Sciatica is one of those words that gets used for almost any pain in the leg, lower back or hip. Some of the time, it’s accurate. Quite a lot of the time, it isn’t. And even when it is genuinely sciatica, the advice people get is often outdated, scary, or simply wrong.
This blog will explain what sciatica actually is, what it usually isn’t, what the evidence says actually helps, and what to be cautious of. It’s the post we wish more of our patients had read before they came in worried they’d done permanent damage.
What sciatica actually is
Sciatica is irritation of the sciatic nerve, the large nerve that runs from your lower back, through your buttock and down the back of your leg. When it’s irritated, pain (and sometimes pins and needles, numbness or weakness) travels along the path the nerve supplies.
The key word there is travels. Real sciatica is leg pain that follows the nerve, often down past the knee.
Common causes include:
- A disc bulge or herniation irritating on a nerve root
- Age-related narrowing of the spaces where the nerves exit the spine
What it usually isn’t
A proportion of “sciatica” we see in clinic isn’t actually nerve pain at all. It’s referred pain from the lower back or hip, which can feel very similar but behaves quite differently and responds to different treatment.
A proper assessment is the difference between weeks of confused, frustrating treatment and a clear plan.
The big myth: that a disc bulge means something is permanently broken
If you’ve had an MRI for sciatica and been told you have a disc bulge, you might have left feeling alarmed. That’s understandable, but the picture is more reassuring than it sounds.
Disc bulges are extraordinarily common, even in people with no pain at all. Studies looking at MRI scans of pain-free adults show that around 30% of people in their 20s have a disc bulge they don’t know about. By their 60s, it’s well over 80%. A bulge on a scan is not the same as the cause of your pain.
Better still, the body has a remarkable ability to settle inflamed nerves and resolve disc problems on its own. Most cases of sciatica improve significantly within 6 to 12 weeks, and the vast majority do so without surgery or injections.
What actually helps
The evidence on this is reasonably clear. The treatments that consistently help sciatica are the unglamorous, hands-on, active ones.
Keep moving. Bed rest is one of the worst things you can do. Gentle, regular movement helps calm the nerve and prevents the back from stiffening up.
Hands-on treatment. Manual therapy from a chiropractor, sports therapist or physiotherapist can ease symptoms and help to restore movement.
Exercise. Not generic stretching, but exercises that match what your nerve and back actually need. Some people need to mobilise the back. Some need to load it. A good clinician will work out which.
Education and reassurance. Knowing that your back isn’t fragile, that the pain doesn’t equal damage, and that this is almost certainly going to improve, changes how you experience it and how quickly you recover.
Short-term pain relief if you need it. Sensible use of anti-inflammatories or painkillers in the early days, on your GP’s advice, can take the edge off enough for you to keep moving.
What to be cautious of
Be wary of anyone who tells you:
- That you’ll need surgery before they’ve even properly assessed you
- That your back is “out of place” and needs putting back in
- That you must rest completely until the pain has gone
- That you’ll need ongoing treatment forever to keep it at bay
There are red-flag symptoms that genuinely do need urgent attention: loss of bladder or bowel control, numbness around the saddle area, or significant, progressive weakness in the leg. If you have any of these, contact your GP or A&E immediately. They’re rare, but they matter.
How we approach sciatica at Dyer Street Clinic in Cirencester
Our process is the same whether you see a chiropractor, physiotherapist or sports therapist. We take a thorough history, examine you carefully, and work out what’s actually driving your symptoms. Then we build a clear plan: hands-on work to ease the symptoms, exercises to address the cause, and a realistic timeline so you know what to expect.
If we think you need imaging or a specialist opinion, we’ll arrange it. If we don’t, we won’t. Our goal is to get you better, not to keep you coming back.
Where to start
If you’ve been struggling with leg or back pain, the most useful next step is usually a proper assessment. If you’re not sure who the right person to see is, a free discovery call is a low-pressure way to talk it through.
Call us on 01285 671442 to have a chat or book online
This blog provides general educational information and is not a substitute for personalised medical advice. If you have specific medical concerns, please consult a qualified healthcare provider for an accurate diagnosis and tailored treatment plan.