Sciatica

How common it is

Leg pain that starts in the back is common enough that the national clinical care standard addresses it directly, describing nerve related leg pain, commonly called radicular pain or sciatica, as pain that starts somewhere in your back but is felt in your legs. ^[1]

It is one of the two reasons people most often ring us in a hurry, the other being a back that has suddenly seized. Many people come to us having already had a few weeks of it.

What can be behind it

Nerve roots leave the lower spine between the vertebrae, join, and run as the sciatic nerve through the buttock and down the back of the thigh. Anything that crowds or irritates a root at its exit can be felt along that whole path.

A disc is the usual suspect, but it is not the only one. Narrowing of the canal, arthritic change at the joints behind, or irritation where the nerve passes through the buttock can all produce leg symptoms, and each points the plan in a different direction.

• Disc irritation crowding a nerve root
• Narrowing of the space the nerve passes through
• Joint change at the level above or below
• Irritation of the nerve deeper in the buttock

How we assess it

We map the symptoms first, because where the pain and the numbness sit tells us a lot about which level is involved. Then a neurological screen: reflexes, muscle strength and sensation, along with the tension tests that load the nerve.

For acute leg pain without severe or progressive weakness, the standard says initial management is the same as for low back pain, while clinical signs of nerve root or cord compression with rapidly progressive neurological signs call for urgent assessment. ^[1] Anything of that kind and we refer you the same day rather than adjust you.

What care looks like

Care is aimed at the level the examination implicates, not at the leg the pain is felt in. Positioning matters more here than almost anywhere else, because the point is to avoid loading an already irritated root while the restricted joint is adjusted.

Guidance for low back pain with or without sciatica suggests considering manual therapy, including spinal manipulation, but only as part of a package that also includes exercise. ^[2] That is how we run it: adjustments plus something to do at home, reviewed as we go.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.