What sciatica feels like
Typically a sharp, burning or electric pain travelling from the low back or buttock down the back of the thigh, sometimes past the knee into the calf or foot. It often comes with pins and needles, numbness in a defined patch, or a leg that feels weaker than it should.
It is usually one-sided. It is frequently worse with sitting, and worse again with coughing or sneezing: both of which raise pressure inside the spinal canal.
What is actually irritating the nerve
Several things produce this pattern, and distinguishing between them is the whole job:
- Disc-related nerve root irritation. The most common cause. Disc material presses on or chemically irritates a nerve root as it exits. See disc herniation and bulging discs.
- Narrowing of the exit canal. Degenerative change reduces the space the nerve root travels through: more common with age, and typically eased by bending forward.
- Piriformis and deep gluteal involvement. The nerve is irritated below the spine rather than at the root. Often mistaken for true sciatica and treated at the wrong end.
- Referred pain from the joints themselves. Facet joints and the sacroiliac joint refer into the buttock and thigh without any nerve involvement at all: this pattern usually stops above the knee.
That last point matters. A great deal of what people call sciatica is joint referral, which behaves differently and generally responds faster.
Seek urgent medical care immediately if you have
Loss of bladder or bowel control, numbness around the groin, buttocks or inner thighs, or weakness in the leg that is progressing. These can indicate cauda equina syndrome, which is a same-day emergency department presentation, not something to book an appointment for.
How we assess it
A first visit takes about 30 minutes. The examination includes proper neurological testing, reflexes, power, sensation across the relevant dermatomes, along with nerve tension testing and a segmental assessment of the lumbar spine, pelvis and hips.
The aim is to establish whether a nerve root is genuinely involved, at what level, and what is compressing or irritating it. Where the picture is unclear or findings warrant it, we have imaging on-site and will refer where a presentation needs medical or surgical review.
What care might involve
- Adjustment of the segments that have lost movement, using techniques appropriate to an irritable spine
- Soft tissue work through the gluteal and deep hip musculature where that is contributing
- Cold laser therapy for the irritable phase
- Spinal decompression for particular disc-related presentations: assessed first, and reviewed at four weeks against your starting scores
- Rehabilitation to restore tolerance and address the loading pattern behind it
Where we will not be the answer
We cannot help a disc that has sequestered, and some presentations need medical or surgical review. If yours is one of them, you will be told on the first visit rather than after six weeks of treatment.