MSK Rehabilitation, Patient Guide

Sciatica: causes, red flags & when physiotherapy helps

Sciatica is pain that travels down the leg from irritation of a nerve root in the lower back, not a diagnosis in itself but a symptom with several possible causes. Here's what's usually going on, the warning signs to never ignore, and how a physiotherapist actually helps.

What sciatica actually is

The sciatic nerve is the longest nerve in the body, running from the lower back through the buttock and down the back of each leg. Sciatica describes pain that follows that path, usually sharp, burning, or shooting, often with pins and needles or numbness, and typically affecting one side.

It's most commonly caused by a disc bulge in the lower spine pressing on a nerve root, though spinal stenosis, and tightness in the piriformis muscle deep in the buttock, can produce similar symptoms. Long periods of sitting or driving, common for anyone commuting into Norwich or spending long days at a desk, are a frequent aggravating factor rather than a direct cause on their own.

Seek urgent medical attention if you notice: numbness around the saddle area, new bladder or bowel changes, or weakness affecting both legs alongside back pain. These can indicate a rare but serious condition called cauda equina syndrome, and need same-day assessment at A&E, not a physiotherapy appointment.

Other red flags worth knowing

Unexplained weight loss alongside the pain
Fever, or pain following a recent infection
Significant pain that wakes you at night regardless of position
A history of cancer, with new, unexplained back or leg pain
Pain following a significant trauma, such as a fall or road traffic collision

None of these are common causes of everyday sciatica, but a physiotherapy assessment always screens for them first, before treatment goes anywhere near exercise or manual therapy.

How physiotherapy helps

Once anything serious has been ruled out, the goal is to identify what's actually driving your particular presentation, a disc-related irritation behaves differently to a tight piriformis, and treat accordingly. That typically means:

A clear explanation of what's going on and why, so the pain makes sense rather than feeling random
Targeted exercises to reduce nerve irritation and rebuild movement confidence
Hands-on treatment where it helps ease muscle guarding around the area
Practical advice on sitting, sleeping, and daily positions while things settle
A gradual return to normal activity, rather than either total rest or pushing straight through pain

This follows the same four-step process used for every condition seen here: assess, diagnose, treat, progress. See the full guide on self-referral for physiotherapy, no GP referral is needed to get started.

What you can do in the meantime

Complete bed rest tends to slow recovery rather than help it. Gentle, regular movement, short walks, changing position often rather than sitting still for hours, is generally more useful than staying completely still. If a particular movement clearly and consistently makes things worse, it's reasonable to avoid it until you've been assessed, rather than push through.

How long does it take to settle?

Many episodes ease within a few weeks to a few months with the right approach, particularly once the mechanical driver has been identified and addressed. Left without a clear plan, it can drag on far longer than it needs to, which is usually the point people get in touch.

Frequently asked questions

What does sciatica actually feel like?

Typically a sharp, burning, or shooting pain that travels from the lower back or buttock down the back or side of one leg, sometimes with pins and needles, numbness, or weakness. It's usually one-sided and can be worse with sitting, bending, or coughing.

Is sciatica the same as back pain?

No. Back pain stays in the lower back, while sciatica specifically refers to pain travelling down the leg along the path of the sciatic nerve, caused by irritation or compression of one of the nerve roots in the lower spine.

How long does sciatica usually last?

Many episodes settle within a few weeks to a few months with the right management, particularly staying appropriately active and addressing the underlying mechanical cause. Some cases take longer, especially without a clear plan in place.

Do I need a GP referral to see a physiotherapist for sciatica?

No, you can self-refer directly for a physiotherapy assessment. See the full guide on self-referral for physiotherapy for more detail.

When should I seek urgent medical attention for sciatica?

Seek urgent care immediately if you notice numbness around the saddle area, new bladder or bowel changes, or weakness in both legs alongside back pain. These can indicate a rare but serious condition called cauda equina syndrome and need same-day assessment.

This guide is general information written by a physiotherapist, not a substitute for individual assessment. If in doubt about any of the red flags above, seek medical attention immediately rather than waiting for an appointment.