your work, family and daily life, previous treatments, and your goals and expectations. This allows us to recommend the most appropriate combination of education, rehabilitation, medication and, where appropriate, injection therapy or surgical referral. Our aim is always to help you recover function, improve confidence and reduce pain—not simply to treat a scan result.
“Sciatica can be frightening, particularly when pain is severe or accompanied by numbness or weakness. The good news is that most people improve without surgery. My role is to understand exactly what is causing your symptoms, explain your options clearly and help you choose the treatment that is most likely to support your recovery. Whether that involves rehabilitation, medication, injection therapy or referral for surgery, our focus is always on helping you return to the activities that matter most to you.”