Key points
- Sciatica describes a symptom pattern. The job of the assessment is to find what is irritating the nerve.
- Pain below the knee that follows a defined strip is the feature that separates it from ordinary back pain.
- Symptoms moving out of the leg and back toward the spine is a good sign, even if the back pain briefly worsens.
- Most cases resolve without surgery, though it can take longer than simple back pain.
- Progressive weakness, or loss of bladder or bowel control, needs urgent medical assessment.
What is actually happening
The sciatic nerve is formed from roots leaving the lower spine and runs through the buttock and down the back of the leg. Anything that compresses or irritates it along that path produces symptoms felt in the territory it supplies, which is why the pain is in your leg while the problem is in your back.
The most common cause is a disc herniation pressing on a nerve root. Others include narrowing of the space the nerve passes through, and irritation as the nerve passes through the buttock. Which one it is changes the treatment, which is why the assessment matters more than the label.
The direction of travel matters more than the intensity
This is the most useful thing to know while you are recovering. If your symptoms move up out of the foot and calf toward the buttock and back, you are heading in the right direction, even if the pain in your back temporarily feels worse.
If symptoms are spreading further down the leg, that is the direction to avoid, and whatever you were doing needs changing. Position and specific movement can shift this reliably in many people, and finding which ones is a large part of the first appointment.
What treatment looks like
Early: positions and movements that centralise your symptoms, manual therapy to reduce the mechanical load on the irritated level, and nerve mobilisation done gently, because aggressive stretching of an already irritated nerve makes things worse.
Then: strengthening the trunk, hips and legs, and progressively returning to sitting, bending and lifting rather than permanently avoiding them.
Nerve tissue recovers more slowly than muscle. Six to twelve weeks is a normal timeframe and is not a sign that treatment is failing.
What not to do
- Long periods of complete rest, which reliably prolongs it
- Aggressive hamstring stretching, which is often nerve tension being pulled on rather than a tight muscle
- Sitting for hours because standing hurts, then wondering why mornings are worse
- Waiting six months to get it assessed because someone said it would pass