Sciatica is pain travelling down the leg below the knee from an irritated nerve root, usually a disc. Most cases improve within 12 weeks without surgery. An examination matters more than a scan at the start. A 30 minute consultation is £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Sciatica is a symptom rather than a diagnosis. It describes pain from an irritated or compressed lumbar nerve root, felt down the back or side of the leg, often with pins and needles or numbness in a defined strip of skin.NICE NG59, 2020
The commonest cause is a disc pressing on a nerve root. In older adults the narrowing of the spinal canal that comes with age is a more frequent cause and produces a different pattern, with leg pain on walking that eases when you sit or bend forward.New England Journal of Medicine Deyo, 2001
The distinguishing feature is that the pain travels below the knee. Back pain with aching into the buttock or thigh is usually not sciatica, and that distinction changes what is examined and what is offered.NICE NG59, 2020
A disc bulge is a common finding on scans of people with no symptoms at all. In a review of asymptomatic adults, disc bulges were present in 30% of 20 year olds and 84% of 80 year olds, so a bulge alone does not explain a leg.American Journal of Neuroradiology Brinjikji, 2015
Send us what you are seeing and we will tell you what it is likely to be.
The examination is what makes the diagnosis. Power in the leg, reflexes, sensation mapped against the nerve roots, and a straight leg raise. The pattern tells you which root is involved, which no scan report can do on its own.NICE NG59, 2020
Imaging is arranged where symptoms are not settling and a specialist decision about injection or surgery is being considered, or where there are features of something more serious. It is not the first step in an otherwise typical presentation.NICE NG59, 2020
Progressive weakness, or any disturbance of bladder, bowel or saddle sensation, changes the appointment into an emergency referral the same day rather than a plan.NICE NG127, 2023
Where the leg pain sits alongside a stiff, aching knee or hip, the joint is examined too. Wear in a large joint refers pain down the leg and is treated in a completely different way from a nerve root.NICE NG226, 2022
Time and staying active
The majority of sciatica settles within 12 weeks without any procedure. Staying active within the limits of the pain shortens it. Bed rest lengthens it.NICE NG59, 2020
A specific exercise programme
Aimed at the nerve and at the muscles that support the spine rather than general exercise. It is the treatment with the best evidence for both the current episode and the next one.NICE NG59, 2020
Medication for nerve pain
Anti inflammatories help some people. Drugs used for nerve pain in other conditions have disappointing evidence in sciatica specifically, and that is worth knowing before a long trial of one.NICE NG59, 2020
Checking for something other than a disc
Weight loss, night pain, fever or a history of cancer alongside leg pain moves the assessment off the disc and onto an urgent pathway.NICE NG12, 2015
A spinal injection
Considered for severe pain from an identified nerve root that is not settling. It works for a proportion, its benefit is measured in weeks to months, and it is a procedure rather than a cure.NICE NG59, 2020
Surgery
For nerve pain that has not settled and is disabling, or for progressive weakness. It relieves leg pain faster than waiting, and by a year or two the difference between operated and unoperated groups narrows considerably.New England Journal of Medicine Deyo, 2001
Most people improve substantially over 6 to 12 weeks. Pins and needles and numbness often settle more slowly than the pain, and a patch of altered sensation that persists after the pain has gone is common and usually not a sign of anything ongoing.NICE NG59, 2020
The inconvenient half. Surgery relieves leg pain faster than conservative treatment, and the gap between the two narrows over 1 to 2 years. So the honest question is not whether surgery works but whether you want relief sooner at the cost of an operation.New England Journal of Medicine Deyo, 2001
Which of those you choose is your decision once the trade is set out with numbers rather than described as an option.General Medical Council GMC guidance, 2020
Map the pain on your own leg before you arrive. Draw where it starts, how far it goes, and mark any numb patch. Pain and numbness follow the nerve root, and your own map is often more accurate than what gets described in the room.NICE NG59, 2020
Test your own strength with two moves. Stand on tiptoes on one leg 10 times, and walk 10 steps on your heels. Failing either on one side is objective weakness rather than pain, and it is the finding that most changes the urgency.NICE NG59, 2020
Learn the three emergency symptoms and check them daily. Numbness in the saddle area, difficulty starting or stopping urine, and new weakness in both legs. Those are the same day, and knowing them means you are not deciding under pressure.NICE NG127, 2023
Do not buy an MRI in the first 6 weeks unless there is a red flag. A disc bulge is present on scans of people with no symptoms at all, so the finding rarely changes what happens next and often changes it in the wrong direction.American Journal of Neuroradiology Brinjikji, 2015
Do not buy a course of decompression therapy or spinal traction. The evidence does not support it for sciatica and the courses are sold in blocks of ten.NICE NG59, 2020
Do not buy a nerve conduction study for leg pain. It measures nerves in the limb rather than the root being compressed in the back, so it answers a question nobody asked.NICE NG127, 2023
Step 1
Power, reflexes, sensation mapped to the roots and a straight leg raise. That is what identifies which nerve is involved and how urgent it is.
Step 2
Specific exercises, what pain relief helps in sciatica and what does not, and the symptoms that mean you stop the plan and go straight in.
Step 3
A scan, an injection or a surgical opinion where the pain is not settling and a decision depends on it, arranged and booked rather than suggested.
Ask before you book if you are not sure this is the right appointment.
Most cases improve substantially over 6 to 12 weeks without surgery. Pins and needles and numbness often lag behind the pain and can take longer, and a patch of altered sensation after the pain has gone is common and usually not a warning of anything.
Not in the first 6 weeks unless there is a red flag. A disc bulge appears on the scans of people with no symptoms at all, in 30% of 20 year olds, so a scan often finds something that was already there and was never the cause.
Loss of feeling in the saddle area, trouble starting or stopping the flow of urine, or both legs weakening together. Any of those goes to your nearest emergency department or to 999 the same day, and it is not a call to make an appointment about.
Most people do not. Surgery relieves leg pain faster than waiting, and by 1 to 2 years the difference between operated and unoperated groups narrows. It is worth having where the pain is disabling or weakness is progressing, and the choice is yours.
Less well than people expect. Drugs used for nerve pain in other conditions have disappointing evidence in sciatica specifically, which is worth knowing before committing to a long trial of one with its side effects.
A 30 minute appointment with a full neurological examination is £150 and a same day urgent slot is £220. The review at 6 weeks by telephone is £59. Where inflammatory markers are needed the Core panel is £350.
No. Bed rest lengthens the episode and staying active within the limits of the pain shortens it. Modify what you do rather than stopping, and keep walking even when the distance is short.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
American Journal of Neuroradiology
Systematic literature review of imaging features of spinal degeneration in asymptomatic populationsBrinjikji, 2015
General Medical Council
Decision making and consentGMC guidance, 2020
New England Journal of Medicine
Low back painDeyo, 2001
NICE
NICE
Low back pain and sciatica in over 16s, assessment and managementNG59, 2020
NICE
Osteoarthritis in over 16s, diagnosis and managementNG226, 2022
NICE
Suspected neurological conditions, recognition and referralNG127, 2023
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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