Condition Guide · Brighton & Hove
Expert assessment and hands-on treatment for sciatica and sciatic nerve pain, with a clinical approach that identifies what's actually driving your symptoms.
Understanding the Condition
Sciatica is not a diagnosis in itself, it's a description of symptoms caused by irritation or compression of the sciatic nerve or one of its contributing nerve roots in the lumbar spine. The sciatic nerve is the longest nerve in the body, running from the lower back through the buttock and down each leg to the foot.
When a nerve root in the lower back is compressed or irritated, most commonly by a disc herniation, bone spur or narrowing of the spinal canal, it produces the characteristic pattern of symptoms that most people recognise as sciatica: pain, tingling or numbness that travels from the lower back through the buttock and down the leg.
Understanding what's causing the nerve irritation is the essential first step. Different causes respond to different treatments, and generic sciatica management without a proper assessment is one of the main reasons people don't get better.
True sciatica involves nerve root irritation in the lumbar spine. However, similar symptoms, pain or tingling down the leg, can also be caused by piriformis syndrome, sacroiliac joint dysfunction, or referred pain from tight hip muscles. These are not sciatica and respond to entirely different treatment. Getting this right matters.
These symptoms require immediate A&E attendance, do not wait for an appointment.
Recognising Sciatica
Sciatica produces a recognisable pattern of symptoms, though the exact presentation varies depending on which nerve root is involved and the underlying cause.
Pain that travels from the lower back or buttock down the leg, often described as electric, burning or sharp.
Sciatica typically affects one leg at a time. Pain in both legs simultaneously may indicate a different and more serious condition.
Pins and needles, numbness or a feeling of weakness in the leg, foot or toes, often following a specific dermatomal pattern.
Sitting for prolonged periods typically aggravates disc-related sciatica. Standing and walking often provides some relief.
Some presentations disturb sleep. Position matters, certain lying positions load the affected nerve root more than others.
Symptoms often fluctuate, better on some days, worse on others. Flare-ups triggered by specific movements or positions are common.
Why It Happens
In ten years of clinical practice, the majority of sciatica presentations fall into one of these categories, each with a different clinical picture and a different treatment approach.
The most common cause of true sciatica. The inner nucleus of a lumbar disc bulges or ruptures through the outer wall, pressing on an adjacent nerve root. Onset is often sudden, sometimes triggered by a specific movement. Typically worsens with sitting and flexion, improves with extension in early stages.
Narrowing of the spinal canal, most commonly from age-related degenerative change, which compresses nerve roots. More common over 50. Characteristically produces leg pain on walking that eases with sitting or flexing forward, a pattern called neurogenic claudication.
Often misidentified as sciatica, piriformis syndrome involves irritation of the sciatic nerve by the piriformis muscle in the deep buttock. Produces similar leg symptoms but without a spinal cause. Responds well to soft tissue treatment and stretching, very different to disc-related management.
Age-related disc dehydration and height loss reduces the space through which nerve roots exit the spine. Can produce chronic low-grade sciatica that flares with certain activities. Management focuses on maintaining movement, building supporting musculature, and understanding what loads the affected level.
How I Treat It
Effective sciatica treatment starts with identifying the cause. The same leg symptoms can have completely different drivers, and what helps one presentation can make another worse.
A thorough assessment including nerve tension tests, dermatomal mapping and movement analysis to identify the level and cause of nerve irritation before any treatment begins.
Targeted work to the lumbar, gluteal and hip musculature to reduce compressive load on affected nerve roots and restore normal movement patterns.
Particularly effective for piriformis syndrome and trigger point referral patterns that mimic sciatic symptoms. Can significantly reduce pain and muscle guarding.
Gentle mobilisation of lumbar and sacroiliac joints to restore movement, reduce stiffness and decompress affected nerve root levels.
Specific nerve gliding techniques to restore normal movement of the sciatic nerve through surrounding tissue, particularly useful for persistent or recurring presentations.
A structured programme addressing the underlying weakness and movement patterns that contribute to recurring nerve root irritation, the part most treatment plans miss.
What to Expect
Recovery from sciatica varies considerably depending on the cause, severity and how long symptoms have been present. This is a general guide, your clinical picture may differ.
Initial assessment to identify cause and severity. Focus on reducing inflammation and nerve irritation, establishing positions of relief, and beginning gentle movement. Prognosis discussed clearly at this stage.
Hands-on treatment to reduce muscular guarding and joint restriction. Progressive movement reintroduction. Beginning neural mobilisation where appropriate. Most patients notice meaningful improvement in this window.
Structured strengthening of the muscles that support and protect the lumbar spine. Movement retraining to address the patterns that contributed to the episode. Return to full activity with confidence.
For presentations that don't fully resolve, a structured management plan to maintain function, reduce recurrence and build long-term resilience. Not failure, for some conditions this is the realistic and most valuable goal.
The following symptoms alongside back or leg pain require immediate assessment at A&E, do not wait for a clinic appointment.
A thorough clinical assessment is the first step. I'll identify what's actually driving your symptoms and build a treatment plan around that, not a generic protocol.